A review of how Supporting People is likely to affect services for those people considered marginal, high risk or hard to reach.

Supporting People is a national policy initiative offering housing-related support to help individuals obtain suitable housing and develop their skills and self-confidence.

This review, carried out in the run-up to the programme’s introduction, aimed to highlight the original policy objectives, to assess progress in local planning and to consider whether the programme is likely to produce real change for individuals and improvement in services. It focuses in particular on the development of strategies and services for people who are considered marginal, high risk or hard to reach.

The report is intended to stimulate debate and encourage commissioning bodies, providers and others to consider how their strategic plans and operational practices can best be geared to addressing the challenging issues raised by the review findings.

Summary

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Supporting People is a national policy initiative to assist people who need help to settle into suitable housing, to develop daily living skills or to maintain their independence. Local authorities will prepare strategies and take the lead in managing the Supporting People budget. This study, by a team for Pathways Research, focused on how the new programme may affect services for people with complex needs or those who are 'marginal' or 'hard to reach'. It was based on reviewing documentation, surveying local teams and interviewing key players. The research found that:

 

• Housing, social services, health and probation service commissioners lacked agreed definitions of marginal, hard-to-reach or high-risk groups and an understanding of the service options. The absence of systematic needs analysis showing demand pressures, exclusions and service users' preferences across the range of current services was a major gap.
• Respondents welcomed the opportunity offered by the new commissioning regime to secure funding and staff time for specialist support (e.g. mental health, substance abuse) alongside generic housing support funded by Supporting People. Lack of specialist support (including crisis intervention) has inhibited service development for those with high needs who are not a priority for community care.
• Respondents felt that people can be put off by formalities which draw them into 'the system' and define them in ways they consider stigmatising. Respondents suggested that funding of designated 'access' support should be explored as a way to encourage people to engage with services.
• Service planners showed scepticism about Supporting People's capacity to extend into the private housing sector. They had mixed views on whether to adopt a promotional approach or to go for incremental growth through individual referrals of people living in private accommodation.
• The aim of improving services for those with multiple needs or those who are resistant to, or remote from, services means that commissioners and service providers will work in a climate of higher management and financial risk. Locally based players were committed to this aim, but were concerned that local Supporting People budgets will not meet the inevitable extra costs.

Background

Responsibility for managing Supporting People lies with local authorities and their partners in probation and health services. Prior to introducing the programme in 2003, Supporting People teams have been appointed in local authorities, together with national and regional development officers and specialist advisers. This study provides an overview of local planning and preparation for Supporting People in England, Scotland and Wales.

Supporting People plans are expected to pay particular attention to improving and extending services for people within 'marginal' groups, which have not traditionally held priority for social services and health agencies. While the new approach paves the way for more strategic and needs-based investment, the focus of the research reflects two concerns:

• The involvement of social services and health agencies at commissioning level could lead to resources being diverted to boost community care and community health programmes, to the detriment of support for those who come into Supporting People by a homelessness or probation route.
• Providers of supported housing and housing-related support to people in their own homes assist large numbers of homeless people and others with specialist needs, but have often found it difficult to develop services for those who require intensive support or a complex support package.

The study concentrates on the local perspective and the views and expectations of Supporting People teams, service commissioners and provider organisations. In adopting this focus, the researchers recognise that various important central initiatives are aiming to assist authorities and providers to improve services for marginal groups, and that the Supporting People programme continue to evolve at a rapid pace.

Services for marginal, hard-to-reach and high-risk groups

Among respondents, there were many interpretations of 'marginal', 'hard to reach' and 'high risk'. The researchers have suggested a categorisation which is intended to promote debate about who is included and the kinds of marginality or risk involved:

• People with complex or multiple needs, who are likely to need support from more than one source, or from a service offering generic and more specialist support. The combination of mental health problems, offending and substance abuse causes greatest concern.
• People who are 'hard to reach' in that they are resistant to services, or have perhaps already been excluded. This includes those who do not want to be drawn into, or are trying to escape, the 'systems' of support and care or of homelessness.
• People who are 'high risk', in that they could pose a danger to others or to themselves, or may be at risk from others. Also included are those who are vulnerable to victimisation, as well as people escaping domestic violence and those whose behaviour is threatening or disruptive.
• People who are remote from services, including those in certain minority ethnic communities which have little or no connection with formal services. Also included are those relying on informal support, and people who live in private-sector accommodation and are unaware of services.

Promoting better services for marginal groups

Among local Supporting People teams and providers there was strong awareness of the difficulties of improving services for people in the above groups, but also a commitment to achieve improvement. Most respondents, although not all, anticipated problems in terms of the scope they would have to extend, adapt and improve services in the short to medium term. This was based on the dual concerns that local budgets will not stretch to meet the extra costs and that there is little flexibility to release funds through reshaping current services.

Key points, as summarised by the researchers, were:

• The lack of systematic, relevant data on the scale, sources and types of need. This will be important in the new regime, as local politicians and strategic partner authorities will have to be convinced of the necessity for action in 'difficult' areas not traditionally given priority. It calls for an approach which makes the case for particular groups and types of service, using socio-economic data and evidence of demand pressures, exclusions and preferences across current services.
• The welcome opportunity offered by the new, multi-agency commissioning regime for Supporting People to build in specialist services funded from other sources (e.g. mental health, substance misuse) alongside generic housing support.
• The shortage of intensive services for people with high support needs not covered by community care and, at the other end, of preventative services for those with low-level needs. The extension of services for marginal groups will require the development of partnerships between generic and specialist providers and the building of staff skills. Service commissioners should identify the additional management risks and extra costs involved (e.g. funding negotiations, public consultation, training, co-ordination of support and crisis management).

Support for people in private-sector accommodation

Under Supporting People, support can be offered to people in any tenure, including privately rented or owner-occupied housing. This is important, as some of the most vulnerable and isolated people live in private rented housing, including a number who have been turned away by existing support services.

There was scepticism about the capacity of Supporting People to extend into the private sector. Some respondents felt that the only realistic option would be to expand existing support services incrementally, as referrals arose. Others wanted a more proactive approach, involving the use of new entry and referral points, such as advice agencies, GPs' practices and public information centres.

Other points raised were that:

• There is a tension between individual needs assessment and the policy objective of creating wider access to services. Many people are put off by formalities which draw them into 'the system' and define them in ways they consider stigmatising. Some respondents expressed concern that Supporting People is shifting towards an eligibility-focused approach, which will be reinforced if budgets are tight and financial pressures mount.
• Charging for support will be a disincentive to people in private housing receiving long-term services. On the other hand, if commissioning bodies decide to promote services for older owner-occupiers in particular, this could have huge resource implications. The losers in such a scenario would be those in the marginal groups.
• There was interest in making support available to young adults and others living in the parental home or staying temporarily with friends. This could be an important preventative aspect of the programme. The policy focus on 'householders and tenants', intended to stress the central purpose of maintaining people in their homes, makes it difficult to offer services which help non-householders to move into more independent housing.

 

Developing new kinds of services and models of support

Supporting People aims to promote more flexible, more inclusive services. This could lead to some kinds of support being offered to people in various community locations, as well as in their own homes. Respondents expressed mixed views on whether this idea should be pursued. The majority recognised that it could be useful for people who are isolated or who might benefit from a support network. Against this, some were concerned that such a development would blur the boundaries of Supporting People and increase the threat that funding would stray towards other objectives.

"Community-based advice centres are a real alternative ... Outreach work is another alternative through youth workers and youth centres. We need to make better use of existing services that go to where people are." (Supporting People lead officer, local authority)

"The more flexible it is, the more vulnerable it is to 'cost shunting'. It could get very woolly. The main thing is to help people cope in the home." (Supporting People lead officer, local authority)

A number of respondents suggested that funding of designated 'access' services should be explored as a way of encouraging individuals who might otherwise reject support, and who need to see demonstrable benefits before making a commitment.

Supported housing and support to people in their own homes

Respondents agreed that support provided on a flexible basis to people living in independent housing (often referred to as 'floating support') can offer intensive assistance and should meet the fluctuating needs of individuals. They indicated that in practice, however, it can be difficult to obtain funding for a high level of support, particularly for making social contacts and addressing isolation. There was also some concern that floating support, as a soft option in political terms and the current 'blueprint model', is expected to cater for too wide a range of needs.

There were diverse views on the role of capital funding for housing in new service development. Some individuals with complex needs were seen as very suitable candidates for accommodation services with on-site support (such as clusters of self-contained flats). However, there was concern about the visibility of such services and the difficulties arising from this, such as having to overcome local objections and the potential for harassment of the individuals concerned.

There was a broad consensus about the need for accommodation-based services which can act as a bridge between large institutions and independent tenancies, or which allow people to develop skills and self-confidence without having to take on all the responsibilities, costs and risks associated with independent living. It was expected that, in future, housing providers will design or adapt accommodation which can be put to general needs use if no longer required.

 

England, Scotland and Wales

Funding arrangements
In England and Scotland, all funds for Supporting People services are being transferred to local authorities in 2003. In Wales, there will be two funding streams for the initial three years: a central budget for services which are not intended solely for older people and which do not include an element of care; and a local authority budget for sheltered housing and support linked to community care services. The central budget will be transferred to local authorities (target date 2006), but not ring-fenced. The lack of ring-fencing was already a concern among service commissioners and providers in Wales.

Eligible services and service users
The draft Grant Conditions for England describe three purposes which can make a service eligible for Supporting People funding (Supporting People Directions and Grant Conditions, Office of the Deputy Prime Minister, 2002). These are:

• developing or sustaining a person's capacity to live independently;
• expanding tenure choices for people who might enter or remain in institutional care, become homeless or breach the terms of their tenancy;
• providing immediate refuge in cases of homelessness or domestic violence.

Wales, like England, has not maintained a list of eligible support tasks, such as that used during the transitional funding regime. In Scotland, the relevant regulations (2002) prescribe the detailed tasks qualifying for funding. These include advising and assisting with personal budgeting, and providing life-skills training in maintaining the dwelling. The list reflects the concern to make a distinction between Supporting People services and personal care, which is provided free in Scotland for those over 60. A Scottish local authority respondent commented that:

"The very specific definition of housing support was a missed opportunity to be more flexible. It ties us into a definition that ... leaves a gap between personal care and housing support."

Charging individuals for support
The charging proposals for England (not yet finalised) are that people living in short-term accommodation or supported on a temporary basis (under two years) will be exempt, as will those receiving Housing Benefit or Income Support. The remaining long-term service users will pay on a means-tested basis. The proposed arrangements for Scotland are similar to those for England. In Wales, individuals will not be charged if the service is funded by the central grant, regardless of whether their support and accommodation are short or long term.

The absence of charging for a significant proportion of service users was widely seen as a positive feature, particularly for those in the marginal groups who wish to find employment while maintaining their support. It was felt that problems would remain, however, for other service users who may have similar aspirations.

 

About the project

The study was led by Pathways Research and carried out by Lynn Watson, Maryrose Tarpey, Caroline Humphreys and Kate Alexander. The research was undertaken over a four-month period in the summer of 2002. The methods used involved:

• website search and monitoring (central government and local authorities);
• review of central policy guidance and consultation since 1998;
• review of local policy documentation and a sample of draft Supporting People strategies;
• email contact with all local Supporting People teams (35 detailed responses);
• discussion with service commissioners, providers, advisory organisations and government officers (40 interviews).

The study was organised, and the data analysed thematically, as follows:

• planning services for marginal, hard-to-reach and high-risk groups;
• support for people in privately rented or owner-occupied housing;
• developing new kinds of services and models of support;
• the roles of supported housing and support to people in their own homes.