The Scottish Government

« Previous | Contents | Next »

Listen

4. Development and aims of Supporting People

4.1 In order to supplement the analysis of secondary data and to enable the study team to establish a deeper understanding of the development of Supporting People a limited programme of primary research was undertaken. This research took two forms: a short questionnaire was issued to SP lead officers across Scotland to supplement the information available from the official statistics (and to assist in interpreting this information), and in-depth interviews were conducted in four "case study" areas - Aberdeenshire, Edinburgh, South Lanarkshire and West Lothian.

4.2 The "case study" interviews with local authority staff and providers are not reported on an "area by area" basis but rather the information has been incorporated in the topic by topic discussion presented below and in other relevant sections of the report as appropriate. The aim was not to present "pen pictures" of the areas but to gather insights from areas which exemplified the conditions and circumstances prevailing across Scotland. This section of the report considers the development of Supporting People programme, how costs are managed and monitored, and how the programme is to be moved forward over the next few years in order to achieve a better fit with strategic priorities (but in the context of generally declining budgets). The survey and case study interviews also generated useful information on the interpretation of the costs data and the benefits secured from the programme which has been incorporated in the analysis.

Development of Supporting People services

4.3 As noted in the introduction, the SP budget has grown considerably since its inception in 2003. Table 4.1 is compiled from the lead officers' survey. It shows significant growth in the number of projects for people with learning disabilities, (199 new services/projects), older people (162), people with mental health problems (63), homeless people (57) young people (32), people with physical disability/ illness (29) and women at risk of domestic violence (19).

4.4 Well over half of these projects were implemented in 2003/04, and consequently will reflect pipeline expenditure; that is projects initiated during (or possibly before) the transition year. Indeed, it is possible that some/many of the projects implemented throughout the period observed will reflect the pipeline (in the later stages, this will particularly apply to building-based projects, which can take longer to move forward, as a result of planning consents, building works, and so on), Thus, while they would have been planned while the authority was working on the SP strategy, it is likely they reflect opportunities to develop projects. This is not to say that these projects will not be addressing support needs - it simply means that the projects were unlikely to have been developed in response to strategic planning/prioritisation of needs.

Table 4.1: New SP commissioned services/ projects

Source: Supporting People Research - Lead Officer Survey

Developing the strategic framework

4.5 The Supporting People programme was intended to provide a strategic framework for the delivery of housing support at the local level. A key issue we wished to explore during the research was whether authorities had been able to establish a strategic approach as the SP programme progressed.

4.6 The case study authorities all stressed that the short timeframe for the change-over to Supporting People funding in April 2003 made it difficult for them to take a strategic overview in the early stages. Most had focussed on ensuring that people continued to receive support services, that providers continued to receive payment, and that new services were established where possible. Even these limited objectives were hampered by the delayed guidance, by providers sometimes giving poor information on the SP1/2 ²⁹ and by inaccurate/delayed information on the final number of support hours per person /the hourly rate from THB. These problems continued through into the period immediately following the change-over to Supporting People, with issues around the need to match manually THB claimant to individual grant allocations, late arrival of grant, and so on.

4.7 There was a significant expansion of services during the THB stage - albeit one authority noted that the level of staffing constrained the expansion that could be achieved. None of the case study authorities adopted a completely strategic approach to expansion at this time. There was a strong view that provision was influenced by past provision: some of the growth appears to have been expansion of existing services, or development of existing services; with many of the authorities talking in terms of growth being provider-led.

4.8 Barriers to establishing new services were noted (though whether these services were being developed in response to the limited efforts at needs assessment that were made as part of the Supporting People Strategies, by local authorities developing services to meet identified needs, or by providers expanding their service delivery is unclear); the rules on the pipeline and the delays in funding for pipeline services meant that a number of proposed services were either not in the end provided for Supporting People client groups or funding had to be mainstreamed.

4.9 Authorities also noted some initial uncertainty around the types of service that were eligible for Supporting People funding. A particular grey area was around medium-level support (as opposed to low-level support or high/intensive support), which some local authorities now consider has left a gap in service delivery, that would, had funding be available, be addressed.

Supporting People Strategies

4.10 All authorities were required to produce a Supporting People Strategy, which should have provided a strategic framework, or context, for service delivery decisions, expansion and, possibly, service redesign/remodelling. However, none of the authorities consulted indicated that the first round of these documents had had a strong independent strategic focus. None of the authorities considered that they had the resources to compile detailed needs assessments, although they had used information from existing sources and from consultation with providers and partners. All had drawn heavily on existing documents and strategies, as well as work with providers and partners, to establish strategic objectives. Nonetheless, there was a common view that the next round of strategies will have a much stronger strategic focus.

4.11 A number of specific issues emerged from the consultations with the local authorities:

• One authority mentioned that their Supporting People Strategy is now being revised, with the strategic lead coming from the Supporting People team. In common with the other consultees, the officers consider that they are only now starting to get a feel for the budget they are working to - this means that they can start to plan properly. They also consider they are developing good relationships with other departments and sections, and developing a good understanding of other disciplines and how these can be used to best effect. For example, they are looking at reprovisioning care for elderly people. Housing with care is an element of this - funding comprises rent ( HB) c. 18%, support c. 50%, and care c. 32%. They would expect to expand this model. The challenge is how to achieve this within a fairly flat budget.
• One authority noted that the location of the Supporting People team within the Council should add value - SP is not located within housing or social work but has strong links with both, with its budget being part of the pooled resources of the local Community Health and Care Partnership.
• One authority considers that the SP strategy is not an end in itself - it provides a base for delivering other strategies. Further, it is seen as a means of managing a programme, but not necessarily a strategic planning device. However, the strategic review is starting to move them towards a strategic position. A number of key questions remain:
• Can the Supporting People strategy be considered to have central objectives?
• And, if so, can they be measured?
• What sort of difference does Supporting People make to different clients?
• Is there a set of consistent measures from these?

Finance

Contracts

4.12 The early phase of the Supporting People was devoted to establishing the structures needed to administer Supporting People and to agreeing - or to attempting to agree - contracts. This almost universally failed, so letters of agreement or skeleton contracts were used instead. Reluctance to sign contracts was principally from housing associations, who were not used a contractual relationship with the local authority. One authority noted that voluntary sector organisations that worked with social work on care contracts were less concerned at the prospect of signing contracts - as they were more accustomed to a contractual relationship with councils.

4.13 All authorities were of the view that contracts should be signed following the service reviews.

Specifying services

4.14 The key task facing authorities in the early phase of SP was to ensure that services would continue to be delivered to clients. Authorities spoke of undertaking work in the early phase of the transition period to enable contracts to be specified. However, as it became clear that contracts would not be achievable within the timeframe, the focus shifted to developing formal agreements for the continuation of service delivery. However, these agreements did not tend to set out in clear terms the services being provided, nor did authorities and providers negotiate around these agreements; they were regarded as a temporary measure (albeit one that may last for some time) until contracts could be established.

4.15 Thus, as a result of the timetable to which authorities had to adhere, work to fully describe and quantify the SP agreements (including a cost per unit/per hour) took place after the agreements had been made. In some cases this took upwards of 12-18 months.

4.16 Once this had been established, the authorities were in a better position to fine tune their agreements with providers ³⁰. Those who had over-purchased, and especially those that had over-purchased on block contracts, seem to be in a better position: this enabled them to make cost reductions, or reallocate the contract to other client groups, other parts of the authority or to meet needs that were not fully met when the agreements were reached.

4.17 Approaches to making these adjustments were based around annual financial review meetings and service reviews. The authorities also appear to have required different levels of control over the client base of the providers (for example one of the authorities wants to assess every client and support package - on spot contracts - whereas another appeared to place greater autonomy on those providers).

Financial criteria

4.18 A number of approaches were used by the authorities to guide decisions on contracts, and achieve the most efficient contract price possible. A number of approaches were mentioned:

• Setting limits on the components of the contract price:
• For example: overheads at 10% (another quoted 8%), with staff costs at 80% in outreach services and 70% in accommodation based services. The balance used for training, etc.
• It was noted that this approach to limiting overheads is problematic as some providers don't specify overheads or pool them within a larger organisation
• Limiting the total cost of the support packages
• One authority set this at £20k pa - any appeal against this would be heard by the head of service, but it was felt that a package costing more than this suggested that a high hourly rate or number of hours is required, indicating that a non-housing support service was being paid for
• One authority set a weekly maximum of level of £300 per client
• A target hourly rate
• One authority had a target basic hourly rate of £13.50. They stressed this was not fixed, but is used as a benchmark. Packages costing significantly below this would be queried, as would those costing above this.
• Use of schedules of rates

4.19 In some cases authorities mentioned concerns that the market is often provider-led - whether that is because of specialised service capability, a remote geographical area, the available budget, a "difficult" client or long/unsocial working hours. There can be limited, or non-existent, competition for contracts.

Staffing

4.20 There were different opinions on how well qualified or specialised staff should be. One authority felt that Supporting People is not a "specialised" service - that is, staff did not need to have undergone professional training to work with clients. Instead, the authority expected staff to meet the Care Commission qualification standards: SVQ III or possibly II for staff, SVQ III for a supervisor and SVQ IV for a manager. They were concerned at one provider charging well below the target hourly rate (they felt that staffing levels/quality must be too low). However, they stressed that was unnecessary to have over-qualified staff for the service - that this would drive costs up. Other authorities and needless to say, providers, did not share this view. They felt that staff with higher SVQ qualifications, and specialist qualifications for the client group were beneficial and, in some cases, essential.

4.21 When packages of care and support are provided by the same provider, it can be the same member of staff delivering both care and support to the client. While this offers considerable flexibility to meet the client's needs, it can blur the distinction between care and support hours. For example, a client may be scheduled to have ten hours care and four hours support each week, but ill-health means that the care is substituted for support for a few weeks. The consultees (authorities and providers) considered that the contracted balance between support and care would generally be achieved over a period of weeks, even if it were not achieved each week. There was a general view that the flexibility of being able to respond to clients needs outweighed any requirement to adhere rigidly to contracted hours. However, the discussions indicated that there is not external monitoring of the balance between care and support. Given that different hourly rates might be charged for care and support, and that the provision is paid from different budgets/under different contracts, this is a potential issue.

Managing costs

4.22 Following the initial period of SP budget expansion, the budget cuts and the service reviews have moved authorities to closer management of the SP budget and to explore approaches to budget reductions.

4.23 A number of specific issues emerged in the local authorities.

• One authority is managing the cuts on a strategic basis. It has decided to apply the cuts using strategic priorities, and has allocated cuts at different levels according to these different service outcomes. However, as far as possible, reductions are made in such as a way as to avoid impacting on people receiving services - either by efficiencies in the contract price, or by restriction in service provision. However, given the scale of reductions required, substantive reductions in contract volume are necessary. These will be prioritised according to strategic outcomes: Finding a home (-25%); Establishing a home (-20%); Maintaining a home (-10%); Developing networks (0%).
• Critically - outcome measures play an important part in this process: an outcomes matrix, which assesses the ways in which people's circumstances are enhanced while using the service, has been developed, and is currently being refined.
• One authority is passing budget reduction on to all providers equally. Providers will have to make absolute cuts - either by cutting hours of service provided or trimming costs.
• One authority, which is not facing a budget reduction, is seeking to redistribute its existing budget. This is being achieved by a process of recovery and reallocation of surpluses. They have identified surpluses - divided into recurring surpluses and one-off savings. These have been clawed back from providers and used to fund to service developments. Providers were invited to submit proposals - either for expansion of existing services or the development of new services. These were screened for strategic relevance and eligibility for Supporting People funding.

4.24 The service reviews have identified some key issues around managing budgets for the authorities:

• One authority has to pay higher hourly rates in some parts of the authority than others. This does not reflect travel costs to these areas, but is considered an effect of rurality - issues around labour shortages, and so on.
• The service reviews in one authority have revealed that some of the services funded under Supporting People may not be strictly housing support. This may well be the case in other local authorities, which have not examined their services as closely ³¹.
• Two of the authorities mentioned that for some contracts there are not enough providers to enable competitive tendering. This compromises competitive tendering, and there were concerns that that this gives providers too much influence over pricing in the contracts.
• Two authorities noted that for some contracts it is hard to find a provider at all.

4.25 A key issue from the authorities is that some providers have moved to change the service provided without reference to the authority. In some cases changes may be introduced to manage budgets. In others, changes in service/contract may be unavoidable (for example to accommodate the joint requirements of the Working Time Directive ( WTD) and the minimum wage ³²). However, it was the process of effecting this change that was of concern: the change had been introduced unilaterally, without recognition that the authority was the client.

Use of other budgets to fund housing support

4.26 The implication from the comments above is that, until the service reviews are complete, authorities will not have a full picture of the services they are commissioning; that providers, in order to respond to external pressures may have to continue to modify the services they provide; and that where support and care services are provided as a package flexibility to shift between the two in response to client needs means that on a week to week basis it is not always clear what level of support has been provided.

4.27 On the budget side, a clear message from the consultations - both authorities and providers - was that the SP budget was being supplemented to pay for housing support, in part to draw on the full range of funds available (authorities and, to a lesser extent, providers) and in part because the SP budget was insufficient to finance the service (providers and, to a lesser extent, authorities)

4.28 The lead officers' survey provides an overview of the role that SP plays in funding the housing support element of services to the different client groups is of interest. It is acknowledged that the use of SP differs across Scotland and there are other ways in which housing support services ³³ are funded. For example, this may be through the use of other funding streams/grants, funded through community care or health monies depending upon local authority need agreements and funding available.

4.29 As Figure 4.1 shows, over half of the local authorities do not use Supporting People funding to fully fund the housing support element of services. However, the use of SP varies between the different client groups:

• Over two fifths of the local authorities use SP to fully fund the housing support element of services for older people, people who are homeless or sleeping rough and people who are vulnerable due to young age;
• By contrast, less than a third of the local authorities use SP to fully fund the housing support element of services for people with a learning disability and people having mental health problems;
• Local authorities use a higher proportion of funding from other funding sources to fund the housing support element of services for people who are vulnerable due to young age and people with a physical disability or sensory impairment. For instance, some 38% of local authorities use up to 50% of funding from sources other than SP to fund the housing support element of services for people who are vulnerable due young age and around a third of local authorities use up to 50% of funding from sources other than SP to fund the housing support element of services for people with a physical disability or sensory impairment; and
• By contrast, only around 10% of the local authorities use up to 50% of funding from sources other than SP to fund the housing support element of services for people who are homeless or sleeping rough, and people having mental health problems.

Figure 4.1: Percentage of funding for housing related support services provided by SP

Source: Supporting People Research - Lead Officer Survey

4.30 Where SP does not fully support the housing support element of a service, the local authorities identified 'other funding sources'. The majority of local authorities identified the Social Work/ Community Care budget as being the main 'other source of funding' for the housing support element of services for the following client groups: older people, people with learning disabilities, people having mental health problems and people with a learning disability. The main 'other source of funding' for the housing support element of services for people who are homeless or sleeping rough was identified as Homeless Strategy Funding, while the main 'other source of funding' for the housing support element of services for people who are vulnerable due to young age was identified as the Children's Services budget.

4.31 In addition, at least one local authority identified the following 'other funding sources' for the housing support element of services for the following client groups:

• Older people - RSL budget for the housing association and the Local Health Board
• People with learning disabilities - Hospital retraction funding and GAE
• People who are homeless or sleeping rough - Housing budget, Social Work budget, Rough Sleepers Initiative, Homelessness Rental Income, Homeless taskforce, Homelessness Grant and Homelessness Partnership monies
• People having mental health problems - Mental Health Care and the Local Health Board
• Physical disability or sensory impairment - Lottery Project/Grant
• Vulnerable due to young age - Social Work budget and Homeless Strategy funding

4.32 Providers in all areas noted that increasingly the funding from SP was becoming insufficient to cover the costs of the services they were providing. Strategies for dealing with the varied according to the type of organisation ³⁴: the larger organisations appeared more willing/able to absorb deficits within the organisation's general budget (" subsidising from elsewhere in the business"), with a view to resolving the situation at the next funding round. All organisations had had to consider restructuring the services provided, including reducing hours of provision that could be provided within the budget. Other approaches mentioned included:

• Drawing on grants/donations, to fund core activities, administration/ management, or activities that are allied to the core 21 SP tasks.
• Fund-raising
• Minimising the service provision categorised as housing support, and having new services categorised as care ³⁵
• Withdrawing from the market

4.33 Generally the first two of these options were time-limited: the providers noted that deficits could only be supported until the service review/contract.

4.34 All the providers commented on the "unfairness" of having to repay surpluses on contracts that were under spent, but not being compensated for contracts that ran into deficit. As noted above, some are managing to cross-subsidise - possibly across SP contracts, although no-one was willing to clarify this point, possibly across other budgets. There was a strong view that cross-subsidy across SP budgets should be permissible.

the Benefits of SP

4.35 The consultations sought to establish the views of lead officers on the importance of SP funding and the impact and benefits of SP. SP lead officers were asked what would be the impact on services if the SP funding were withdrawn. Views were also sought on the measurement of the benefits of SP from authorities and providers during the case studies.

Impact of withdrawal of SP funding

4.36 Table 4.2 provides an indication of the expected impact on each client group if SP funding were no longer available (where 5 would be a severe impact, while 1 would be a minor impact). The table shows both the average score across all the authorities responding to the survey, and the distribution of scores. For example, services for people homelessness/rough sleepers ranked highest, with an average score of 4.8, and almost three quarters of the local authorities identified a severe impact if SP funding were no longer available; no authorities assigned a score of 1 or 2. Conversely, services for people with HIV/ AIDS scored just 2.7, with just 4% of authorities (1 authority) assigning these services a score of 5; while most authorities noted that they do not currently provide services for this client group (N/A).

Table 4.2: Rating of impact on the client group if SP funding were not available

Source: Supporting People Research - Lead Officer Survey

4.37 The local authorities in the case studies provided evidence on the types of impacts expected if SP funding were not available. Obviously many argued that services would be cut back or closed. The predicted effects of this on clients included:

• Increased social isolation and exclusion of client groups;
• Clients being unable to live independently in their own home - particularly people with physical disabilities, older people, people having mental health problems and people with dementia;
• Increased hospital admissions and admissions to residential care;
• Increased tenancy failure;
• Increased homelessness and repeat homelessness;
• Increased risk of domestic violence.

4.38 It was also suggested that there would be effects on the local authorities:

• Impacts on other council budgets and budgets of health services;
• Reduction in capacity to provide low level preventative services;
• Failure to meet government targets and agendas;
• Pressure on crisis intervention services.

4.39 These predicted impacts on clients and organisations mirror the responses produced by the consultations undertaken in relation to and reported in the Matrix work. It is essential to be able to form a view on the effects of SP projects in order to begin the process of measuring benefit and the general consistency between these responses from the survey and the interviews and the assumptions embodied in existing cost/benefit frameworks is reassuring. These responses have been taken into account in developing the framework of cost and benefit assessment set out below.

Measuring benefits

4.40 All the case study authority areas considered the measurement of benefits from Supporting People programme to be at a fairly early stage of development, and all indicated that they would welcome support and/or guidance with this. Approaches to measurement could be considered at three distinct levels: individual measures, service reviews, and strategic approaches.

Individual measures

4.41 None of the organisations had developed a series of individual measures across the range of client groups of services provided. However, it was appreciated that different types of measures would be appropriate for different types of services/client groups. It was suggested that measures should be capable of capturing improvement, steady state or possibly even a deterioration over a period of time in the situation of clients. As has been seen in the review of the Matrix work, the focus to date has, in practice, been discrete "change events" rather than on the process of change.

4.42 Authorities and providers identified a range of possible measures under each of these headings (and which reflected those identified in the literature review). These include:

• Improvement measures: effects in enabling clients to sustain own tenancy, reduction in hours of support required by clients, instances of client moving on to college/work, reduction in repeat homelessness, reduced offending behaviour
• Sustaining measures: no change in outcome measures, safety and security measures
• Managed decline: admission to residential care delayed

4.43 Critically, it was noted that it is difficult to measure preventative services - both in terms of quantifying the numbers assisted (authorities and other services do not appear to keep accurate numbers of those provided with information and advice) and in estimating the impact of those services. Second, while it was considered to be in principle easy to measure the impact of services which produced an improvement, , officers were unsure as to how long that impact should be estimated to last (for example - if the service had a positive impact on offending behaviour, should that be taken to last for a year, or should it be assumed that the person would have continued to offend for several years, so a measure that stopped them offending should have an impact that should be measured over several years?). Again we may note that the existing studies have tended to measure impacts over one year only.

Service reviews

4.44 All the authorities are undertaking reviews of the services in their areas. These allow a detailed review of what is covered by the "contract", a breakdown of the cost of the provision, as well as discussion of issues around effectiveness, quality and strategic relevance. Reviews may also cover issues around user views, staff views, demand, capacity and future development of the service. Critically, the reviews may include outcome measures - for example, whether the service has prevented clients entering institutions, becoming homeless or re-offending. As yet, however, this information is not available.

Strategic approach

4.45 One authority has developed an outcome matrix that is being used to monitor the impact of SP services on clients. This information can be used to identify the ways in which people's lives are enhanced through service interventions. The outcome matrix is based on the Edinburgh HOMES approach, which has been used for some time to assess the impact of services for homeless people in the city ³⁶. However the outcome matrix has been extended so that the criteria being assessed reflect full range of the authority's Supporting People strategic and service objectives. These include accommodation and security of tenure, health, substance use, offending behaviour, hospital admission, safety and security, and training and employment. Outcomes are measured on a scale of 0 to 4, depending on the level of risk the client is at - ranging from no risk, to crisis point.

4.46 Thus far, one set of outcome matrix data has been collected from all Supporting People providers in the city. Further rounds will be required before impacts and trends can be assessed. This is a development of possible future relevance rather than a tool which can be applied generally now.

Conclusions

4.47 The speed with which the Supporting People programme was introduced, coupled with volume of work that local authorities had to manage in terms of ensuring continuity of key services, meant that that an operational rather a strategic approach to SP service development was initially adopted. This approach continued for many months as authorities dealt with issues around contracts, grants and scoping the agreements. Indeed, it took well over a year in some authorities to establish the "contract" specification; and in some cases it appears that the service reviews are the key sources of information on whether services purchased are Supporting People-eligible.

4.48 Authorities are moving to a more strategic approach, but this appears to be hampered by a lack of information on needs and demand for services (although it was noted that authorities could not meet all the need that had been assessed anyway), and pressure to manage costs downwards is, in most cases, acting as further disincentive to develop services strategically.

4.49 Lead officers and other stakeholders are convinced both that SP funding is critical to maintaining a range of services and that those services are effective in improving the lives of clients and in reducing the call on other public services and funds,

4.50 The benefits of SP which have been identified by consultees and respondents are entirely consistent with the conclusions of the other existing studies - notably the Matrix work. Although respondents found it difficult to quantify benefits, the main types of benefit were clearly identified as:

• Enhanced or maintained ability of clients to live in the community rather than to go into forms of care
• Reduced demand/need for health services
• Reduced homelessness
• Reductions in crime including domestic violence
• Improved quality of life for clients

4.51 There was widespread recognition of the need for improved measures of and information on the benefits of SP and some expectation that this process would be advanced by the service reviews.

« Previous | Contents | Next »