NHS Greater Huddersfield Clinical Commissioning Group

and NHS North Kirklees Clinical Commissioning Group

‘Good Housing, Good Health’

A Joint Commissioning Strategy

Accommodation for People Who Experience

Mental Health Problems in Kirklees

2016 – 2018

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CONTENTS

1. INTRODUCTION ......................................................................................................................................... 3

Supporting principles ................................................................................................................................ 3

The Impact of Housing on Social and Healthcare Costs ........................................................................... 4

2. INFLUENCING POLICY ................................................................................................................................ 7

National Policy .......................................................................................................................................... 7

The Care Act 2014 ..................................................................................................................................... 7

Children and Families Act 2014 ................................................................................................................ 8

Winterbourne View ................................................................................................................................... 9

Old Problems, New Solutions: Improving Acute Psychiatric Care For Adults In England......................... 9

Housing, Council Tax and Welfare Benefit Changes ............................................................................... 10

Local Policies ........................................................................................................................................... 11

3. CURRENT ANALYSIS OF SUPPORT SOLUTIONS ....................................................................................... 12

Fig.1 Range of Accommodation Options to be Commissioned ............................................................. 15

4. THE VIEWS PEOPLE HAVE ABOUT HEALTH & SOCIAL CARE SUPPORT ................................................... 16

5. COMMISSIONING IMPLICATIONS ........................................................................................................... 18

Appendix One – Moving Forward - Commissioning Implications & Improvement ................................ 19

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1. INTRODUCTION

1.1 People who experience mental health problems require different levels of housing support throughout their lives to enable them to live as independent citizens with choices and options open to them about where and how they live. This strategy focuses on that belief, encouraging intervention at the earliest possible moment to avoid an escalation to a crisis situation and to aid independence and continued wellbeing and resilience for all people experiencing mental ill-health, from those experiencing lower levels of depression, anxiety and stress to those with more severe episodes that may require admittance into. However, inevitably this strategy has a main focus on those with ongoing support needs, with principles to support this:

Supporting principles

1. Individuals who experience mental health problems should not have to undergo a change in accommodation to receive the level of care and / or support that they need at any particular time and a range of options should be available with regards to having a place to live.

2. The focus on achieving independence and autonomy should not be lost for individuals who do require periods of support within specialist accommodation services.

3. Support solutions for individuals should be co-produced with those individuals and focussed on the individual’s aspirations.

1.2 The relationship between good mental wellbeing and suitable accommodation has long been agreed. This is recognised in the Council’s ‘Housing Commissioning Strategy 2013 - 2016’1 which supports this strategy by recognising that people need timely support to increase independence and meet their housing need along with more appropriate accommodation to meet that need and which they can afford to heat.

‘Having a settled home of the right type and in the right place is fundamental to helping people, with a range of support needs, to live independently. We need to increase access to settled housing for people who have in the past been most at risk of exclusion; for instance people with mental health problems…………’

Kirklees Housing Commissioning Strategy 2013 - 2016

Housing and mental health, including general health, are closely related and in policy terms have been afforded a good deal of consideration over the last decade. Those who experience mental health problems find that their illness can lead to the breakdown of a tenancy, loss of a job and hence the ability to pay a mortgage or rent and in turn can lead to the loss of a family home and potential family breakdown. Being homeless, on the streets or insecurely housed can, of course, further exacerbate mental health and wellbeing and lead to poor physical health.

1.3 It is fair to say that safe, secure and affordable housing is critical in enabling people to work and take part in community life as a valued member of society. Having settled housing and accommodation is known to have a positive impact on our mental health, as described in the

1 http://www.kirklees.gov.uk/beta/housing/housing-strategies-policies.aspx

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mental health strategy for England ‘No Health without Mental Health’2 and as we move towards more personalised, co-produced services that seek to intervene at an earlier stage and away from ‘traditional’ residential provision, non-institutional services become more important and can save commissioning authorities a significant amount of money. Housing provides the basis for individuals to recover, receive appropriate support to improve health and resilience and in many cases return to work or training.

1.4 The impact on mental health of poor housing is well evidenced. Compared with the general population, people with mental health conditions are one and a half times more likely to live in rented housing, with higher uncertainty about how long they can remain in their current home. They are twice as likely as those without mental health conditions to be unhappy with their housing and four times as likely to say that it makes their health worse. Mental ill-health is frequently cited as a reason for tenancy breakdown and housing problems are frequently cited as a reason for a person being admitted or re-admitted to inpatient medical care.3

1.5 Lack of housing can impede access to treatment, recovery and social inclusion and accessing mental health services and employment is more difficult for people who do not feel settled in their accommodation. So, housing is generally recognised to be a central part of an effective recovery pathway. It provides the basis for individuals to recover, receive support and help and in many cases return to work or education. For all of us, housing is a critical part of our wellbeing - both physical and mental.

1.6 The necessity for good housing is recognised in the national cross government strategy for mental health ‘No Health Without Mental Health’4, where good housing is continually identified as a key element in the recovery process, aiding better outcomes and equality for people with mental health problems.

Social inequality of all kinds contributes to mental ill health, and, in turn, mental ill health can result in further inequality – for example worse outcomes in employment and housing for people with mental health problems.

No Health Without Mental Health (2011)

Kirklees’ ‘Housing Allocations Policy’5 is framed to ensure that a ‘priority band’ is awarded to those who need to move due to medical welfare reasons, this includes where the current living arrangement is having a significant impact on a person’s mental health. Currently people are placed in ‘Band B’ in these circumstances, one of five bands (A- E).

The Impact of Housing on Social and Healthcare Costs

1.7 Unsuitable housing, or a lack of suitable housing related support, can also lead to an escalation in an individual’s care needs and trigger admission to hospital. This can often, as a result, reduce an individual’s or carer’s confidence that they can live safely within the community and in turn this places additional pressure for residential or other institutional care which could be alleviated by

2 https://www.gov.uk/government/publications/the-mental-health-strategy-for-england

3 http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/Housing_MH_021211.pdf

4 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf

5 http://www.kirklees.gov.uk/housingallocationspolicy

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more suitable, community based supported housing options with the added benefits of being more cost effective.

1.8 A lack of appropriate accommodation and support to enable the accommodation to be maintained can lead to worsening mental health and to people being placed out of the area, living in residential care or to delayed discharges. This can be an issue of supply, such as a lack of supported housing and other independent living options being available locally. It can also be due to a lack of appropriate and timely advice and support for people who are in hospital planning to return to community life, as well as housing not being regarded as a key component of care planning.

1.9 The quality of accommodation and its appropriateness also have an impact on the mental health of individuals and in turn could lead to increased health and social care needs, or indeed mental health problems where none have been experienced before. The lack of housing options, such as supported housing, affordable and social housing, means that people turn to private rented accommodation. Whilst we recognise that there is good quality, private rented accommodation in the area, we also know that that there is a degree of contrasting poor quality accommodation which is more insecure, often has associated social issues (anti-social behaviour, substance misuse etc.) and which all may lead to increased mental health need, safeguarding concerns and an increasing call on services.

1.10 The ‘National Mental Health Development Unit (NMHDU) in their report of 2011 ‘Housing and Housing Support in Mental Health and Learning Disabilities – Its role in QIPP’6 identified that where community based housing support is used well the savings to social care, as residential care is avoided, stood at £19k a year per person, with savings of in the region of £4k each 4 weeks should that individual remain in hospital.

1.11 Other potential savings have been identified by the Care Services Efficiency Delivery (CSED) programme at the Department of Health (DH). Based on a series of service audits it is suggested that:

Housing based support services for people with mental health problems could deliver cost savings to health and social care of £10,000 to £20,000 per year per individual

Supported housing for people with moderate mental health needs, after discharge from hospital, could offer estimated savings of £22,000 for each person per year across the wider health and social care system

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1.12 Clearly people who are living in appropriate supported accommodation will be making less call on more expensive services with better individual outcomes. The NMHDU report also identified that the benefits of community based provision options are more than financial and lead to:

Improved quality of life for the individual including greater independence, improved health, greater choice of options on where and how to live and lessened dependence on relative and carers

Prevention of further mental health problems and fewer suicides

Reduced burden of care for carers (leading to improved quality of life); and

Easier access to appropriate services.

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2. INFLUENCING POLICY

National Policy

2.1 The national mental health policy ‘No Health without Mental Health’ set out six objectives for improving mental health and wellbeing:

• More people have better mental health

• More people will recover

• Better physical health

• Positive experience of care and support

• Fewer people suffer avoidable harm

• Fewer people experience stigma and discrimination

In working to achieve these objectives the policy highlights the needs for commissioners to increase settled accommodation choices for people on an ageless basis. However, this strategy focuses on people over 18 and excludes people who have dementia as a complementary national strategy ‘Living well with dementia: A National Dementia Strategy – Putting People First’7 is in place.

The Care Act 2014

2.2 The new ‘Care Act 2014’8 has created a single, modern law that makes clear the kind of care people should expect and sets out new duties for local authorities and partners, such as the NHS, as well as bringing new rights for service users and their carers.

2.3 The emphasis of the Act is on individual wellbeing, including the consideration of the ‘suitability of accommodation’ in its definition of ‘Wellbeing’ and having reference to housing and / or accommodation in most chapters of the care and support statutory guidance document9. This strategy very much seeks to be a part of this by improving and securing the housing and accommodation support needs of people which in turn will aid their wellbeing and recovery.

2.4 The Act includes a statutory requirement that local authorities collaborate, cooperate and integrate with other public authorities, this includes housing and this can only enhance the strength of this strategy in raising the profile of the housing needs of people with mental health problems and their carers. Similarly, there will need to be development of appropriate options through the wider market development in Kirklees that enables ample choice for individuals and the Council will retain a lead role in developing and managing the housing need in Kirklees. It also has to be recognised that sometimes ‘out of area’ provision may be the most appropriate and supportive in a person’s recovery.

2.5 The provision of information and advice on care and support is another duty that the Care Act introduces, ensuring that this is available to all and is at a time when it is needed. This is an area that will require strengthening so that the experience of service users and carers when seeking

7 https://www.gov.uk/government/publications/living-well-with-dementia-a-national-dementia-strategy

8 http://www.legislation.gov.uk/ukpga/2014/23/pdfs/ukpga_20140023_en.pdf

9 https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance

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accommodation and housing options, and support to do so, is a positive one and secures appropriate accommodation through the provision of good advice to navigate a path through the availability of housing options, consider welfare benefit options and to find suitable accommodation.

2.6 The recognition of the role of the carer is a strong theme in the Act and any needs being met by the carer will be a part of the assessment. Equally, and maybe more importantly, the Act recognises the carer and that they too have needs and may require support and are therefore eligible for an assessment in their own right. By supporting the carer this may keep them well, enable them to continue in their caring role and in turn this could help in maintaining an individual in their accommodation, avoid hospital admittance and the potential breakdown of tenancies, sustain their family life, reduce debt etc.

2.7 The importance of personal budgets is also recognised and will form part of any care and support plan – this can also include carers.

Children and Families Act 2014

2.8 Whilst Part 1 of the Care Act 2014 deals with adult social care for anyone aged over 18 with care and support needs, Part 3 of the ‘Children and Families Act 2014’10 introduces systems of support for parents and carers of children and young people who have special educational needs (SEN) or disabilities which extend from birth to 25 years of age. There are many places where the duties in both Acts overlap. This means there will be young people aged 18 - 25 who will be entitled to support though both pieces of legislation.

2.9 The Children and Families Act particularly looks to transform systems for disabled children and young people and those with SEN, where the Local Authority and partners work together in preparing children and young people for adulthood and independent living. The Act also highlights the importance of engaging young people and their families in all processes including developing and planning, commissioning of services and strategic decision making. This includes providing services and publishing information which responds to the physical and mental health and emotional wellbeing of children and young people.

2.10 The ‘Kirklees Local Offer’11 responds to the Children and Families Act by publishing information about services relating to special educational needs, disabilities, education and more for children and young people aged 0-25.. As this resource is developed it will look to include local information

10

https://www.gov.uk/government/news/landmark-children-and-families-act-2014-gains-royal-assent 11

www.kirklees.gov.uk/localoffer

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2.11 for young people and their families to assist in their preparation for adulthood and independent living which includes provisions relating to:

Transition to adulthood

Educational and training provisions

Finding employment

Obtaining accommodation

Participation in society

Winterbourne View

2.12 The government’s response to the investigation into Winterbourne View, ‘Transforming Care: A National Response to Winterbourne View Hospital’12, highlights the need to improve services and respond to the needs of those with learning disabilities or autism who also have mental health conditions.

2.13 It recognises that people often stay for too long in hospital settings, have the ‘right to be given the support and care they need in a community-based setting near to family and friends’ and that placing people in accommodation outside of their locality or into larger residential settings can cause harm to people by weakening relationships with their family and friends and taking them away from familiar places and communities.

2.14 National policy guidance since Winterbourne 2011 has made clear the need to reduce the number of people receiving assessment and treatment in hospital settings via the development of more specialist community solutions, these solutions will also reduce the number of people still being admitted to secure hospital settings.

Old Problems, New Solutions: Improving Acute Psychiatric Care for Adults in England

2.15 One of the recommendations in the final report by Lord Nigel Crisp in February 2016 - ‘Old Problems, New Solutions: Improving Acute Psychiatric Care for Adults in England’13 focuses on the need for better access to a mix of types of housing and greater flexibility in its use to provide for short-term use in crises, reduce delayed discharges from inpatient services and offer long-term accommodation.

2.16 This will involve collaborative working across health, social care and housing providers in all sectors, working together to ensure that there is an adequate supply of appropriate housing to enable patients to be discharged from hospital when they no longer need inpatient treatment including:

crisis housing

short-term temporary accommodation for patients ready for discharge

12

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213215/final-report.pdf 13

http://www.rcpsych.ac.uk/pdf/Old_Problems_New_Solutions_CAAPC_Report_England.pdf

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supported accommodation for patients with mental health problems

accommodation for patients with complex problems who may be difficult to house

2.17 Mental health support services in health, social care, housing and the voluntary sector, and workers who support people with mental health issues can help to signpost and support individuals to help in preventing homelessness for this group of people.

Housing, Council Tax and Welfare Benefit Changes

2.18 The reduction in welfare spending brought about by central government measures will have an impact locally on people experiencing mental ill-health and for their families. There are a number of changes that have and will be made in the coming years that this strategy covers, all of which are likely to increase pressures across the local housing system and inevitably impact on the health of those affected – mentally and physically.

2.19 The introduction of the lowering of the benefit cap, brought about as a way of encouraging a move into work and away from the need to claim benefits, from £26,000 to £20,000 per annum locally will impact most greatly on those families who require larger sized homes to provide adequate housing and who will then find that housing benefit does not cover the cost of rent. However, where people experience ill-health this will mean that opportunity to move to employment is limited and therefore they are at greater risk of poverty and a potential loss of their accommodation.

2.20 For those in work but in receipt of work allowances (Universal Credit) the earning thresholds will be reduced and in some cases removed altogether for non-disabled claimants which will result in potential reduction in household income, again leading to pressures that may affect the mental health of individuals. Additionally there will be a lowering of tax credits meaning that anyone earning more than £3,850 per annum will have their credits reduced quicker.

2.21 Pressure on housing providers and the Council’s housing revenue account is also increasing as a reduction of 1% per year for four years from April 2016 is made to social sector rents brought about as part of reducing the country’s housing benefit bill. This will bring further challenges for the sector in terms of future development programmes for the delivery of affordable and social rented housing.

2.22 Further changes are to be made into 2017:

Tax credits and the child elements of Universal Credit will be limited to 2 children only

Employment Support Allowance (ESA) will have the work related activity component removed which will reduce the amount received

Housing support will be abolished for many 18-21 year olds where people are not in work (although there are some exceptions for those seen to be ‘vulnerable’)

For those aged 18-21 there will be a more intensive regime of support from day one of their benefit claim with an expectation that after 6 months they will be expected to apply for an apprenticeship or traineeship, gain work-based skills, or go on a mandatory work placement

There will also be a significant impact due to the reducing of housing benefit for those in social housing (or the housing element of Universal Credit) to local housing allowance levels, especially for those under 35 years of age who will receive the shared accommodation rate of £55 per week.

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This will affect tenancies starting after the 1st April 2016 but will not affect people until the 1st April 2019. The impact on supported housing will similarly not affect people until the 1st April 2019 when a new model of funding supported housing is due to be in place.

Local Policies

2.23 If appropriate accommodation is to be realised for individuals experiencing mental health problems, then it is important that a broad range of housing opportunities are included in any accommodation strategy, and that strategies aimed at increasing good mental health and wellbeing are complimentary. This strategy supports the overarching ‘Kirklees Mental Health Joint Commissioning Strategy’14 which identifies as a priority the move to improved independent living options away from residential support and with an emphasis on prevention, with its implementation monitored by the Mental Health Partnership Board. The Council’s Housing Strategy along with the Kirklees Economic Strategy and the Health and Wellbeing Strategy, where two of the six main initiatives relate to housing, also support the development of appropriate housing options.

2.24 In addition other local strategies and service developments will impact on future potential improvements in housing options and increased and better choice for individuals. Namely these will be those associated with learning disability, autism and housing but will also include dementia and older peoples strategies.

2.25 The purpose of this strategy is to ensure that people who experience mental health problems have choices about, and access to, a range of housing opportunities that suit their individual needs. It is underpinned by the substantial evidence that confirms that individuals are much more likely to recover and stay well where they have suitable accommodation.

2.26 To support individual’s choice and to maintain their mental health good housing advice is also a necessity where this can not only support people to find suitable housing, but also to support them where they may be experiencing difficulties and potential loss of their accommodation. There are numerous circumstances where this may occur and good support and advice to assist them in such things as possession proceedings, benefit appeals and negotiations with landlords is valued in enabling people to either retain, or move to more suitable accommodation. In Kirklees this is provided by the Council’s Housing Solutions service along with partner agencies, such as voluntary housing groups and Citizens Advice Bureau.

14

http://www.kirklees.gov.uk/beta/adult-social-care-providers/pdf/kirklees-joint-mental-health-commissioning-strategy.pdf

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3. CURRENT ANALYSIS OF SUPPORT SOLUTIONS

3.1 Accommodation options for citizens of Kirklees are spread throughout the borough and range from specialist mental health units through to registered residential care, supported housing options and floating support at home. These are shown below:

Home / Community Support Services

-

Home support services offer practical, emotional and / or social care support and advice to people with mental health problems and their families.

Services that are provided by workers attached to Community Mental Health Team’s (CMHT), the LA’s Housing Solutions service, voluntary housing providers etc. are included in this area.

Floating Support - This is support available to people in their own homes, irrespective of their tenure which offers flexibility as to when provided according to individual’s needs and will be provided by commissioned floating support services and housing providers.

Shared Lives -

Kirklees Shared Lives (provided by Kirklees Council) is a flexible and unique arrangement where approved and registered carers offer day support, short breaks or provide a long term home for someone to whom they are matched for compatibility.

Supported Housing - Housing with support from staff which can take many forms and includes independent living schemes with support and shared houses with integrated support.

Registered Care Homes - Care homes registered with the ‘Care Quality Commission’ to provide residential care which will include personal care and where relevant nursing provision when registered to also provide nursing care

Rehabilitation Support - This is accommodation which will be registered with the CQC and will provide longer term provision working towards rehabilitation and recovery and may be for a number of years.

Short-term breaks and respite

- These are often targeted to offer relatives, friends and carers a break from their caring role and can be provided in the service user’s own home or away from home in other staffed accommodation

Crisis Accommodation - Provided to enable people somewhere safe to stay at times in their lives when they may need additional support quickly. This may be provided in a variety of locations which may include Shared Lives, respite units, hospital etc.

3.2 Specialist support placements in out of area locations are sometimes appropriate, but the focus needs to be much more on wherever possible a choice of options being available for individuals in local provision, within their own communities. Not only will this provide better value financially, but will obviously be of greater benefit in an individual’s recovery and the ability of their family and other networks to support them.

3.3 The need for 24 hour residential and nursing care funded by the local authority has remained reasonably static during the years from 2012 to 2015, with an average of 84 placements in long term units being used each year. Short stay use is much lower with an average of 6 placements being used per year.

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3.4 In Kirklees 67% of people (approx. 2300 people) subject to the ‘Care Programme Approach’15 (CPA) and / or receiving social care support from the Council are in stable accommodation, meaning that approximately some 700 people are likely to have accommodation needs. This is slightly higher than the national average of 64% and is an improvement from 64% in 2013/14.

3.5 Locally in comparison to our neighbouring authority areas Kirklees has a lower number of people living in stable settled accommodation, however the percentage difference is small with most other areas being around about 70% and our trajectory is an increasing one.

3.6 The range of providers in Kirklees is good, with a willingness to develop the accommodation and service options to improve the standard and quality of care and support provided, whilst still being mindful of the pressures due to the changes in benefit policy and imposed rent reductions. The range of flexible support packages which are responsive to people living in their own homes which enable greater independence, prevent problems escalating and supports people to maintain their tenancy requires further expansion and will need to also consider supported and sheltered housing options as well as self-directed support options.

3.7 A generic vulnerability support system is in the process of being put in place which will support the ability to enable individuals to remain in their own homes and avoid hospital admission. Work is also ongoing in developing how this will link in with the ‘Early Intervention and Prevention’ work ongoing within both the health and social care field in Kirklees.

3.8 Whilst there are options for individuals needing sheltered housing options, further exploration and development of this as an accommodation choice would be of benefit, further widening the range of housing options available.

3.9 Some providers are able to offer tenancies with a basic level of support included as part of that offer and purchased through personal budget options. This model could develop further and enable individual’s to purchase and commission their own support services, enabling them to maintain and retain their tenancies and to continue to live within the wider community.

3.10 When considering accommodation needs many people will be part of a family unit and the needs of that family are an important consideration, not only for the support they offer, but also to meet their needs individually and as a unit. Inadequate or inappropriate accommodation has been identified through the assessment process and can lead to poor mental health and stresses on that family unit, and this needs to be considered as part of future available accommodation options.

3.11 Kirklees Shared Lives (provided by Kirklees Council) is a flexible and unique arrangement where approved and registered carers offer day support, short breaks or provide a long term home for someone to whom they are matched for compatibility.

Day Support is provided in the carers home or the carers home can be used as a base for accessing community activities

Short breaks can be for an overnight stay, a weekend or longer. It allows family carers to get the break they need and the person using the service has opportunities to have new experiences when staying with their matched Shared Lives carer

15

http://www.nhs.uk/conditions/social-care-and-support-guide/Pages/care-programme-approach.aspx

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Long term arrangements are an option that gives a person the opportunity to live with a matched carer in an ordinary household in the community

Kirklees Shared Lives has historically been an under-used alternative compared to the use of such schemes by people experiencing mental health problems nationally. More recently Kirklees Shared Lives has been providing arrangements to people experiencing mental health problems in line with the national average, but if its use could be developed further it would offer another choice for individuals and their families.

3.12 Good advice is also key where individuals are in accommodation and because of their mental health problems may need support around maintaining this, whether rented or privately owned. Options are available in the area, but consideration needs to be given as to how interventions can be made earlier so that people do not reach crisis point and the risk of losing accommodation is counteracted by making the availability of advice more accessible and timely and supports individuals where there may be issues such as eviction, homelessness, rent / mortgage arrears etc. We will continue, with our partners, to embed and strengthen our approach to preventing the risk of homelessness through good quality advice and innovative, more joined up, ways of working.

3.13 In order to support the current accommodation requirements identified above and to develop and improve this for the future we need continue to better understand the needs of Kirklees residents and develop a longer term view which takes account of this, but which is also mindful of the increasing financial pressures and challenges being experienced across the sector in meeting peoples housing needs, given the rising population and reducing number of affordable homes and for individuals and families themselves.

3.14 The following diagram (Fig.1) details the range of accommodation options currently available, along with future commissioning intentions to support the range of needs identified by people using services, carers, providers and care managers.

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Fig.1 Range of Accommodation Options to be Commissioned

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4. THE VIEWS PEOPLE HAVE ABOUT HEALTH & SOCIAL CARE SUPPORT

4.1 This strategy relies heavily on national and local mental health policy and evidence to inform commissioners of the direction and needs of people using, or who may use services in the future. The identified areas shown below provides a summary of the views of people and policy and guidance:

• People will want to be co-productively supported into their own self determined solutions

• People want support as early as possible to avoid problems getting worse

• Solutions within neighbourhoods are the preferred option

• Support provision is best trusted where it has its roots in localities and GP surgeries

• Community networks are preferred

• Self-directed support will influence the choices people make

• Peer support has a good evidence base

• Provision will be able to deliver social return on investment

4.2 From a commissioning perspective we want to align the future potential activity with the evidence base demonstrating what works. Accommodation is not the complete picture, and to support individuals in their recovery and wellbeing people express a number of areas which are needed to compliment and assist in them maintain their health and accommodation needs. These are:

• Suitable accommodation

• Supportive social relationships

• The avoidance of isolation and loneliness

• Valued day time activity and ‘out of hours’ support

• Independent advice about support options, including education and training

• Advocacy

• Paid work and access to advice about self-employment

• Job retention

• Access to physical activity

• Advice about practical day to day living

• A realistic view about recovery

• Safe neighbourhoods and personal safety

• Opportunities to contribute positively to the community in which they live

• Informed and evidenced based treatment

• Access to emotional support and wellbeing

• Crisis support

• Physical health care

• The absence of stigma and discrimination

4.3 Community provision from health, housing support services and social care to support people to remain in their accommodation and manage their mental health will need to be in place to support people through short or longer term needs. There may be periods when due to an individual’s

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health needs an admittance to hospital, or into a period of respite care may be necessary and the role community provision and support plays in this is key to maintain an individual’s accommodation needs by working with them to support them both into and out of such support.

4.4 This strategy supports the Care Closer to Home agenda which is the vision for the development of integrated services across Kirklees, summarising the benefits that patients and their carers will see and the on-going work to integrate health and social care services within Kirklees. This work supports the national direction of travel which is to increase integration both in the commissioning and provision of health and social care, the introduction of the Better Care Fund being an enabler to support this. The case for better integration is compelling, as there is a growing evidence base that outcomes for managing crisis at home are better than admission to hospital and that home based services are both safe and effective where they combine health and social care.

4.5 The overall ‘Kirklees All Age Joint Mental Health Commissioning Strategy 2012 – 2015 supports the provision of these services and this accommodation strategy.

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5. COMMISSIONING IMPLICATIONS

5.1 There are a number of implications for the commissioning of accommodation based services for people with mental health problems in Kirklees, many of which have been mentioned throughout this strategy and which will have impact on service users and their carers as well as for service providers. These will present challenges, but with aims to improve the accommodation options across Kirklees we should begin to see a better range of support options.

5.2 The future support of those people with low level needs who do not meet social care funding criteria also needs to be understood, particularly in the light of the Council’s responsibilities under the Care Act.

5.3 Many of the implications focus on the gaps in current options and how we can create solutions to improve and fill these gaps to meet the needs of service users. This strategy will aim to move forward and improve on the current position through planning and service developments over the coming years.

5.4 In order that the strategy does indeed move forward to improve the accommodation needs of people within Kirklees an ‘Action Plan’ will be developed, based around strategic objectives, and will be monitored through feedback to the Mental Health Partnership Board, or any successor arrangement.

5.5 To enable the effective implementation of the action plan and to report on progress to the Mental Health Partnership Board a project group will be required to be set up. This will consist of members from the local authority, the 2 CCG’s, SWYPFT, LA housing and the private and voluntary sectors and will also include service user and carer representation. At times other members may become a necessary part of the group, dependent on work streams.

5.6 The detail on the commissioning implications can be found in Appendix One – Moving Forward - Commissioning Implications & Improvement. This will form the basis of the developing ‘action plan’.

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Appendix One – Moving Forward - Commissioning Implications and Improvement

Suitable Accommodation

• There is a lack of appropriate and affordable accommodation that meets individual's needs in 'ordinary' settings

• Housing needs to be recognised as part of a recovery pathway to improved health, resilience and wellbeing with better individual outcomes

• 'Out of Area' options may be preferable in some circumstances

• National evidence suggests that the lack of appropriate accommodation results in delayed discharge

Housing Support

• Support available needs to be timely, flexible and responsive avoiding increases in escalation of care needs and hospital admittance and improved confidence in ability to live in the community

• A 'vulnerability' service to support people with low / moderate needs is not available

• There is a lack of supported accommodation of all types

• Good information sharing between the individual, provider and care management is needed to fully involve the individual and aid their recovery

Specialist Provision

• Improved offer needed for those with complex needs or offending history which may include small scale 'residential' provision

• There is potential for 'Shared Lives' to offer some people a small family based long term living experience

• 'Out of Area' placements may sometimes be an appropriate solution

Best Value

• Placing in local / community provision will provide best value, in most cases, both financially and in an individual's recovery

• Developing the market to fulfil the gaps in accommodation locally will offer savngs and potential re-investment

Housing Advice

• Good quality advice about housing options, benefits and discrimination arising from disability (Equality Act 2010) ensuring compliant access will be needed both from independent and statutory provision

• Changes to benefits will have an impact on people with mental health problems

Personal Budgets

• Personal Budgets offer an opportunity for people to tailor their support to specific needs

• Providers will need to be clear on their charges as more people choose to buy their own support

• A Peer Brokerage pilot will assist people in finding appropriate support to meet their needs, offering choice

Suitable Accommodation

• A wider choice of options in ordinary settings is available

• Work will be undertaken with exisiting housing providers to deregister or decommission and move towards a more suitable offer

• Reduce the number of placements made 'out of area', whilst recognising that for some this may be the most appropriate option

• See a reduction in delayed discharges through improvements in accommodation options and timely availablity

Housing Support

• More suitable, community based supported housing options will be available

• Increased confidence of service users and carers in ability to live in the community will be measured through developing outcome models

• A 'vulnerability' service to support people with low / moderate needs will be in place

• The introduction of Care Act duties will seek to improve advice on care , support and housing to individual's and their carers

Specialist Provision

• Work will be undertaken with exisiting providers to improve the offer for those with complex needs or offending history

• Further development of the options available for those with complex needs or offending history will be taken as apporpriate

• Continued development of shared lives placements will increase the available offer

• Reduce the number of placements made 'out of area', whilst recognising that for some this may be the most appropriate option

Best Value

• Local placements will improve the outcomes and recovery of individual's and support carers

• Financial value will be achieved through more local placement, both for the LA and NHS as well as individual's and their carers

• Market awareness of need within Kirklees will be highlighted through market position statements and mental health strategy and accommodation documents

Housing Advice

• The introduction of Care Act duties will seek to improve advice on care, support and housing to individual's and their carers

• Good benenfit advice options will be required which support people with mental health problems in a timely manner and contribute to their continuing and / or improving mental health

• Good quality advice about housing options will be available through Housing Solutions Service and voluntary providers

Personal Budgets

• Increases in the use of personal budgets will offer more control and creative solutions for individuals

• Increased use of personal budget options will aid in an individuals recovery and reduce the requirement for specialist mental health support

• The range of service offers availabe in the area to support people's choice will increase through the further development of 'Connect to Support' and the potential for 'micro-commissioning'

• A review of the pilot peer brokerage service will determine commissioning intentions for this service into the future