Archived decisions

Name:

Best Value Review of Mental Health Services: Residential Care & Housing with Support

Purpose:

· To ensure there is a range of residential care & housing with support available to meet the assessed needs of people with severe and enduring mental health problems

· To develop in partnership with Health & Housing agencies, safe, high quality housing with flexible care & support in the local community which promotes independence

· To ensure that Residential care, which is needed to meet some specialist & complex need is close to home, optimises quality of life, is regularly reviewed

· To meet legal duties & guidance under NHS & Community Care Act 1990, National Care Standards Act 2001, National Service framework for Mental Health & Supporting People agenda

· To achieve meaningful involvement & outcomes for users & carers

Current performance

Hampshire's performance compared to other Authorities in 2000/01 as evaluated by the Department of Health (on a scale of 1 to 5, with 5 being very good) was rated as GOOD (4) in the following areas:

· The unit cost of residential & nursing care (Hampshire fifth lowest unit cost out of fifteen Shire Counties)

· The number of people admitted to residential care (Hampshire second lowest number of placements out of nine neighbouring/comparator Authorities

· The number of people helped to stay in their own home (however there is substantial variation across the county with less housing provision & community services resulting in higher numbers of placements in residential care)

All Residential & Housing with Support services are provided through the private or voluntary sector

· Few Providers are available with an even smaller number who can meet specialist need

· There is significant cost variation which reflects the high level of need & local market conditions (e.g. high cost of care in north Hampshire)

· A quarter of total placements are `out of county' but the vast majority of these are located in neighbouring authorities

· The numbers of placements in Registered Care is relatively low

· Cost

· The mental health residential spend is a relatively small proportion of overall Departmental budget and in 2002/3 amounts to £2.4 million, 31% of total budget

· The cost of residential care for adults with mental health problems is substantially lower that for other adult groups

· A steady rise in costs is apparent as services focus on people with specialist & complex needs which are costly

The results of Consultation indicate the following

· Service users want independent accommodation with appropriate flexible support in the local community

· There is still a need for some Residential care particularly in meeting specialist & complex needs

· Some areas have low usage of registered residential care and high community support & services (e.g. Eastleigh/Romsey)

· There is a range of provision across the county with gaps in some services at local level

· Fifty percent of all placements are within the weekly Hampshire rate

· Seventy four percent of placements within county with the vast majority of out of county placements being in neighbouring authorities

Areas for improvement include

· The need to improve user & carer involvement

· Training to improve housing practice in mental services

· Access to specialist accommodation in all areas

· Each area needs access to a wider range of provision

· Partnership working with Health & Housing agencies needs developing particularly to meet specialist & complex need

Proposed improvements and how they will be achieved

Improvement required

· The full range of residential & housing with support services will meet need (including those of specialist groups) in each locality and comply with national/quality standards

Achieved by

· Social Services & Housing joint working and funding to provide local community accommodation and support services

· Mental health Local Implementation Teams (LIT's)developing needs analysis & priorities and implementing action plans for each area

· Training & information for staff on housing assessment & resources within Care Programme Approach (CPA) framework

· Development of Adult Mental Health Information System to help identify resources, in met need and prevent & manage crisis situations and train staff appropriately

· Robust contract monitoring of registered care to ensure needs of specialist groups and national standards are met

Improvement required

· The planning process will involve Health, Housing & Social Service and users to meet the specific mental health agenda and make best use of the available funds

Achieved by

· Users & carers involved in LIT's and specific housing developments

· LIT's to identify a local system & a lead officer to develop Housing Inclusive Forms in each area & local `move on' panels

· Maximise the use of Transitional Housing Benefit (THB) through the `deregistration' of social landlords and use the funds to create new services in the community to reduce need for high cost residential placements

· Develop joint Health & Social Services commissioning to purchase specialist accommodation

Improvement required

· Development of joint recording systems of information & framing for operational & strategic staff to ensure good housing practice and management information exists

Achieved by

· Securing multi agency funding and developing joint training covering: housing; assessment & resources; basic benefit entitlement; employment issues; risk assessment and developments in Supported Housing

· Delivery of training to professionals and LIT's.

· Improve recording of need, resources & financial information using CPA process and in time the Adult Mental Health Information System

· Using CPA Audit to ensure Housing needs assessment & review are routinely undertaken

· Consider the use of Specialist Housing Workers attached to Community Mental Health Teams (CMHT's) to give expert advice for individual housing needs

Conclusion

Whilst Hampshire has been relatively successful in preventing admission to mental health residential care and thus helping people live in the community, the findings of this Best Value Review identify several areas for improvement as identified above.

The integrated nature of mental health services, having partners in the Health Service, Supporting People, Housing Sector, Providers and working in consultation with users & carers reinforces the fact that Social Services need to work with their partners to achieve the identified outcomes. Therefore, implementation of the action plan & improvements in mental health services generally is contingent upon robust partnership agreements, including joint working and joint funding arrangements