Responding to the “Funding Supported Housing” Consultations: Issues and Principles
The Policy Statement and Consultations produced by the UK Government were published in October 2017. We have undertaken a series of 15 events across England (to which the detail of the Policy Statement applies) to talk to providers, commissioners, Housing Benefit colleagues and others about the Policy Statement and to put a perspective forward on how best to respond to these proposals, which we feel are seriously flawed and show signs of having been put together in haste.
It’s not appropriate in our view for us to try and provide “model answers” to the 2 Consultations on Sheltered & Extra Care Housing and Short-Term Supported Housing. However, it is appropriate to analyse them and constructively respond with an alternative view.
There are some questions to which we respond directly in this Briefing; however, many of the questions are directed at specific audiences and ask for factual data on needs, systems and services that can only be provided by the parties they’re aimed at.
What we have decided to do is to identify some key principles that you might want to consider when responding to the Consultations, which close on 23rd January.
Our principles, and those answers we do give, are sometimes based on the need to challenge the assumptions and definitions, for example, of different types of supported housing, behind some of the Consultation questions and to offer views on related issues that are not directly addressed by the Policy Statement and associated Consultations. The UK Government does not clearly define what it means when it uses the term “support” (it identifies “soft support” and “care, support or supervision” within the Proposals without clarifying what it means by those terms).
The Key Principles
1. Value for money does not necessarily equate to “lowest unit cost”. The overriding preoccupation with “cost control” within these Proposals and Consultations should be replaced with a commitment to “Value Generation” which is:
- Outcomes for people
- Cost-benefit for the public purse
- Wider community benefit
“Cost control” is a means of restricting expenditure within a segmented commissioning environment. The practical impact of this is that different commissioning interests, for example, the NHS and local authority social care departments, witll feel constrained to negatively compete with each other to NOT fund additional needs because “cost control” says they have to manage and restrict expenditure on their separate budgets. If commissioning was regionalised in England and integrated and if funding was pooled across the total range of additional needs that people have we could focus on generating value as defined above. Value Generation saves money. Cost control is simply a means of trying to pass necessary expenditure to meet peoples’ additional needs over to another part of the segmented system, often at the expense of people with additional needs and at significantly greater cost to the public purse. We need integrated commissioning infrastructure, as they have begun to develop in Scotland and in Manchester, and we need pooled budgets.
We therefore need a change in the structures and values within the English system of meeting additional needs. Commissioning should be regionally integrated across the totality of additional need and funding should be pooled and paid to organisations and people who generate value. Cost control and segmented commissioning have failed us all, whether we commission, provide or receive services.
2. It is important to ensure the link is made between the preventative and enabling capacity of supported housing and its ability to act as a solution to the funding and capacity crisis in the National Health Service, social care, criminal justice & public health. This link is not well made within the Proposals & Consultations.
3. The proposed definitions of Short-Term, Long-Term and Sheltered & Extra Care Housing do not reflect the diversity of supported housing services. For example, where do Shared Lives/Adult Placements, Respite Care, Housing First and Intermediate Housing fit in? No consideration is given to the sometimes high degree of overlap between Sheltered & Extra Care, Long-Term Supported Housing and Specialised Supported Housing. The lack of a Consultation on Long-Term Supported Housing is problematic given that ALL supported housing should operate on a continuum of need.
We are strongly of the view that the definitions within the Consultation of types of supported housing are inappropriate and unhelpful. So-called “short-term supported housing” should be redesignated as “Immediate Access Housing”. Within that definition refuges and other forms of emergency accommodation for which Universal Credit is not appropriate should be funded by a ringfenced local authority fund for up to 6 weeks, after which Universal Credit including an enhanced housing component should fund it. Other forms of supported housing which are not long-term housing solutions but accommodate people in crisis with intensive levels of need should be funded via Universal Credit, including an enhanced housing component. These forms of Immediate Access Housing must not be arbitrarily restricted to 2 years, although many if not most people would be in it for much less time than that. People in crisis with the most entrenched levels of need sometimes need specialist input which goes beyond that timescale. Immediate Access Accommodation beyond a 2 year timescale would still be a far better option in all respects than prison or hospital.
Whilst so-called “long-term supported housing” is not dealt with through a Consultation we would still make the point that applying a timescale to its definition is not the right way to proceed. Perhaps it would be better to redesignate it as “Intensive Needs Housing”, which might be short-term, medium-term or long-term and which might accommodate any client group with an intensive need who might otherwise require residential care or hospital admission. It might be appropriate to redefine “Specialised Supported Housing” so that capital funding could be private, public or mixed and therefore combine that definition with what the UK Government was trying to do with so-called long-term supported housing.
In the same sense as we think it is wrong to define supported housing types by timescale, we think it is wrong to attribute particular client groups to particular types of supported housing, with the possible exception of local authority funded Immediate Access Housing, which might accommodate people fleeing domestic violence and abuse or the threat of it, offenders, ex-offenders and people with substance misuse needs many of whom might then move to Universal Credit funded Immediate Access Housing after assessment of their needs.
4. Piloting is essential. This must be in areas where integrated regional commissioning has developed and areas where it hasn’t. We believe that a 2020 implementation date is unrealistic, bearing in mind the need for piloting, and that 2022 is a more realistic implementation timescale. Pilots should be designed and evaluated by external, objective specialists such as universities with a social policy research track record. An effective pilot requires 6 months to develop, 1 year to run and 6 months to evaluate. This renders 2020 an unrealistic implementation date. It might be appropriate to phase the introduction of the finally agreed changes, for example, sheltered and extra care housing might be piloted and implemented first as it seems to be the least contentious part of the proposals, albeit imperfect.
5. There should be new arrangements for integrated commissioning of health and social care, criminal justice and public health on a regional basis in the England. Specific “collaborative” arrangements and integrated commissioning should be written into the grant conditions for any funding that it provided to local authorities and should be expected within Supported Housing Strategic Plans. However, we reiterate our concern that funding to local authorities should be limited to Immediate Access Housing, which is used to assess peoples’ needs in a short timescale that Universal Credit does not lend itself to (see 3 above).
6. This should be an independent audit of local authority and statutory sector costs, especially in relation to the ring fence and the relationship between ring-fenced funding for housing & eligible service charge costs and other funding, for example, for “soft” support. This is also important in relation to political debates around the need for additional funding for the NHS in particular.
7. There is a need for clarity about the scope and extent of “eligible service charge” both within Immediate Access Housing, Sheltered and Extra Care Housing and Intensive Needs Housing. This should include the inclusion of at least some of the rental components deemed ineligible to be funded through Housing Benefit (which won’t exist, so the basis upon which certain chrges such as water rates, personal heat and light, alarms, TV licences and food are deemed “ineligible” won’t exist either).
8. A banded system of charges for ALL forms of supported housing, based on variable needs and variable geographic costs for housing, is worthwhile within a system of “Value Generation”.
9. The accreditation of providers should not be “subcontracted” to existing regulatory bodies if it means that certain providers become ineligible, for example, those that are not registered and regulated by the Homes and Communities Agency (Homes England) or the Charity Commission.
10. The draft National Statement of Expectation states that local authorities should provide preventative services and support to people with additional needs who aren’t in supported housing. No detail is given on this and this is an important oversight. If we neglect the additional needs of people who don’t live in supported housing then we will increase the human and financial costs of meeting those needs further and put unnecessary pressure on statutory and other services. This would constitute a failure to invest in prevention.
11. In Immediate Access Housing the relationship between the right to claim Universal Credit (“for help with housing costs”) and direct funding for housing and service charge costs to the providers of such accommodation is unclear. This relationship must be made clear and appears to be contradictory. In any event, people in supported housing who claim Universal Credit should retain the current exemptions from Spare Room Subsidy (“bedroom tax”) and benefit cap.
12. It is unclear from the Proposals whether the sum of money to be devolved for funding of short-term supported housing/Immediate Access Housing equates to the total £2.1bn of the enhanced Housing Benefit pot or just the amount of enhanced Housing Benefit payable to Immediate Access Housing.
Sheltered and Extra Care Housing Consultation Questions
It would be inappropriate and impossible for us to provide model answers to the consultation questions as they are aimed at different agencies that do different things so we have decided to identify key principles that should be applied to the entire consultation process. These are set out above.
We have also tried to address specific consultation questions within these parameters where it is appropriate to do so.
Definition (Question 1)
There is a need to ensure that the scope of sheltered and extra care housing is not increased, or that the levels of dependency within it are not increased, without the guarantee of additional resource. The “alternative to residential care and hospital” model is more a function of “Specialised Supported Housing” to the extent to which that is different from long-term supported housing. Please see our observations about Intensive Needs Housing in 3 (above).
If extra care housing in particular is to fulfill this function it must be fully funded through a banded system, based on Value Generation principles (see Key Principle 1 above) with a recognised and visible link to National Health Service outcomes in particular.
Sheltered and Extra Care housing are established but nuanced models of provision. It is important that respondents to the Consultation questions take the opportunity to explain what Sheltered and Extra Care housing is, and more particulalry what it is not, given the stated implication in these proposals that it should relieve pressure on the NHS and act as an alternative to residential care.
Funding Model (Question 2)
There needs to be clarity of the levels and components of:
- Bricks and mortar and housing management costs
- Eligible service charges
- Top-up costs
Service charges should be based on varying levels of need and should be banded, dependent upon need and geographical location. The idea that the “bricks and mortar” costs of Sheltered and Extra Care housing should be restricted to “Forumla Rent +/- 10%” is inappropriate and insufficient in most cases.
Funding eligibility should be based on Value Generation principles, one of which is cost-benefit (as distinct from cost control). Clarity is required on the relationship between top-up funding and welfare system funding. What are “eligible service charges”? What funding stream kicks in, where necesary, beyond the scope of eligible service charges and what is the mechanism to ensure continuity of funding in such circumstances?
Service Charges (Questions 3-6)
Under “Sheltered Rent” rent control will apply to “gross eligible rent”. This includes service charges that are “eligible under welfare rules”. This would presumably mean at present Housing Benefit, Universal Credit, and the Guarantee Credit component of Pension Credit together with any needs-based benefits people receive (PIP, for example). The “welfare rules” are currently changing and won’t be the same after the introduction of Universal Credit.
Given that Local Housing Allowance will no longer apply to sheltered and extra care housing (and others supported housing) rents, the UK Government wants to know what are the key principles and factors in setting service charges. The principles should be based on fully recovering the costs of services in the provision of adequate accommodation bearing in mind the assessed needs of residents. This should include such services such as concierge/night security where required, having regard to the nature of the tenant group and the number of individuals residing under one roof. We should recognise that currently “ineligible” service charges under the Housing Benefit rules (alarms, water rates, food, personal heat and light, TV licence costs) will by definition not be “ineligible” when Housing Benefit ceases to exist. So we should ensure that at the very least some of them are covered by the new service charge structures.
The point is, what do people with additional needs require in order to ensure their levels of dependency are reduced, or at least do not increase? If we fail to fund preventative, enabling services properly, including the property components, we’ll end up passing on much higher levels of cost because people will need more expensive and humanly painful emergency interventions because we failed to invest in prevention. This is another example of the failure of the “cost control” approach.
Differing levels of additional housing need and geographical location, which might support the banded approach within a Value Generation system, drive variations in service charge levels.
Service charges should not be capped in the way the proposals describe but should accommodate variable need and full recovery of legitimately incurred costs.
Implementation (Questions 9 & 10)
It is really important that the testing of the new arrangements, including Sheltered Rent based on full cost recovery, variable levels of service charge and Value Generation principles are tested in advance.
This should be piloted fully in areas where progress has been made towards integrated regional commissioning and also in areas where limited no such progress has been made. typically a pilot will take 6 months to structure and organise, 1 year to run and 6 months to evaluate. The methodologies of pilots and their evaluation should be overseen by skilled and truly objective agencies such as universities for which methodological rigour is a first principle. Unlike providers, local and central government, universities have no financial or operational bias in structuring and reviewing pilots.
We believe that the 2020 implementation date is unrealistic and that these proposals should be delayed or staged over time such that full implementation does not occur until 2022 at the earliest.
Commissioning (Questions 11 & 12)
Value change is necessary. Outcomes and cost-benefit are both components of Value Generation. This should be underpinned by joint commissioning in which provider representatives should have equal status with statutory sector colleagues.
Short-Term Supported Housing Questions
Definition (Question 1)
We need reassurance over the continuation of funding for “support” and clarity over what “support” means as distinct, if indeed it is intended to be distinct, from housing that accommodates people with additional needs funded from ring-fenced grant.
We really need an explanation of the apparently contradictory statements that people in so-called short-term supported housing (Immediate Access Housing by our definition) “will not pay rent” yet they’ll be entitled to Universal Credit “for help with housing costs”. The Proposals say that people will be relieved of the stress of paying rent whilst looking for work and that providers will be relieved of the burden of chasing benefits claims and rent arrears. Furthermore, if a resident doesn’t pay rent what is the their legal basis of occupation, and for that matter, how is their occupancy ended?
The use of terminology should such as “short-term” is disappointing and risks making need subservient to the management of a budget within the discredited cost control paradigm.
Short-term supported housing would be best defined as “Immediate Access Housing”. Whilst it is always desirable to work with additional needs towards greater levels of independence, people should not be denied continuation of service for the lack of “suitable long-term accommodation”. This is especially so given the lack thus far of a Consultation on long-term supported housing (or Intensive Needs Housing, as we have termed it).
Even if we’re forced to use terms such as “short-term” these terms should not be used crudely. Certain forms of Immediate Access Housing, refuges for example, might need to move people through quite quickly. However, other forms of supported housing that might accommodate and work with people for significantly longer, for example one or two years or more.
What is meant by “soft support”?
New Funding Model (Question 2)
The commitment to a Value Generation methodology would provide the necessary assurance that costs will be met.
There needs to be an acceptance that the role of Immediate Access Housing is to reduce dependency, be enabling, achieve reduced use of health, social care criminal justice and public health resources.
There should be shared clarity over what the roles of Immediate Access Housing are and a focus on cost-benefit, within a Value Generation system, not cost control.
We need a commitment that says people with entrenched levels of need do not have to leave after two years has elapsed in circumstances where “suitable long-term accommodation” is not available for whatever reason.
There may need to be an acceptance of overlap between Immediate Access Housing and other supported housing in some instances.
Provided that Immediate Access Housing is achieving the three value generation outcomes it should be fully funded. Clearly, it is appropriate for people with oversight of such services to make comparative judgements about the outcomes over time that such services achieve.
Strategic Plans & Meeting Local Need (Questions 3-6)
Providers should always provide local authorities and others with an assessment of local need for their services and the other needs of the client group.
The Supported Housing Strategic Plan would fit better with other local authority strategies (and other local/regional strategies) if it was developed within the parameters of an integrated commissioning infrastructure, preferably regionally organised and based on Value Generation principles. This would protect the diversity of the sector’s providers, and therefore its services, as well as the other three outcomes of Value Generation.
There are inherent risks in giving local authorities such wide-ranging roles, as defined by the National Statement of Expectation, especially without clarity over their resources.
Where local authorities maintain that they are underfunded, the risk is that a focus on cost control may be used as a means of limiting funding to Immediate Access Housing, especially in circumstances where commissioning is segmented and there is consequently negative competition between different budget holders to avoid funding services and needs.
It is important that the overhead costs of local authorities are audited, as part of this direction of travel. The UK Government should give serious consideration to regionalised integrated commissioning in England, using Manchester as an example in practice.
There is a risk that local authorities may be tempted to effectively “subcontract” the accreditation of providers to third-party regulators such as the HCA (Homes England) and the Charity Commission. This would mean other providers couldn’t be accredited in their own right.
The tasks and functions identified in the National Statement of Expectation are perfectly reasonable. However the infrastructure of many local authorities is not currently fit for this purpose, hence our concern for regionalised integrated commissioning. The emphasis on “cost control”, as opposed to Value Generation, will simply mean services with low unit costs will win out against those that seek to generate value.
Local Connection (Question 7)
We are concerned about the viability of cross-authority arrangements, which were required under Supporting People but were seldom agreed and not kept to for any length of time when they were agreed. Regionalisation would help to simplify problems with this.
We believe that local authorities will be tempted to assume that the obligation to provide accommodation and services to people with no local connection (i.e. people fleeing domestic abuse, offenders and ex-offenders and people with addictions) is not categorical.
The UK Government should make clear whether a local authority’s obligations are limited to “advice” to people without a local connection, or whether they are required to provide accommodation and appropriate services either in their own area or via a neighbouring authority with which they have a cross-authority agreement.
Commissioning (Question 8)
Please see the comments above in relation to integrated commissioning, preferably on a regional basis, and Value Generation principles. It is important to use those principles in any piloting of the new arrangements.
It is also important to make a clearer connection between the roles and outcomes of all forms of supported housing and the needs of health, social care, criminal justice and other statutory sector needs.
Implementation (Questions 9 & 10)
Piloting is essential and it is too risky to be categorical about a 2020 implementation date. It may be more appropriate to consider staged implementation, especially as there is no Consultation on Intensive Needs Housing (“long-term supported housing”) thus far.
Piloting should occur in areas where progress has been made towards integrated regional commissioning, for example, Manchester; and also where no such progress has been made so we can see the relationship between improved commissioning infrastructure and the outcomes of any pilots.
Support Solutions UK
 Outcomes for people; cost-benefit to the public purse; wider community benefit