8. The Supporting People Strategy states the Government's ambition for "people to have services which are appropriate and responsive to their individual needs and expectations."[2] It outlines a range of commitments for central and local government in delivering this objective. During our inquiry, we learned of a great many cases where the needs of some of the most vulnerable and 'invisible' groups in society have been significantly promoted by the programme. HMI Probation, for example, illustrated this to us in oral evidence:

I think one of the great benefits of Supporting People is the way it made offenders centre stage in looking at the vulnerability agenda because Supporting People has been much more about supporting vulnerable people rather than an over-concentration on bricks and mortar. Before these arrangements probation was in something of a silo that did not really communicate effectively with local authorities and I think having Supporting People has been a catalyst for probation to be working effectively in partnership but also making sure that offenders who have multiple needs are seen as one of the vulnerable groups.[3]

9. However, the evidence we received indicated that there are some major issues in "keeping people that need services at the heart of the programme" which remain unresolved. For some witnesses, there is a sense that the needs of certain service users are being "'lost' within the needs of the wider client group."[4] For others, this failure is more sweeping, with witnesses identifying a fundamental lack of service user empowerment and involvement in the delivery of the Programme across the board:

An area of weakness in the delivery of the strategy has been the real empowerment of service users in the design, delivery and monitoring of the strategy, at national and local levels. This has never been a strength of SP and greater effort is needed by all parties to ensure that service users are truly "at the heart" of the programme.[5]

Can users access the types of services they need?

GENERIC AND SPECIALIST SUPPORT

10. Supporting People services cater for an extremely wide range of client groups. It is an aim of the Programme for these services to be flexible and tailored to individual needs. Alongside this aim, local authorities have a duty to ensure value for money in the services they provide, as Andrew van Doorn of Hact put to us in oral evidence: "How do we make sure that the resources we have that are limited actually reach the most number of people?"[6] It can be a difficult task to reconcile cost with truly person-centred services for all those in need.

11. It was perhaps no surprise, therefore, when witnesses told us that some specialist needs are not being addressed due to local authorities moving towards the purchase of large, generic, services which are able to address the needs of a wide range of clients. Evidence from domestic violence charity Refuge demonstrated how serious the impact can be when the particular needs of a client group are not handled by a specialist organisation:

In the field of domestic violence there has been a trend for the commissioners to make the floating support[7] services generic and not geared to the need of any particular specialist group and that has been dangerous because everything about domestic violence services needs to be particularly thought out. For example, the moment when a woman first calls for help is the moment when the most dangerous thing she can do is try to leave. That is when 75% of the murders take place. So the point of referral needs to be very carefully handled by a specialist organisation.[8]

Conversely, several witnesses including, for example, provider organisation Family Mosaic, explained that the introduction of generic floating support services has also been a major success of the Supporting People programme in terms of engaging with some 'hard-to-reach' and excluded groups:

The introduction of large generic floating support services, which can support anyone who needs it within a community, has had a massive effect. The majority of service users referred into floating support including through self referral are people who do not receive services from any other agencies; they previously would not have been picked up by statutory agencies and literally had no support.[9]

12. Whilst most witnesses we spoke to recognised the need for a 'portfolio' of services—some generic, some specialist—we learned that moves towards increased commissioning of generic floating services create secondary issues in the provider market in terms of the sustainability of smaller, specialist, and often Third Sector, providers. Maurice Condie of Byker Bridge told us that whilst floating support "has been an incredibly positive thing for a huge number of our service users"[10], it was more likely to be tendered as a generic service, meaning that "small voluntary agencies do not get a look in because it is one big tender for maybe eight or ten services."[11]

13. The significance of losing the expertise of small Third Sector providers was brought home to us by Hact, which explained to us that

A lot of supported housing and housing support came from Third Sector organisations identifying the needs in their local areas and creating services to do that, and also through voluntary effort. Once that social capital is lost it is not easily replaced. I think we should be worried about those kinds of things.[12]

14. The Audit Commission, in accordance with several other witnesses, saw a move towards increased commissioning of generic support as a "risk" of the Supporting People ringfence being lifted.[13] Hact raised a more fundamental issue, suggesting it was not possible to tell whether or not those fears were justified because of the lack of a clear evidence base demonstrating the effectiveness of different models of intervention in meeting the needs of service users. As Andrew van Doorn said, "We really do need to invest in that evidence base so that providers and commissioners can make the right kind of decisions about how to meet the needs that exist in our communities."[14]

SHORT TERM, CRITICAL NEEDS VERSUS LONG TERM SUPPORT: ATTAINING OR MAINTAINING INDEPENDENCE?

15. A central premise of the Supporting People strategy is that it should help people "to attain or maintain independence".[15] 'Attaining' independence implies progress: from a state of dependence—for example on drugs or alcohol—to independence. For many service users, this focus on recovery, through a range of low, medium and high level interventions, is key to them achieving successful outcomes. Mental health charity Rethink presented us with a case study to illustrate this point:

One service user […] was discharged from a secure unit and went into a 24 hour supported housing for two years and established community living. She then moved on to lower supported housing and entered employment. She would never have been able to make the move directly from forensic secure[16] to low support as the judge and the forensic services involved in her case needed to know the risk management structures and specialist support was in place to support her appropriately and maintain community safety.[17]

16. However, for other users of Supporting People services, 'maintaining', rather than 'attaining', independence may be more relevant. Into this category may fall, for example, older people, or individuals with learning difficulties, for whom recovery and 'moving on' to full independence are unlikely outcomes of their engagement with Supporting People services. This point was illustrated in evidence from Brighton and Hove Sheltered Housing Action Group:

Sheltered Housing is different to most other categories of service user in that there is no next step […] Ex-offenders will move from one band to another in a progression that hopefully means they will be able to participate equally within society, and similar outcomes are available for rough sleepers, substance misusers, teenage parents […]. There is no such outcome for Older People. For the majority Sheltered Housing is their last home. The only progression will be a wooden box.[18]

In this context, learning disability charity Mencap warned against viewing all Supporting People services as a "cure"[19] and concurred with Rethink's judgment that "there is currently little provision under the system for the minority of people for whom complete independence is not a possibility and who will need low level support on an ongoing basis."[20]

17. A great deal of evidence we received focused on the importance of low level, long-term interventions for older people—and more specifically, sheltered housing. The issue of sheltered housing is discussed in greater detail later in this report, but it is important to highlight at this stage that some other client groups appear to be experiencing similar problems in securing appropriate services.

CONCLUSIONS: CAN USERS GET THE TYPES OF SERVICES THEY NEED?

18. Supporting People has been good at raising the profile of vulnerable groups, but there are still some whose needs are not being properly addressed. As the Supporting People programme develops, further steps need to be taken to ensure that those needs are met. As we have seen, particular care needs to be taken as delivery mechanisms for Supporting People services are developed. Generic and specialist services are both important but local authorities need to be careful not to lose specialist services in the rush to rationalise delivery and 'make the money go further'. In particular, while Supporting People has been excellent in helping people to 'move on' to independence, there is a shortage of low-level, long-term preventative support services, such as supported housing, for people who are less likely to 'move on' and instead need to 'maintain' independence.

19. We agree with Hact that a clear evidence base demonstrating the effectiveness of different models of intervention in meeting the needs of service users is crucial if the problems described in the above paragraph are to be addressed and providers and commissioners of Supporting People services are to make decisions which keep users at the heart of services. We recommend that CLG take steps to ensure that evidence base is developed and made widely available to Supporting People providers and commissioners.

Service user involvement

20. Several commitments within "Independence and Opportunity" promote service user involvement throughout the life of services, from commissioning to monitoring and review. Most witnesses recognised this involvement as vital in ensuring service quality. In common with several witnesses, provider organisation Family Mosaic's evidence stated that "We can honestly say that our services are better and more responsive because of the service users' involvement."[21]

21. During our inquiry, we heard of many examples of very effective service user involvement, such as Hampshire having permanent user representation on its Commissioning Body and Stoke inviting service users to partake in review panels when services are recommissioned. 148 out of the 150 commissioning authorities make service user involvement a condition of their contracts,[22] and contract compliance is monitored through the Quality Assessment Framework.

22. In addition to the focus on service user involvement in the QAF, CLG also introduced the Supporting People Outcomes Framework in 2007. This framework is described as "one of a few frameworks which is able to evidence if service user needs have been met or not whilst in receipt of Supporting People services."[23] A key criterion of the Outcomes Framework is that service users have support plans which clearly identify their housing support needs and ensure their involvement in identifying the outcomes they hope to achieve through engagement with Supporting People services. CLG claims that "The result has been greater control and choice of which service people wish to access.

23. However, despite some excellent practice, our evidence showed a tendency for local authorities to think that user involvement is working well, but for service users themselves to be less convinced.

24. The Supporting People strategy states that "Through the Quality Assessment Framework and support planning, individuals can have a clear say over what support they receive and over how and when they receive it. This can range from something as simple as agreeing the time of a visit, to being able to agree what sort of support services are needed".[24] Whilst the overwhelming majority of the evidence we received recognised the QAF as being highly effective in this respect, Mencap's evidence cited research undertaken by the Joseph Rowntree Foundation in 2007 into the impact of the Supporting People programme on people with a learning disability. One of the findings was that the concept of user choice was not always being properly facilitated:

Fundamental choices, such as where to live, who to live with and who to receive support from, were still typically made by service managers or commissioners.[25]

25. During our visit to a resident in local authority sheltered housing, we heard of elderly residents' frustration over the lack of consultation and communication by the local authority as to how services were delivered. It was claimed that residents were not consulted about changes to their services and that the local council tended to convene meetings relating to sheltered housing in venues which were inaccessible to elderly people. We also heard that communications with residents from the local authority and health services were confusing, leading to a lack of understanding amongst residents as to what services were available to older people in the area.

26. An inevitable consequence of inadequate user involvement in the design and delivery of services is complaints. Unfortunately, the evidence we received suggests that mechanisms for handling complaints have been a weakness of the Programme, particularly for users of sheltered housing schemes. Age Concern & Help the Aged's joint submission explained that

Residents who make complaints to their provider are referred to the commissioning authority that may then refer them back to the provider. It appears that neither the Local Government Ombudsman Service nor the Housing Ombudsman Service take responsibility for complaints in this area. Residents who previously wrote to the Housing Corporation or CLG have been told that they cannot deal with problems as they are the responsibility of the local commissioning authority.[26]

27. This point was backed up by Nigel Hamilton of Sitra, who explained to us where he believed the accountability for dealing with users' questions and complaints should lie:

There is a very important point there I think about service planning and making sure that the support plan is honestly and openly discussed with the service user so that they are very clear that they do know what they will get and that the provider and the commissioner can be held accountable for that. […]Ultimately it must be the commissioner's responsibility to ensure that those procedures are there, but certainly in terms of the present arrangements whereby someone is referred to a service then it will be the service provider's responsibility to have that discussion in an open and honest way.[27]

28. Several local authorities raised the failure of the government to put into effect Charters for Independent Living, a commitment of the 2007 Strategy. The Audit Commission's inspections of Supporting People services found "no evidence […] of the impact, or any improved outcomes for services users, from the development of charters for independent living […]".[28] These charters were intended to provide service users with information on the standards and accessibility of service they should expect from Supporting People providers, including details of relevant complaints procedures.

29. When we asked CLG about the lack of progress with charters, we were told that

The Charters for Independent Living are relatively new, so I would not expect to see any evidence to suggest that services users have gained from the Charters. However, in terms of the Quality Assessment Framework, for any provider to have reached a minimum standard the local authority should ensure that each service user has an understanding of where to go for a complaints procedure.[29]

We were also advised that a Ministerial group which was set-up in response to Age Concern and Help the Aged's Nobody's Listening report will address complaints handling as part of its wider remit to look at a range of ways in which to listen and work with residents in sheltered accommodation.

CONCLUSIONS: INVOLVEMENT, COMMUNICATION AND CONSULTATION WITH SERVICE USERS

30. User involvement is crucial to Supporting People services. However, it is not happening consistently and users tend to feel that they are not being listened to. Communication and consultation with service users is not always good—sometimes very poor—and this leads to complaints. But complaints handling mechanisms themselves are seen to be a major weakness by many service users.

31. There is some very good practice, but there is clearly also some poor performance which needs to be addressed. The tools for ensuring appropriate and high quality services—the Quality Assessment Framework and the Outcomes Framework—already exist and are widely used. However, they are not mandatory. We recommend that the QAF and the Outcomes Framework should be mandatory for all local authorities unless and until they can demonstrate that they are achieving a high level of involvement, communication and consultation with service users, and a commensurately high level of client satisfaction.

32. Meanwhile, progress with Charters for Independent Living has been too slow. Consequently, there has been an inadequate focus on clarifying complaints mechanisms and other means of ensuring that individual service users get the services they need. We recommend that CLG prioritise the implementation of Charters for Independent Living, with a particular focus on clarifying complaints handling mechanisms.

Service user involvement in the new local government landscape

33. The potential loss of dedicated Supporting People teams, Commissioning Bodies[30] and service user involvement mechanisms resulting from the change in the funding mechanism is regarded as a potentially serious risk to user involvement. The risk is that such structures may be subsumed within generic commissioning teams and Local Strategic Partnership decision-making structures, compromising their ability to focus on Supporting People client groups. As Helen Williams of the National Housing Federation told us, "Some Local Strategic Partnerships are not well set up to hear the needs of vulnerable people or to listen to those needs locally."[31] Sitra expressed "concern that new decision making structures may be further removed from service users who may, for example find it impossible to access LSPs".[32] These comments come in the light of evidence from a service user showing that even some existing dedicated Supporting People bodies can be difficult to engage:

A […] problem with SP is their inaccessibility. It took the author [of this memorandum] over 6 months to be made aware that he and his fellow tenant reps could attend local SP meetings […] and only a few weeks ago was he invited to an SP Core Strategy Group meeting where he was able to access just a little more information.[33]

34. Whilst these comments give some cause for concern, we are somewhat reassured by the focus on service user involvement in the new performance regime, the Comprehensive Area Assessment. Under that regime, "The views and experiences of local people are key sources of evidence for CAA"[34] and

[inspectors] will take account of the area's own evidence about users' views of local services. We expect this to include information about the views of: children and young people; those who may experience disadvantage in accessing public services; groups and individuals whose views are seldom heard; people whose circumstances make them vulnerable and the third sector.[35]

It is to be hoped therefore, that local authorities will recognise the continued need to provide effective mechanisms for user involvement, if nothing else then to succeed in inspections.

35. Comprehensive Area Assessment cannot alone be relied upon to ensure the continued quality of Supporting People services. The development of Local Strategic Partnerships as decision-making forums for Supporting People services may pose a risk to user involvement in some areas. In order to retain a proper focus on housing-related support and facilitate good service user involvement in the decisions of local strategic partnerships, there is a very strong argument to keep the existing Commissioning Body and associated service user involvement structures established under the Supporting People programme. We return to this point later in this Report.[36]

Personalisation

36. A key concern for many witnesses is the challenge posed by the 'personalisation' agenda. Whilst most of the evidence we received supported the principles of user-centred services—and indeed, there was a widely held belief that Supporting People services are already highly personalised—many witnesses were rather more dubious about the practicalities of such a system. Choice can confuse and discourage as well as stimulate. UNISON, for example, told us that it is

fully committed to service user involvement in service design, and to giving service users the maximum possible say in how they receive services. However, our members feel that service user involvement is not facilitated properly by Supporting People—many of them are asked to be involved in ways they cannot deal with. This will become more of a problem as the government's personalisation agenda is rolled out, through mechanisms such as individual budgets.[37]

In oral evidence, Charles Fraser of St. Mungo's told us that "[the St. Mungo's] service user group has said to us that they are getting rather impatient with this kind of thing. They find the plethora of choice rather disempowering".[38] Mr. Fraser also made the pertinent assertion that "Choice between poor services is not a good choice on quality services."[39]

37. The concept of Individual Budgets—whereby service users are given a cash or notional sum to spend according to their particular needs and circumstances—was the focus of much discussion within the evidence in the context of personalisation. Again, witnesses conveyed mixed views, with Sitra, for example, being generally supportive of the opportunity to further promote service user autonomy rather than dependence on professionals, but other organisations highlighting potential pitfalls. Maurice Condie of Byker Bridge argued that individual budgets would not be appropriate for certain client groups such as high-risk offenders who, if given the option to make decisions about their support and supervision, would prefer to "escape and go and play with the kids!":[40]

[…] personalisation tends to work best for people who want support […] In order to test this thesis, it would be worth investigating how many offenders would choose to pay for their Drug Treatment and Testing Order (DTO), Community Rehabilitation Order (CRO), [or] Home Detention Curfew (HDC) […] from a personalised budget without restrictions.[41]

38. Because of the risk to vulnerable individuals (and to society) of providing too much choice to certain client groups, care would need to be taken to ensure a balance of commissioned and individually purchased services:

[…] Home does not believe that individual purchasing of support is always the most effective way to ensure that clients have real choice and control. Commissioned services are more appropriate to many clients who would choose them because they don't (or don't yet) want to exercise a greater degree of choice and responsibility. Individual budget systems which give control of actual or virtual money to clients are not appropriate to those with chaotic or addictive lifestyles.[42]

This is also seen to be particularly relevant to accommodation-based services, as Greg Roberts of Westminster City Council explained to us in oral evidence:

Where I really do struggle seeing how it works is where you have an accommodation based service, so the standard ten flats, people with learning disabilities, three members of staff, say it cost £90,000, that is £9,000 per head; if you put that into each individual's individual budgets and those individuals choose not to spend it on that core staffing, I really do struggle to see where that works. If you have four who decide to do it and five do not, does that mean then it is no longer a 24 hour support service? Do those members of staff walk past in the corridor without saying hello to the people who have decided not to support?[43]

39. These views strike a chord with the findings from the pilot exercise on Individual Budgets, published by CLG in March 2009, which concluded that "Based on experiences to date, all the pilot sites feel that IBs have a key role to play, but that they should not be considered as the only option for personalising housing-related support services and increasing choice. Commissioned Supporting People services can be responsive and person centred, as well as providing consistent coverage over large geographical areas.[…]"[44] The same report suggests that Individual Budgets would be most appropriate for individuals who meet the current Fair Access to Care criteria for social care services, namely those with critical and substantial needs. Commissioned preventative services for individuals with less critical and substantial needs may therefore continue to be needed to prevent a crisis from happening in the first place.

40. Although some useful conclusions have been drawn from the pilot exercise on Individual Budgets, most witnesses felt it was too early to draw any conclusions as to how personalised services should be shaped in future. The pilot exercise was considered by most witnesses to have been too short and some felt that increased consultation with service users would be needed in order to capture their preferences as to how their support should be delivered. In oral evidence, CLG told us that a working group between CLG and DH has been set up with elected council members, providers and local authorities to see how the personalisation agenda can be rolled out across housing and related support. We were assured that "Obviously that will involve service users widely about how they are empowered to have greater choice, how they get support planning that very clearly links back to their level of need and how providers need to change their attitude to working very closely with service users in delivering services that those individuals require."[45]

41. Personalisation of services is good for increasing service user choice, but sometimes too much choice is overwhelming or even inappropriate. Careful consideration must be given to how to balance personalisation with important commissioned services for people who need emergency support, or who are unable—or unwilling—to choose. Careful consideration is particularly needed of how personalisation will work in accommodation-based facilities. We recommend that the Government extend the Individual Budget pilots to learn more about how personalisation works in practice.

Developing more integrated assessments

42. The Supporting People Strategy recognises the importance of "including Supporting People services within the wider health and social care assessment processes." [46] The Strategy specifically highlights CLG's involvement in the Department of Health's work on developing cross-Government work on a Common Assessment Framework (CAF) for Adults and outlines its intention to explore the inclusion of housing and housing-related support in the CAF.

43. However, the lack of progress with this agenda was highlighted in written evidence from provider Housing21:

We also ask the Committee to consider how the debate about the impact of and future of Supporting People will link to the debate about social care and personalisation especially looking more closely at developments such as ensuring that housing-related support would be part of the common assessment framework promised in the 2007 strategy.[47]

44. It is therefore reassuring to note the continued focus on this subject in the Social Care Green Paper which was published a week after our final evidence session. This Paper stresses the need for health, housing, social care and other public services to work together more closely to promote early intervention and preventative services, along with the Government's ambition "to create an assessment process that considers people's individual needs, means and eligibility for all forms of support in a more joined-up way. This will build on the developing arrangements for the Common Assessment Framework for adults, to minimise multiple questioning of the same people for the same information."[48] We welcome the progress, albeit slow, which has been made on developing more integrated assessments of service users' needs. The consideration of housing and housing-related support in the context of needs assessment in the Social Care Green Paper is a positive development, and we look forward to seeing further progress in the inclusion of housing and housing-related support in the Common Assessment Framework for Adults.

3   Q 1 Back

4   Ev 138 Back

5   Ev 180 Back

6   Q 77 Back

7   Floating support, as opposed to accommodation-based support, is not tied to accommodation. It can therefore be used to provide services to users in a variety of accommodation settings.  Back

8   Q 98 [Ms Keeper] Back

9   Ev 66 Back

10   Q 105 Back

11   Ibid. Back

12   Q 65 Back

13   Ev 174-75 Back

14   Q 77 Back

15   Communities and Local Government, Independence and Opportunity: Our Strategy for Supporting People, June 2007, Executive Summary. Back

16   Forensic psychiatry deals with some of the most disturbed and difficult to manage patients in psychiatric practice. Its focus is the assessment and treatment of mentally disordered offenders, and other patients, presenting with severe mental disorder in association with significant behavioural disturbance. Treatment settings vary from high security hospitals through to medium secure units and community forensic services, as well as the opportunity to treat patients in prison settings. Back

17   Ev 97 Back

18   Ev 191 Back

19   Ev 151 Back

20   Ev 97 Back

21   Ev 65 Back

22   Q 39  Back

23   Ev 220 Back

24   Communities and Local Government, Independence and Opportunity: Our Strategy for Supporting People, June 2007, p 15. Back

25   Ev 151 Back

26   Ev 128 Back

27   Qq 33-34 Back

28   Ev 172 Back

29   Q 329 Back

30   The membership of a Supporting People Commissioning Body comprises all statutory partners in an area: districts (in two-tier areas), health and probation. A Supporting People Team is employed by the local authority and delivers against the decisions of the Commissioning Body. Back

31   Q 51 Back

32   Ev 201 Back

33   Ev 188 Back

34   Audit Commission, Comprehensive Area Assessment Framework Document, February 2009, p 37. Back

35   Ibid. Back

36   See para 81. Back

37   Ev 86 Back

38   Q 121 [Mr Fraser] Back

39   Q 123 Back

40   Q 121 Back

41   Ev 74 Back

42   Ev 146 Back

43   Q 195 Back

44   Communities and Local Government, Learning and experiences from the Individual Budget Pilot sites, March 2009,
p 8. Back

45   Q 330 Back

46   Communities and Local Government, Independence and Opportunity: Our Strategy for Supporting People, June 2007, p 16 Back

47   Ev 105 Back

48   HM Government, Shaping the Future of Care Together, Cm 7673, July 2009, p 55. Back