What is "Supported Housing"?

Context

The purpose of this Briefing is to seek to redefine what we mean by ‘Supported Housing' in the context of a crisis in health and social care and in the wider context of the reorganisation of the administration of public services in England in particular. We'll make reference to Scotland and Wales, for which health and social care functions (or social work in Scotland) are devolved. Funding for ‘Supported Housing' isn't currently devolved in Scotland and Wales, but will be as a consequence of the UK Government's proposals on the future funding of supported housing.

We will address the current state of play regarding the reforms proposed by the UK Government for the future funding of ‘Supported Housing' and identify the very obvious relationship between ‘Supported Housing' and the NHS and social care, which appears to have been missed by the UK Government, and is far too important to be the victim of party political posturing. It is a UK-wide issue and demands a much better response from our political representatives of whatever persuasion.

We also want to identify a ‘Community Sustainment' solution to the financial and operational problems of the NHS and social care/social work functions across the UK, which is not related to devolution beyond acknowledging that devolution is the context within which we will be operating.

 

The Future Funding of Supported Housing

We ran a series of events last winter on the Consultation on the Future Funding of Supported Housing. As a consequence of that we've been involved in submitting written evidence to the Consultation itself, and subsequently to the Joint DWP/DCLG Inquiry into that Consultation. We also met with members of the Parliamentary Secretariat to comment on some of the evidence submitted to the Inquiry. 

The key features of the proposals are:

  • The Intensive Housing Management component of Housing Benefit will be quantified and devolved to "local level" from 2019/20. It amounts to £2.12bn pa. We are not certain that this timescale, which relates to the full implementation of the Welfare Reform Act, will be adhered to. Indeed, Dame Louise Casey has recently urged the UK Government to relax the timescale for full implementation of Universal Credit.
  • The devolved money should be used as the basis for a new funding model (we called it a Prevention Fund and suggested it be used for a Community Sustainment approach)
  • Core rents and Universal Credit-eligible service charges will be capped at Local Housing Allowance levels.
  • A 1% annual rent reduction will apply to the core rent component of English social rents up to and including 2019/20, including supported housing (but excluding almshouses, refuges and "Specialised Supported Housing").
  • The "shared accommodation rate" of Local Housing Allowance will not apply to people living in supported housing.
  • There will be no change to existing funding streams, for example, Supporting People. The devolution of the £2.12bn will be made in the context of "wider commissioning interests".
  • The devolved fund will be ring-fenced and set on the basis of "current projections of future need"
  • There might need to be a separate funding model for "short-term services"

You may be aware that the UK government had intended to publish a White Paper based on the Consultation but this has yet to be published. Our communication with the Parliamentary Secretariat confirms that no committee arrangements have yet been put in place for this. However, on 10th October there was a House of Commons debate on the future funding of supported housing. It was brief (30 minutes) but very well-attended and we are pleased to see some of the themes we have promoted being reflected therein. You can read the Hansard record of the debate here. According to the Hansard record the UK Government now intends to publish a White Paper imminently.

In addition, in September this year Lord Best wrote to Clive Betts MP, the Chair of the Communities & Local Government Committee setting out proposals for a banded "Supported Housing Allowance" system. The letter, which you can download here contains some modelling work on this system and includes themes that we are pleased to have promoted for some time, particularly the concept of Specialised Supported Housing and the need to avoid a postcode lottery through the use of LHA. Our own view on LHA is that, if it is to be used as part of the funding for supported housing of any type, it should be equalised on a regional basis in England. These views are prominent in our Briefings and our evidence submissions to both the Consultation on the Future Funding of Supported Housing and the subsequent Inquiry.

A Green Paper on Social Care (in England) has been published, which suggests, however, that the UK Government has not yet made the very obvious policy connection between supported housing and health & social care. This is unfortunate because, in our view, supported housing is a very large part of the solution to the funding and operational crises in the NHS and social care (and for that matter, criminal justice commissioning). However, the UK Government and national governments in Scotland and Wales still have the opportunity to consider supported housing as a solution to the health and social care crisis.

The UK Government has apparently bigger fish to fry, such as Brexit, at the moment; however, the resolution of the health and social care funding and capacity problems are too important for mere party politics and we sincerely hope that the political establishment in Westminster grasps this. We have commented before on the structural progress made by the Scottish Government in merging health and social work commissioning on a county-by-county basis. The UK Government might well consider the merging of health and social care commissioning in England on a regional basis, as indeed it appears to be doing in places such as Manchester.

This being so, it is incredibly important that we are clear about what we mean by ‘supported housing'. This might sound obvious but the Consultation, and more particularly the Inquiry into it, simply didn't grasp what it is and what it could become. That's not a fault of the Inquiry particularly; it is rather a consequence of some of the answers that participants gave the Inquiry when it asked them ‘what is supported housing'? Lord Best's subsequent letter has redressed that to some degree and we're glad to see that some of our thinking on these issues has got through, albeit via third parties.

The Inquiry did advise strongly (as we did too) that Local Housing Allowance in its current form should not be used as the basis for funding the core rent component of supported and sheltered housing. Local Housing Allowance levels vary widely from area to area but the costs of providing supported housing do not. Compare the Local Housing Allowance levels in Hull with those in London for example.

We believe the UK Government will revisit this issue, which is a matter of considerable concern for providers, and this was confirmed by the recent House of Commons debate. We made the point in our Consultation and Inquiry submissions that the varying Local Housing Allowance levels across the UK are a problem for a variety of reasons and it might be appropriate to iron out these differences by rationalising Local Housing Allowance levels on a regional basis in England and Wales. Again, this was acknowledged as a way forward in the House of commons debate. It is likely that Scotland will have full control of its own housing and welfare systems post 2019/20, if that remains the timescale for the implementation of Universal Credit. 

The next steps for supported housing are hugely important. The key issue is its relationship to the funding and capacity problems of the NHS and social care services. So to what extent can supported housing be part of the solution?

We have always had a problem with how supported housing is seen and defined. The NHS and social care have historically seen supported housing as just buildings although there are increasing examples of more imaginative thinking now. 

It is also important to make the point that many supported housing providers remain entitled to enhanced levels of Housing Benefit and this will continue to be the case until the proposed reforms are implemented. Furthermore, it is proposed that those providers that have enhanced HB claims in place will retain that funding, post 2019/20, whilst it remains ringfenced for a period of time thereafter.

We continue to act for very many providers in England, Scotland and Wales to obtain enhanced HB allocations, having developed the approach since 2005. The £2.12bn of funding that is likely to be devolved is comprised, in large part, of the enhanced HB allocations providers have received based on the technical basis of claim that we have developed over the years.

If your organisation hasn't looked at this yet it is important that you do so quite urgently now. We are able to undertake this work for you for a fixed percentage commission and we don't charge if we don't achieve an increase.

 

So what is ‘Supported Housing' then?

The experience of interacting with and observing the joint DWP and DCLG Inquiry into the consultation on the future funding of supported housing leaves us with a number of observations and suggestions. 

We said in our last briefing that supported housing needs to redefine itself in terms of providing preventative enabling services to people with additional needs ranging from intensive housing management all the way up to and including some healthcare services. 

To say that it is "is about providing high-quality homes in ordinary neighbourhoods for people who need a bit of support"[1] is to limit its scope, relevance and future. That definition by David Orr of the NHF may well be a common perception, but it needs to change.

Supported housing is a victim of its own limiting misdescription and, sadly, we shouldn't be surprised at the apparent disinterest by colleagues in the NHS and local authorities many of whom don't understand what ‘supported housing' is beyond accommodation for ‘people who need a bit of support'. Such a limiting definition sidelines its potential as a solution to the challenges facing health and social care. The fact is that if we reimagine ‘supported housing' as a wider and deeper contribution to the lives of people with additional needs then we might stumble across the solution to the health and social care funding and capacity crisis.

A revised understanding what we mean by ‘supported housing' is essential. The context is the future funding of supported housing and its relationship with the future shape of health and social care.

In 2014 the UK Government introduced The Social Housing Rents (Exceptions and Miscellaneous Provisions) Regulations 2016 which redefines supported housing in England as ‘conventional' or ‘specialised' supported housing. This applies to England only in legislative terms and is fundamentally important. There is nothing to prevent this definition being used in other parts of the UK, however.

Specialised Supported Housing is defined as housing:

(a) Which is designed, structurally altered, refurbished or designated for occupation by, and made available to, residents who require specialised services or support in order to enable them to live, or to adjust to living, independently within the community,

(b) Which offers a high level of support, which approximates to the services or support which would be provided in a care home, for residents for whom the only acceptable alternative would be a care home,

(c) Which is provided by a private registered provider under an agreement or arrangement with

(i) A local authority, or

(ii) The health service within the meaning of the National Health Service Act 2006(d),

(d) In respect of which the rent charged or to be charged complies with the agreement or arrangement mentioned in paragraph (c), and

(e) In respect of which either-

(i) There was no public assistance, or

(ii) If there was public assistance, it was by means of a loan secured by means of a charge or a mortgage against a property.

Conventional Supported Housing is defined as:

Low cost rental accommodation provided by a registered provider which:

(a) Is made available only in conjunction with the supply of support, (b) Is made available exclusively to residents who have been identified as needing support, and

(c) Falls into one or both of the following categories:

(i) Accommodation that has been designed, structurally altered or refurbished in order to enable residents to live independently

(ii) Accommodation that has been designated as being available only to individuals within an identified group with specific support needs; "support" includes:

(a) Sheltered accommodation,

(b) Extra care housing,

(c) Domestic violence refuges,

(d) Hostels for the homeless,

(e) Support for people with drug or alcohol problems,

(f) Support for people with mental health problems,

(g) Support for people with learning disabilities,

(h) Support for people with disabilities,

(i) Support for offenders and people at risk of offending,

(j) Support for young people leaving care,

(k) Support for teenage parents,

(l) Support for refugees.

Specialised Supported Housing could be the solution to the apparently intractable financial and operational problems in the NHS and social care. 

The significance of this appears to have been widely missed by much of the sector the Consultation was targeted at and by the Consultation Inquiry report, perhaps because of the limiting definition of supported housing that people focus on.

The Inquiry Report didn't make the distinction between ‘Conventional Supported Housing' and ‘Specialised Supported Housing'. The type of supported housing it described in its report is very much Conventional Supported Housing not Specialised Supported Housing. However, as we note above, the letter from Lord Best has gone some way towards rectifying this oversight.

In addition the Consultation Inquiry seems not to have acknowledged that devolved governments will be able to plot their own course with the supported housing and health and social care agenda, especially the Scottish Government. 

There is also a failure to acknowledge the strategic significance, in the mind of the UK Government, of Specialised Supported Housing to the health and social care funding and capacity crisis. Remember that the Specialised Supported Housing model redefines supported housing in terms of widening its role to include everything from Intensive Housing Management up to and including some healthcare. It is easy to see the intended link between the development of the Specialised Supported Housing model and the need and possibility of relieving pressure on statutory health and social care services.

Specialised Supported Housing is also exempt from the 1% rent reduction that applies to English social landlords up to and including 2019/20 and from the HCA Rent Standard.

The UK government has said that it wants to see much more supported housing. It says this at the same time as it is restructuring and reducing revenue via the welfare benefits system as a consequence of the Welfare Reform Act and effectively abolishing public capital investment as a routine source of development funding for social and supported housing. 

We can conclude from this that the UK government is particularly interested in Specialised Supported Housing, and perhaps to the extent to which it is interested in conventional supported housing is the extent to which it can become Specialised Supported Housing. But Specialised Supported Housing is a single concept within a wider Community Sustainment framework. We anticipate a likely ‘contracting out' of local authority statutory services to the supported housing/Community Sustainment sector as a consequence of the likely future merging of commissioning infrastructure. The Scottish Government has already structurally merged commissioning functions but will likely keep local authority services. England doesn't have a government of its own and English local authority services are consequently subject to the whim of the UK Government, which probably believes that such services have excessive overhead costs and should be removed from local authorities as the latter merge with NHS and other commissioning infrastructure on a regional basis.

Specialised Supported Housing is, by definition (above), developed with the use of private capital, often provided by pension funds. Many of the representatives of the pension funds and other private capital funds talk to us about how they can get in front of providers and commissioners in order to fund and develop new Specialised Supported Housing, or buy and/or refurbish existing properties. 

The UK government has identified a variety of private capital institutions, including pension funds, as the vehicles for the capital financing of supported housing, specifically Specialised Supported Housing. 

It has done so because it will be mindful of the recent poor history between social provision and private capital, especially through the Private Finance Initiative (PFI). It has required pension funds to work to a social commitment in their investment strategies that limit their percentage return to "reasonable" levels over a substantial period of time. 

Support Solutions has become increasingly involved in working with capital finance providers, such as pension funds and their representatives, and we have introduced significant sums of capital for the development of new Specialised Supported Housing. We have acquired properties and existing services that might otherwise have closed, for Specialised Supported Housing services.

The capital providers we work with have a background in social housing provision for people with additional needs. They are very interested in talking to existing providers that have property to sell, especially where there is an existing supported, sheltered/extracare or registered care service in place. Such properties and services are then transferred to a specialist Registered Provider that will continue to run the service for the existing tenants and providers.

Please contact us if you have existing services and properties for ‘disposal' as we are likely to be able to find a buyer for you who will retain the existing service.

 

Health & Social Care Crisis

The UK government has recently announced that housing will play a central role in any new policy on health and social care. 

So this is the opportunity for supported housing to redefine itself as an equal partner with health and social care in the management of services for people with additional needs. Supported housing, in particular the Specialised Supported Housing model, is expected to provide wider, deeper and more holistic services to a wider range of people with a greater level of additional need. In so doing it should take significant cost and operational pressure from a merged health and social care function. 

Different nations of the UK will have their own approaches. The Public Bodies (Scotland) Act 2014 has already merged health and social care commissioning into 32 partnership boards across Scotland. 

How long will it be before the UK Government decides, on behalf of the otherwise ungoverned English, that health and social care should be merged on a regional basis in England with a pooled budget to fund preventative enabling services? Such services will be provided by what we currently call supported housing, especially in its Specialised Supported Housing form. However, if supported housing is to avoid continually being a victim of its own misdescription it needs to redefine itself.

 

Community Sustainment, prevention & a wider, deeper role.

For some Specialised Supported Housing and Conventional Supported Housing are defined in terms of buildings. However, we need to go beyond this. The Registered Providers (or Housing Associations depending on where you are in the UK), charities, statutory and private providers that operate supported housing of any type need to be equally concerned about developing their wider Community Sustainment role which means meeting additional need within communities. In the same sense that housing associations reimagined the development of buildings as one component of the regeneration of communities, the wider sector has to see its role as being Community Sustainment, of which supported housing is only a part. 

Community Sustainment is a good description of the solution the UK Government seeks to manage and resolve the crisis in health and social care. It has supported housing at its core. However, as we wrote in our Community Sustainment briefing, the reform of health and social care requires a change in the infrastructure of its administration (most commissioning, which in England would be merged and regionally organised) but also in its values base

The latter point is of critical importance. Support Solutions identified in our briefing on Community Sustainment that the fault lines in the current health and social care system are:

  • Fragmented commissioning (i.e. a separation between health, social care, criminal justice and other commissioning) and
  • The management of cost, not the generation of value[2], as the key basis for decisions about funding services.

The keys of the Community Sustainment approach are the notions of preventative intervention and enablement as the alternative to reacting to otherwise preventable emergencies. Community Sustainment will provide for people across the totality of additional needs, including some healthcare.

 

Conclusions

So to bring the threads of this Briefing together, we have a revised definition of Supported Housing in England (which can also be used by other UK nations if it fits within their governments' policy agendas) and we have a crisis in the structure, funding and operational capacity of the NHS and local authority services.

At the same time we have a revised model of Supported Housing known as Specialised Supported Housing. The primary purpose of this is to alleviate pressure on the NHS and social care/criminal justice services by developing supported housing that provides everything from Intensive Housing Management up to and including some healthcare services for people who would otherwise require hospital or care home admission for the short or long term.

In our view, Specialised Supported Housing is at least part of the solution to the operational and funding crisis in statutory services.

The UK Government has published a Social Care Green Paper (for England) and the Scottish Government has already restructured its health and social work commissioning functions. The UK Government has also consulted on, but not yet produced, a White Paper for the future funding of supported housing. We sincerely hope that the UK Government (and national governments) will see the connection between a redefined notion of supported housing and the solution to the health and social care funding and operational crisis. The future supported housing White Paper will likely recommended a banded "Supported Housing Allowance" system as per Lord Best's letter (above) and the regionalisation of Local Housing Allowance in England.

We have already proposed a Community Sustainment model, which adds form to this idea and identifies the need for a new values base for the future commissioning of Community Sustainment services of which supported housing of all types forms a part. The existing models of segmented commissioning and the management of cost above all else have failed.

It is very important that party political arguments about what should happen with the NHS and local authority and criminal justice commissioning are seen for what they are: party political arguments. These have a habit of getting in the way of reform, and this issue is too important for that.

Michael Patterson

September 2017



[1] David Orr, National Housing Federation in https://publications.parliament.uk/pa/cm201617/cmselect/cmcomloc/867/867.pdf

[2] Value Generation is based on 3 factors: outcomes for people; cost-benefit to the public purse and wider community benefit.

(Added to site Friday, September 29th, 2017)


Other Articles In This Issue

DWP Consultation Proposals: Support Solutions Response
A 1% Rent Cut, the Privatisation of Social Housing & a Redefinition of Supported Housing: Challenges & Opportunities
The Silver Surge: wellbeing & prevention services for older people
Social Return On Investment (SROI) for organisations that support people with additional needs
The LHA Cap & the Future Funding of Housing, Support & Social Care
SROI: the cost of everything & the value of nothing
Exempt & Specified Accommodation & Intensive Housing Management
Exempt Accommodation & Welfare Reform Act Update
funding alarms
Welfare Reform, Universal Credit & Exempt Accommodation
Exempt Supported Housing, Universal Credit & Intensive Housing Management
Universal Credit & Supported Housing
Welfare Reform Bill 2011
Intensive Housing Management & the DWP HB Consultation Proposals
Funding for Housing Support and Social Care Services in a Time of Change
Issue 12 Home
The Future Funding of Supported Housing: Responding to the Consultation

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