Contact: Richard Ellis Tel:01962 847284 email:[email protected]

1. Summary

1.1 The purpose of this report is to present an approach to the development of extra care housing within Hampshire.

1.2 Extra-care housing supports the overall aims of Hampshire County Council's strategic direction for older persons. The proposal is that extra-care housing in Hampshire should respond not just to those who have retained most of their independent living skills but should also enable people to have the choice to live in their own homes until the end of their lives thus becoming a real alternative to residential care.

1.3 Extra Care provides a housing solution for people that are unable to remain in their own homes that maximises their independence. It is key to the Adult Services response to the demographic pressures as it represents a most cost effective support option than residential care. Our proposed partnership approach allows us to set the standard and promote the development of extra care housing with a minority investment of capital and land by the County Council.

1.4 These recommendations support the Corporate Strategy in that:

a) Hampshire safer and more secure for all: Extra-care offers older people the safety of care and support available on-site where they live and also the security of tenure that they would not enjoy in residential care.

b) Maximise well-being: Extra Care housing promotes independent living and empowers older people who might otherwise have required residential care.

c) Enhance quality of place: Extra Care housing offers older people a higher standard of personal accommodation than they would be likely to enjoy in residential care and access to a range of excellent communal facilities.

d) This report also fits with the Priority D of the Hampshire Local Area Agreement: Improve access to housing and accommodation, in particular to Action 3: Better use of the existing older persons housing stock and ensuring housing schemes are produced across the county.

2. Recommendations

That Cabinet:

a) Agrees the development of a long term strategic approach to the provision of a new generation of housing support and care for older people. The overall target is to commission 400 additional places in Extra Care Sheltered Housing over a five year period, 2008 - 2013. Four new build schemes will deliver 200 of these places, with the balance commissioned by contracting for and enhancing existing provision.

b) Agrees that 4 new extra care schemes are commissioned in partnership with Hampshire's eleven district councils and the Housing Corporation.

c) Agrees to provide up to £5m capital for investment, approximately 10% - 20% of the total required to commission four new Extra Care Housing Schemes, subject to approval of a site specific business case. The proposed new services will be in Gosport, New Forest, Basingstoke, and Test Valley.

d) Delegates authority to the Executive Member for Adult Social Care to approve each development upon presentation of a site specific business case developed in consultation with County Treasurers, Property & Business Regulatory Services, Legal services and District Councils, where appropriate.

3. Background

3.1 Extra-care housing is a modern housing model designed to meet the demographic needs and aspirations of older people in the 21^st century. In Extra Care people either rent, own or part-own their own flat or bungalow within a scheme of similar units. Extra care ensures inter-agency care and support are provided, 24 hours a day, on site, in accordance with people's assessed needs. There are communal facilities where people can participate in activities as part of the wider well-being agenda.

3.2 Extra care sheltered housing will provide an improved model of support and care for many people who would other wise have been supported in residential care homes.

3.3 The County's aspiration is very ambitious: working in partnership with district councils and independent sector providers, the County will produce the best possible models of housing care and support, comparable to any service in the country. The development of new build schemes will set the standard for extra care and promote independent development of extra care by signalling a clear commissioning intent for the future.

3.4 The Hampshire County Council Capital Strategy 2007 confirms the intention to work with partners to develop projects which will increase the supply of high quality extra care housing throughout the County through a combination of remodelling existing sheltered housing schemes and new build developments.

3.5 The County Council wishes to ensure that older people in Hampshire have the very best range of options from which to choose in order to meet their housing, care and support needs. Currently older people are able to choose from a range of options which includes sheltered housing, day care, domiciliary care, residential care and nursing care.

3.6 Extra Care Sheltered Housing adds a new option which will meet 21^st century expectations in terms of quality and choice and may also provide new day-care activities/ opportunities as part of the wider scheme. Older people have the opportunity to ensure their care and support needs are met whilst retaining their independence, their "own front door". For the majority, the quality and design of the accommodation and the availability of care and support on site will ensure that they will be able to remain in their chosen home for the rest of their lives.

3.7 Demographic projections indicate there will be significant growth in the over 85 population of approximately 23% in the coming decade, placing a potential increased burden upon Adult Services budgets. Extra Care sheltered housing provides a modern and highly cost effective alternative for many of these people who may otherwise have been supported in residential care.

3.8 This is a shared agenda with District Councils. Many local authorities and Registered Social Landlords face difficulties as their sheltered housing stock is out of date, inaccessible and often poorly located. Extra Care is seen as a modern alternative to sheltered housing as well as residential care.

3.9 Increasing the supply of Extra Care is a national trend which some authorities have developed to great effect. The White Paper, "Independence, Wellbeing and Choice" promotes Extra Care Housing as good practice. Hampshire intends to learn from the experiences of others and utilise the skills of a nationally known specialist housing care and support consultancy.

3.10 Hampshire County Council seeks to be ambitious: to work with partners in the District Councils to produce the best models of housing, care and support, comparable to any provision in the country. Through the development of high quality new build schemes the standard will be set for the market, signalling a clear commissioning intent for the future.

3.11 There are two essential characteristics to Extra Care sheltered housing:

a) All new build developments must be fully accessible to all people, including wheelchair users

b) Care services must be available on site 24 hours a day, seven days a week

3.12 Extra Care housing is a cost effective housing model where people may rent, own or part-own their own apartment or bungalow within a scheme of similar apartments. A tenancy or leasehold agreement ensures their security of tenure. Whatever the tenure extra care sheltered housing apartments will primarily be funded to be affordable social housing.

3.13 Extra care services provide an opportunity for independent living supported by flexible care arrangements which cater for a range of care needs. This enables a balanced scheme that is able to cope with higher levels of need than sheltered housing and also maintains a vibrant community.

3.14 Residents have their "own front door" and personal space in a self contained one or two bedroom private apartment linked to a range of communal spaces.

3.15 Extra care services offer a higher quality of life to older people living in their own homes. Residents, are not isolated but are part of a community that they can help to shape.

3.16 New services may provide the opportunity to develop services for community use, such as day care and drop in services.

3.17 Extra care provides a cost effective commissioning alternative to residential care as it can attract alternative capital and revenue funding streams.

4. Focus on Local Planning

4.1 The overall target is to produce 400 new places in Extra Care Sheltered Housing over a five year period, 2008 - 2013. Two hundred places will be developed in four new services; each scheme will provide approximately 50 apartments of accommodation.

4.2 Existing sheltered housing can provide short and medium term extra care solutions as part of a detailed local housing plan for older people. A plan for each district will be developed as part of the Supporting People Strategic Review of Older Persons services, to be completed by May 2008.

4.3 For capital investment to be approved, or "drawn down" a detailed business case will be presented for approval to the Executive Member for Social Care. Each business case will include details of consultation with District and County elected Members and local residents, demonstrate need, value for money, revenue and capital implications, and include impact and risk assessments. Other issues such as nominations, the balance of tenure and referral routes will also be addressed.

5. Progress Made

5.1 Discussions are taking place with providers and local authorities within Hampshire to establish partnerships and a development timetable. There are opportunities to develop schemes in several areas of the County. Early results of commissioned needs analysis suggests that the priority areas will be Gosport, Basingstoke, New Forest and Test Valley.

5.2 The most advanced proposal is located in Gosport, an area of the County with a high level of unmet need in terms of a lack of provision. Gosport Borough Council is working in partnership with a registered social landlord to develop a high quality service consisting of 50 apartments (a mix of one and 2 bedroom apartments). Plans include an excellent range of ancillary services and communal spaces. The scheme will be developed on the site of existing sheltered housing. Consultation has been undertaken with local residents with positive feedback and it is hoped that planning consent will be given by November 2007.

5.3 A contribution of £750,000 from Hampshire County Council (equivalent to the contribution to be made by Gosport Borough Council) will ensure the scheme is financially viable, secure nomination rights for the County, greatly increase the chances of securing Housing Corporation capital funding and ensure that a quality range of ancillary services are retained as part of the development and available budget.

5.4 A potential site is available in Basingstoke. A planning brief for the whole site is currently being prepared by the Director of Property Business and Regulatory Services for consultation. The next step would be to select a suitable Registered Social Landlord as a partner. The use of Hampshire County Council land could therefore create the opportunity to make extra care housing a possibility. This model will be discussed with other District Councils.

5.5 In the New Forest, discussions have been held with the District Council. Current investigations into sheltered, extra care and residential provision in the Lymington area suggest that there is already significant provision of accommodation provided by the County Council, District Council and the private sector. There is however an opportunity to upgrade existing sheltered accommodation closer to extra care models. Discussions are continuing with the district council regarding a potential new development on one further site .

5.6 In Test Valley discussions are taking place relating to 2 potential sites.

5.7 Discussions have already been held with the Housing Corporation regarding plans to establish a funding partnership over the next five years and beyond. Initial indications are positive and include encouraging signs regarding the availability of funding to support partnership based initiatives.

5.8 This project is a complex and multifaceted with extensive support and input being provided by many County Council departments. These include Legal Services, looking at nominations agreements, Property Business and Regulatory Services, looking at potential sites for development, Planning, ensuring that Extra Care is integrated into the local planning systems, and County Treasurers, building the business cases for developments.

6. Value for Money - Capital

6.1 Extra Care offers a popular best value alternative for older people. This is evidenced from around the country in areas where Extra Care has already been developed where all provision is in high demand.

6.2 In capital terms the percentage of development costs required of Hampshire County Council is a small percentage of the total.

6.3 Current estimates indicate that a contribution of around 10 - 20% of the total cost will be required of Hampshire County Council. The actual investment required will be determined on a case by case basis and will be examined in each business case.

6.4 Capital finance sources for the majority of Extra Care Housing schemes where there is a large social rental element, include :

· Social Housing Grant, provided by the Housing Corporation

which can be accessed by Registered Social landlords

· Department of Health Grant which is available to Social Services

Authorities (currently there are no funding opportunities available from the Department of Health)

· Private finance in the form of a mortgage (or similar loan

mechanism) taken out by the Registered Social Landlord partner in the development which is repaid by the rental income from the apartments

· Contribution of land and/or buildings from one of the partners

involved in the development such as a land contribution by the district council or county council

· Capital can also be generated through the sale of Extra Care

apartments in mixed tenure development; a percentage of apartments will be retained for rental and the remainder are sold on a variety of differing bases including shared ownership.

6.5 An example of approximate indicative development costs and sources of finance is shown in the table below:

Capital cost	Total cost        £
Land	780,000
Build	6,200,000
Project costs ( on costs )	930,000
TOTAL	7,910,000

Financed by	£
Supported Housing Grant from Housing Corporation	3,770,000
Value of land provided by e.g. Local Authority	780,000
Long term loan ( Registered Social Landlord mortgage to be repaid by rental income )	2,610,000
Hampshire County Council Funding contribution	750,000
TOTAL	7,910,000

7. Value for Money - Revenue

7.1 In revenue terms, Extra Care is more cost effective than residential care

or domiciliary care as the model attracts a wider range of funding sources. Additional available funding sources include Supporting People Grant to fund housing related support costs and Housing Benefit which will help to pay rental costs (where a service user qualifies under financial assessment regulations). Neither of these funding sources are available to fund an individuals housing support and care costs in a residential care setting.

7.2 £700,000 annual revenue has been made available by the Supporting

People County Core Group for the housing support element of the service.

7.3 Value for money is also achieved through economies of scale. Extra

Care schemes are likely to provide approximately 50 apartments of

housing care and support. Many of the flats will be for more than one person. This is considerably cheaper to provide than domiciliary care due to the economies of scale and delivery within a defined area.

7.4 Capital and revenue funding analyses are best made on a case by case basis. It is therefore proposed that individual business cases are developed in relation to each proposed development to ensure a thorough assessment of value for money, strategic fit and evidenced.

7.4 It may be decided that extra care accommodation should be provided to

those already in receipt of a care package in which case additional revenue funding required of Hampshire County Council Adult Services would be nil or in many cases a direct saving to the department because of the economies of scale available within the extra care model of service.

8. Financing the development programme

8.1 A commitment is sought from Hampshire County Council to provide

up to £5 million of capital funding for investment over a 5 year period, to part fund approximately 400 new places of extra care sheltered housing: By using County capital in this way substantially more capital funding can be attracted from a range of partners including the Housing Corporation, housing providers, the private sector, and others to fund a range of services around the County which will provide a modern cost effective alternative to residential care.

8.2 The County's investment can take the form of capital investment or discounting the value of land and or property to be used to provide a site for development. £1.75m of the funding requirement will be met from the disposal of one of the two residential units that the Executive Member for Adult Services recently authorised for closure. The closure of these units is in accordance with the Adult Services financial recovery and modernisation programme. The proceeds from the other unit have been ring-fenced for improvements in other County Council residential units. The balance will be met from the Adult Services capital programme over the life of the Extra Care programme.

8.3 It is important for the County to invest in Extra Care as, through its investment of 10% -20% of the capital costs and the

building of partnerships, the County will be able to ensure that new services are developed where Social Care service users need them.

8.4 Investment will guarantee that the County can ensure the delivery of the highest level of quality in terms of the built environment and the quality of care and support, will secure nomination rights for the Adult Services Department as part of its continuing interest in the properties and ensure better value for money in terms of revenue costs through providing access to a wider range of revenue funding sources as detailed within section 7.

9. Links with other projects

9.1 This project will link with the development of Telecare services.

Section 100 D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1 Published works

2 Documents which disclose exempt or confidential information as defined in the Act

List below the documents and their location or if there are no background papers, state: None

Appendix 1

The Government view of Extra Care

The white paper, "Independence, Wellbeing and Choice"¹ promotes Extra Care Housing as good practice; specifically, page 52, paragraph 9.10 and 9.11 states:

Extra care housing has been developed to give choice to very frail or disabled people whose care needs might traditionally have been met by residential care. It offers a model which allows people to live in their own homes with a range of facilities and support designed to meet their needs. Extra care housing can also form the basis of a range of intermediate care and outreach services, preventing older people from going into hospital or facilitating the discharge of those who have been in hospital.

In addition, in the green paper Our Health, Our Care, Our Say the Government emphasises its desire to enable people, wherever possible, to remain in their own homes:²

For some people, residential care may be the best option, but we want

to ensure that, wherever possible, people have the option to stay in their

own homes. Greater use of community services including extra-care housing,

intermediate care services, community equipment, intensive support at home

and support for carers, has enabled more people to be cared for closer to

home and to continue to live in their own homes for longer.

As far back as In February 2004, Ministers set-out their commitment to extra care housing. The then Health Minister Stephen Ladyman said:

`Most older people want to stay in their own homes for as long as possible. If they can't stay in their own homes for whatever reason, then they do not want to trade independence for dependence. What they want is to have control over their lives.

Extra care housing offers another choice to the individual; a choice based on security, rights and control. A private home with your own front door but all the support you might expect in a residential home. But it must be more than a housing solution - it must be a community solution which requires the full commitment of housing, health and social care agencies. This desire to offer quality and choice in housing for older people is reflected in the successful bids announced today.

The Government's vision is to improve the range of health, social care and housing choices available to older people. I believe extra care housing will have a hugely important role in making that choice a reality for many older people.'

The Department of Health, together with the Care Services Improvement Partnership³ has set up a Housing Learning & Improvement Network (Housing LIN). This network is the main source of information for commissioners of housing with care. The document Developing and implementing local extra-care housing strategies was commissioned by the Housing Learning and Improvement Network (LIN) as part of the Health and Social Change Agent Team Programme within the Department of Health. It complements a number of other documents that have been produced as part of the Housing LIN programme of work and development, and is designed to help authorities develop a strategy with regard to Extra Care housing.