A Supported Step Towards Independence

A Supported Step towards Independence

Mental Health services

The underpinning vision for all mental health services in Glasgow is that they will operate in line with the principles of recovery, which is defined by the Scottish Recovery Network as follows:

“Recovery is being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms. It is about having control over and input into your own life. Each individual’s recovery, like his or her experience of the mental health problems or illness, is a unique and deeply personal process.”

In line with this,the Glasgow HSCPexpect that all parties accept that Supported Accommodation is not a “home for life” and should work towards greater independence and eventual move on. Supported accommodation is there to support people to achieve outcomes that are important to them and to assist people to transition to more independence.

In general terms, accessing a supported accommodation placement should be a planned part of a service users’ recovery but in reality there are times when unpredictable events occur and unplanned placements are required. Guidance is now included on how these situations will be managed via SARA.

What is the Supported Accommodation Resource Access (SARA)?

SARAis an online process that gives individuals who have been assessed as requiring supported accommodation, access to these resources.

Who is it for?

The supported accommodation that can be accessed through SARA,is for individuals that have a severe and enduring mental health problem and,as a result,require daily support to live within the community.

In order to be eligible to access this accommodation, an individual must be a Glasgow resident and have a current GGCSW(Glasgow City Council Social Work) Adult Servicescare manager who can undertake a support needs assessment. They must also be willing to accept the financial implications (Appendix 1) that comes with living in supported accommodation and also be ready to move in within 28 days of a placement being offered.

How it works?

There are a number of stages to the process:

Stage 1 Needs assessment- the individual, following asupport needs assessment and with agreement at RAGfrom the service manager, is assessed as requiring supported accommodation.

The care manager is responsible for determining the social care needs of service users in discussion with their team leaders, service users, family members and the wider multi-disciplinary team. As part of local assessment processes some areas also operate a local screening group who

provide early advice to care managers on what social care support is available that would meet the person’s needs, including supported accommodation.Following this,the care manager completes the assessment and then presents to RAG to agree a budget and, if relevant, to get agreement to supported accommodation.

Please note that anyone who is already in supported accommodation and who doesnot require an urgent move to an alternative supported accommodation resource will be required to go through the SNA and SARA process.

Stage 2Presentation to SARA-following this assessment,a referral (see Appendix 2) and presentation is made by the individual’s care manager (with support of colleagues in the individual’s care team) to the SARApanel (Appendix 3) for them to be allocated a priority status (Appendix 4).

Stage 3Vacancy advertising and allocation- After a priority status has been allocated, individuals in group A or B and designated members of their care team, will have access to the online resource hub (Appendix 5a). At this stage,the care manager, theirteam leader or nominated representative from the care team,will be authorised to note interest in any vacancy.

In the event that there are a number of notes of interest for one vacancy, the vacancy will be offered to the service user who has been waiting the longest.

Allocations to service users in group C that are made on the basis of risk and publicprotection will be overseen by the SARA panel. (Appendix 5b)

Allocations to service users in group EXwill be made on the basis of available resource and risk management. These will be overseen by the SARA panel(Appendix 5b)

Stage 4Support planning and move in- the individual who is allocated a vacancy will be notified (via their care manager) within 1 working day of the closing date and a meeting will be arranged between the service user and provider to start the assessment process (Appendix 6).

Individuals who are allocated a placement via the SARA panel will also be notified of the offer via their care manager and they would follow the process outlined in Appendix 6.

What happens next?

Once a service user has moved into supported accommodation the support that it offers will be available for as long as it meets the individual’s assessed needsand is considered by theservice user and the MDT to be an effective placement.

However,as stated above,Glasgow HSCP does expect all parties to accept that supported accommodation is not a “home for life” and should work towards greater independence and eventual move on.

Appendix 1 (Financial Implications)

Registered Mental Health Care Homes

When an adult is entering a registered mental health care home, they will be required to make a contribution to the cost of their placement in the care home. This is known as a client contribution. In order to calculate the client contribution that an individual will have to make, a financial assessment will be undertaken by the local authority.

This assessment will look at all sources of the person’s income and capital, and based on this, a calculation will be made on how much the individual may have to pay towards their care home fees.

All income and capital including benefits - with the exception of Disability Living Allowance (mobility component) which the individual can keep- will be counted in the calculation that determines what the client’s contribution to their care will be on a weekly basis. The local authority will pay the remainder of the weekly cost of the placement.

For those who have transferred from DLA over to PIP (Personal Independence Payment), the care and mobility components are included in the assessment and disregarded in the same way

Whilst residing within a mental health care home, the individual is entitled to retain a weekly Personal Allowance. The current 2017/18 rate is £26.40

Mental Health Supported Living Placements

Whilst residing in a mental health supported living place, the individual will have access to full benefit entitlement but will also be subject to the non-residential Glasgow City Council Charging Policy. All service users will be required to make a contribution to the cost of their service. This is known as a client contribution. In order to calculate the client contribution that an individual will have to make, a financial assessment will be undertaken by the local authority.

This assessment will look at all sources of the person’s income and capital, and based on this, a calculation will be made on how much the individual may have to pay towards their service. The client contribution is calculated in the same way as it would be for any other SDS community support package.

As part of the financial assessment process, the local authority will also ensure that the individual’s income has been maximised at their point of entry to the supported living service by assisting with all relevant welfare benefit applications.

Appendix 2 (Referral Process)

Access to SARA will require the following documents to be available:

Essential

• Service User Profile (SUP)form (completed online)
• Support Needs Assessment (signed off and available via Carefirst)
• RAG Minute (signed off and available via Carefirst)

Where appropriate

• OT assessment (mainly required for people who are in hospital)
• Specialist Risk Assessment e.g. HCR20

These additional documents should be submitted to box, 7 days before the SARA meeting. Timeslots will be confirmed 5 days before SARA meeting.

NB: Timeslots will only be issuedonce the documents have been received or are available on Carefirst.

Appendix 3 (SARAPanel)

Membership of the panel will come from Health and Social Work. The proposed members are as follows:

• Operational service manager (SW Co-Chair)
• NHS bed management representative (NHS Co-Chair)
• Representative from commissioning
• Medic/Clinician
• Social care services co-ordinator

Frequency of meetings: The panel will meet 4 weekly to prioritise referrals and oversee pending allocations to service users who are in priority group Cand group EX.

Delegated authority will be given by the chairs to the social care services co-ordinator and/or commissioning representativeto make placement offers outwith the meetings

Appendix 4 (Priority Groups)

There will be 4 priority groups which are defined below:

Group A: This group is for people who have been assessed via SDS process as requiring supported accommodation

Group B: This group is for service users who are either in hospital, in a placement that is causing concern or are considered to be extremely vulnerable and have been assessed via SDS process as requiring supported accommodation

Group C: This status will be allocated to service users whose needs include a high degree of risk to others, that is associated with their mental health problems and, where there is a high level of public protection concern. However, the panel would reserve the right to allocate priority status C to any service user that there are significant risk management concerns around.

Group Exceptional (EX): This status will be allocated to any service users who are already in supported accommodation and who have,for example, to urgently move as a result of a serious incident or someone whose service is being decommissioned.

Only in urgent situations will moves take place without the service user having been through the SNA process. Once that person has been urgently accommodated a review should be completed within 4 weeks to confirm that this placement is now meeting the service user’s needs and any further moves will also require an SNA review and presentation at SARA in line with appendix 2.

Exceptional status may also be allocated to service users who are in urgent need of supported accommodation and who have not previously been known to mental health Social Work Services. In these cases there would need to be written agreement froma locality Service Manager to waive the SNA process and confirm that supported accommodation is appropriate in the circumstances. Once that person has been accommodated a review should be completed within 4 weeks to confirm that the placement is meeting the service user’s needs and any further moves will also require an SNA and presentation at SARA in line with appendix 2.

To accommodate these service users, risks permitting, SARA will only consider resources that are currently available and that no existing SARA service users have made a note of interest for.

Appendix 5a (Online Vacancy Hub)

The online vacancyhub is for the following service users:

Group A and B’s (Care team/service user choice)

Once a vacancy has been advertised online, it will be available for service users in priority group A and B to note their interest in the vacancy. This note of interest should be done on the basis that the service user and their care team believe that the vacancy will be a good match to their needs.

The advertising of a vacancy will take place once notice has been served that a vacancy will be available. The vacancy will then be advertised for a minimum of sevendays, unless the individual

with the highest priority makes a note of interest at any time in the advertising period. The advert will then be closed and the placement will be offered to that individual.

If no note of interest is received, the vacancy will be advertised until the first note of interest is received.

Following the closing date, the notes of interest will be collated and the placement will be offered to the service user from group B who has been waiting the longest. If no individuals from group B have noted an interest then the service user who has been waiting the longest from group A will be offered the placement.

NB: If more than 2 people have been waiting for the same time, the SARA panel will consider factors such as length of stay in hospital, level of risk, discharge priority and match to available placement. Placement would then be offered to the person who is considered to be the best match.

Appendix 5b (SARA panel allocation)

This allocation process is for the following service users:

Group C

Placements for service users in group C will be made on the basis of the SARA panel matching the needs profile to an appropriate vacancy. Therefore, service users in group C will not get access to the online vacancy hub.

All vacancies will be screened to see if they are a match for any priority group C’s before the vacancy is advertised to the other groups.

Group EX

Placements for this group will be made on the basis ofmental health commissioning and the SARA panel considering the resource that is available and matching the service users’ needs to these as closely as possible. These service users will not get access to the online vacancy hub. SARA will respond to these situations as, and when, they arise.

Appendix 6 (Access to Supported Accommodation – Timescales and Process)

The purpose of this guidance is to set out the revised process and timescales for accessing supported accommodation, following notification that the service user has been allocated a placement. This guidance seeks to set out the various steps in the process and also clarify responsibilities at each stage.

Notification of Referrals

• Notification of a placement offer will be made by MH commissioning to the care manager and Provider within 1 working day of the closing date by a commissioning representative.

Initial Contact (following confirmation of a new referral)

• Providers will have up to 7 days, from date of referral, to make initial contact with the service user’s care manager to initiate pre-admission assessment

Provider Pre-Admission assessment and Lead in Period

• Provider will co-ordinate the pre-admission assessment with the service user, care manager and wider MDT -this period of assessment can last up to a maximum of 21 days
• Provider will advise commissioning of move in date

NB: The initial contact and Provider pre-admission assessment should last no longer than 28 days in total

Trial Period

• At the end of the assessment period, the service user will move in for a 28 day trial period. The funding for the placement will commence on this date and the Provider will make arrangements to collect the client contribution separately
• A review should take place at the end of the 28 day trial period to confirm the placement as permanent

Extended Assessment

In exceptional and limited circumstances assessment periods may go beyond the initial contact and pre-admission assessment period of 28 days. At this point the care manager can submit a request, via MH commissioning, to finance for an extended assessment period. These can only be authorised by head of commissioning and procurement.

Examples of where this may occur are in relation to forensic service users who are subject to Compulsion or restriction orders (CORO), or similar, or where there are risk management concerns that necessitate a longer period of assessment.

Appendix 7 Providers Vacancy Management

Refer toSARA webpage