Item 8 – Appendix 1

Joint Commissioning Team Mental HealthAccommodation Strategy 2008 - 2011

Final Draft

Adult Mental Health

Hertfordshire Accommodation

Strategy

2009 - 2013

Contents

Section / Title / Page
Definitions / 3
Vision / 5
Introduction / 5
Key Aims and Objectives of the Strategy / 7
Eligibility for Specialist Mental Health Accommodation / 8
Safeguarding Vulnerable Adults / 10
A Total System Approach / 10
The National and Local Context / 12
Historical Perspective to Specialist Mental Health Accommodation / 13
Recent Trends in Mental Health / 15
Supply and Demand / 18
Housing Related Support in Hertfordshire / 19
Matching Supply and Demand for Specialist Accommodation / 21
Alternatives to Acute Inpatient Care and Step Down Accommodation / 22
14 / Finance and Unit Costs / 23
15 / Property / 24
16 / Cost for the Provision of Care / 25
17 / Communication Strategy / 27
18 / Strategic Objectives and Action Plan / 29
19 / Review / 30

Appendices

Title / Page
A / Data on Supply and Demand / 30
B / Action Plan / 31
C / Mapping of Services / 34
D / Hospital Beds in the Community / 42
E / Supporting People Commissioning Paper / 43
F / Fair Access to Care Eligibility Matrix / 51

Definitions

1. Specialist Adult Mental Health Accommodation

Eligibility for specialist mental health accommodation is dealt with in section 10

1a. Supported Accommodation. Supported accommodation is defined as accommodation at a specific address, where support and care are offered to meet the day to day needs of the resident. The period of residence is variable and can be long-term.

The property at which the care and support is offered is available only to a person that is eligible for care and support. The property will be managed by a housing association, Voluntary / charitable organisation or private provider and care support provided by the managing provider or another organisation..

The average level of support will vary according to the setting:

  • Group Homes – 2 or 3 people share a house and receive up to 5 hours support per week from visiting care workers.
  • Independent low support flats - up to 5 hours support per week from visiting care workers.
  • Independent high support flats – staff on site, available as required and offering high levels of daily support

1b. Rehabilitation is defined as a property with a specific number of beds and 24/7 staffing on site, delivering a structured rehabilitationprogramme for a period of up to 2 years.The property could be managed by a housing association, Voluntary / charitable organisation or private provider and care support provided by the managing provider or another organisation.

1c. Long stay/residential is defined as accommodation in a specific home with 24/7 staff on site and offering full daily care including the provision of some, or all, meals. The period of residence is usually long-term. Many of the homes are registered care homes however some have been de-registered and therefore detailed as supported accommodation.

  1. General Needs Accommodation.

2a. General Needs Housing is defined as rented accommodation that is of a suitable size for the number of people who will be resident in the house, flat or maisonette. Residents apply for general needs housing to the local housing provider and are prioritised for nomination for a dwelling according to local authority eligibility criteria

2b. Homeless accommodation is defined as temporary accommodation thatismade available in a local area. Homeless accommodation can be in bed and breakfast or in homeless hostels or in any other dwelling defined as available for homeless people by the local authority.

2c. Privately owned accommodation is defined as owner occupied or shared ownership

Adult Mental Health

Hertfordshire Accommodation Strategy

  1. Vision

1.1.To recognise residents of Hertfordshire with mental ill-health are first and foremost ordinary citizens who do not wish to be marginalised or excluded in any aspect of everyday life

1.2.To recognise the provision of affordable, decent quality, adequately supported accommodation is a key factor in helping people with mental ill health achieve the highest degree of independence and social inclusion.

  1. Introduction

2.1.The objective of this strategy is to ensure people with mental ill-health are able to appropriately access general needs housing but also have access to a range of specialist mental health accommodation when this is required.

2.2.The strategy concentrates on accommodation that is required for people with mental ill-health in permanent or medium to short-term accommodation.

2.3.The strategy will deliver on the need for both crisis and step down accommodation as Identified by the Investing in Your Mental Health programme. The strategy will look at current models that have a proven outcome and evidence base.

2.4.For any strategy to be successful there must be agreement and commitment by all stakeholders. The strategy should be based on evidence which should identify the major changes required

2.5.The Adult Mental Health Accommodation Strategy is based on evidence gathered and is written following discussions with representatives of:

  • Viewpoint
  • Carers in Hertfordshire
  • 10 District/Borough Councils
  • Registered Social Landlords (RSL) Sub Regional Group
  • Other local RSLs
  • Hertfordshire Partnership NHS Foundation Trust
  • Supporting People
  • Adult Offenders Project Group

2.6.Evidence presented in a 1999 Sainsbury report identifies that the largest percentage of people with mental ill-health prefer to live independently within the community. There are, however, many who live on their own, or are homeless, that are vulnerable and, due to mental ill-health, require a period of time in a supported or rehabilitation environment.

2.7.Living in a supported environment at a time of vulnerability due to mental ill-health enables most people to achieve levels of confidence and independence and as a result be able to make the transition to independent living.

2.8.For a minority of people with serious mental illness the transition to independent living may not be possible due to the nature of the illness. In such situations access to specialised accommodation in a long stay/residential setting is essential

2.9.This strategy identifies how access to a range of accommodation can be achieved by 2012 to ensure residents of Hertfordshire with mental ill-health can access appropriate accommodation to meet their needs.

2.10.The strategy is agreed following the consultation and agreement of:

  • Strategic Commissioning Group (SCG)
  • Joint Commissioning Partnership Board (JCPB)
  • Supporting People Commissioning Group
  • Stakeholders as identified in S2.4 above
  1. Key Aims and Objectives of the Strategy

3.1.To work closely with all stakeholders, including service users, local councils, Supporting People, Hertfordshire Partnership NHS Trust, Adult Offenders Accommodation Project and Registered Social Landlords (RSLs) ensuring they are adequately represented on the Joint Commissioning Team Mental Health Accommodation Steering Group. The Steering Group will agree and deliver on an Action Plan arising out of this strategy. Section 18

3.2.To ensure the Mental Health Accommodation Strategy dovetails with national priorities and other relevant local strategies such as Supporting People and Adult Offenders Strategies.

3.3.To set priorities for action to ensure that by 2012 people with mental ill health will have as greater a choice as possible over where and how they live.

3.4.To plan for the future in partnership with housing providers ensuring the range of accommodation provision is based on what people need now and will also cater for future needs.

3.5.To ensure that the supply and demand for all types of specialist accommodation and rehabilitation is monitored and that the data is analysed, at regular intervals of no less than bi-annually.

3.6.To re-configure existing specialist accommodation according to demand and taking into account current trends in demand.

3.7.To develop local crisis accommodation in line with the IIYMH programme. Such accommodation will provide a positive and short term alternative to admission to acute care.

3.8.To develop step down accommodation aimed at those service users who no longer require the level of care and treatment that an acute setting provides and have no viable alternative accommodation. Such accommodation will be short term and focused on allowing any individual to move on to more stable and appropriate accommodation.

3.9.To ensure the needs of Hertfordshires BME are addressed and fully included in the development of supported housing opportunity.

3.10.To ensure that the accommodation needs of Mentally Disordered Offenders and those leaving prison with mental ill-health are taken into account within this strategy.

3.11.To ensure a comprehensive communication strategy is in place and that this strategy dovetails, and does not overlap, with other similar working groups within Adult Care Services or housing providers.

3.12.To ensure the Action Plan agreed to deliver the strategy is reviewed at annual intervals taking into account data collected in regard of supply and demand.

  1. Eligibility for Specialist Mental Health Accommodation

4.1.People eligible for specialist mental health accommodation are adults, over the age of 18 years, suffering from a functional mental illness and being managed within the appropriate care planning process

4.2.During the next 2 years Enhanced Primary Mental Health Teams will be developed within Hertfordshire and it is envisaged referrals for specialist low support accommodation may be generated from this source if the person is eligible for social care services.

4.3.HPFT work within parameters of eligibility dependent upon the type of specialist accommodation resource required. Details are as follows.

4.4.All services provided within the Fair Access to Care requirements will be subject to the local authority charging policy, this is inclusive of supported accommodation.

4.5.Continuing Care 100% Health Funded Care

  • Residents registered with a Hertfordshire GP.
  • Adults over 18 years of age
  • The criteria for qualification for fully funded NHS care is explained in the National Framework for Continuing Care introduced on 1 October 2007

4.6.Eligibility for Registered Care Home (or long stay in the private sector)

  • Adults over the age of 18 years and a resident of Hertfordshire
  • Eligibility for social care services is determined by Department of Health guidance “Fair Access to Care Services (FACS)” and is a national requirement.
  • Currently social care services in Hertfordshire are provided to people whose needs are identified as being within the critical or substantial risk bands.
  • Applications for a registered care home or a long stay home should show evidence that all other options for care have been explored and tried
  • The service user should be managed on CPA or SAP (Single Assessment Process)

4.7.Eligibility for Specialist Rehabilitation Placement

  • Within Hertfordshire rehabilitation is available in both health and social care settings. Dependent upon setting of the rehabilitation applicants for a health setting would be required to meet the conditions set out in Section 10.2 and for a social care setting Section 10.3 above

4.8.Eligibility for High Support Independent Accommodation

  • The service user must be a resident of Hertfordshire over the age of 18 years
  • When the service user is eligible for social care services (FACS) in the critical or substantial band
  • When the service user is managed on Enhanced Level or SAP

4.9.Eligibility for Group Homes and low support Independent Flats

  • The service user must be a resident of Hertfordshire over the age of 18 years
  • When the service user is eligible for social care services (FACS) in the critical or substantial band (See appendix G)
  • When the service user is managed on the Care Programme Approach
  • Applications for all types of supported accommodation can be made for people over the age of 18 years with functional mental ill health

4.9Recommendations

Clear social care review processes to allow for the monitoring of Fair Access to care Eligibility and the potential to support individuals through the care pathway.

  1. Safeguarding Vulnerable Adults

5.1The strategy must ensure that the following Safeguarding values are delivered by all stakeholders and service providers. As such all stakeholders and service providers agree to adhere to the principles and statutory requirements of the Safeguarding procedures.

5.2Commissioners and contract mangers will ensure that services uphold 5.1 above and monitor both understanding and use of the procedures with individual services.

All agencies and service providers must work within the law and must not

support or condone abusive behaviour to vulnerable adults. Where abuse isoccurring or believed to be occurring then staff must pass their concerns on toa responsible person and the Safeguarding Adults from Abuse procedureshould be followed.

Public agencies and services providers have a responsibility to protect

vulnerable adults from abuse. All those making a complaint or allegation or

expressing concern, whether they be staff, service users, carers or membersof the general public should be reassured that they will be taken seriously.Reporting bad practice or “whistle blowing” is a requirement for all staff in theLocal Authority, the National Health Services and registered provider servicesunder the National Minimum Care Standards.

Whilst client confidentiality should be respected it should not override all otherconsiderations. There will be occasions when it will be necessary to shareinformation with the police and other agencies to protect the vulnerable adultand others.

  1. A Total System Approach

6.1.Planning for any change requires a whole system approach and this is essential when considering accommodation issues. All stakeholders should have an interest in ensuring the strategy will be able to deliver on set targets.

6.2. Stakeholders however will also wish to ensure the strategy complements their own organisations targets. Service users and carers will have personal targets they wish to see delivered.

6.3.This strategy therefore represents a model that is agreed by stakeholders and is focussed upon social inclusion, the appropriate evidenced based re-configuration of existing resources and the development of new resources in order to achieve the vision identified in section 1.

6.4.Below is a model for a Care Pathway. The key goal for stakeholders is to enable service users to move to the greatest independence provided by level 1 and 2.

Level 1

People living in their own home. Able to access Information, Advice and support. / Does not require housing related support or care. Not FAC eligible

Level 2

People living in their own home who require minimum intervention by a floating support style service. / Relevant for Supporting People housing related support. May be eligible for social care funding.

Level 3

People living within own home who require medium level support short to medium term (up to 2 years) / Relevant for Supporting People housing related support and social care support provided via individual budget.

Level 4

People who need specialist accommodation with medium level support and access to support when required. / Relevant for Supporting People housing related support and social care support provided via individual budget.

Level 5

People who require specialist high support accommodation or high support package within own home or rehabilitation programme. Medium term. / Relevant for Supporting People housing related support and social care support provided via individual budget.

Level 6

People who need high support provided by registered residential or specialist high supported accommodation. Medium to Long Term / Possibly relevant for Supporting People housing related support. Eligible for social care residential funding or via an individual budget.

6.5.Essential partners in the delivery of the social inclusion model are:

  • Service users and carers
  • District and Borough Councils
  • Hertfordshire County Council
  • Registered Social Landlords
  • Supporting People
  • HPFT

6.6Recommendation.

A Total System Approach and single care pathway model is formally accepted by stakeholders

  1. The National and Local Context

7.1.The Adult Mental Health Accommodation Strategy dovetails with national and local policies some of which are detailed below.

7.2.National Policies, including the Promoting Mental Health Strategy and the National Social Exclusion Programme, clearly identify the importance of housing and appropriate support for people with mental ill health.

7.3.The Hertfordshire Supporting People Strategy recognises the central role Supporting People plays in addressing homelessness and enabling people to live as independently as possible. Thus contributing to improving the health and well-being of local people, reducing social exclusion and enabling people to contribute and participate fully in their local communities.

7.4.The Hertfordshire Adult Offenders Accommodation Project in partnership with the Supporting People Programme have been charged with leading the development of a detailed strategy for meeting the housing related needs of adult offenders in Hertfordshire.

7.5.District and Borough Councils within Hertfordshire recognise the needs of vulnerable and/or homeless people including those with mental ill health. The councils are currently working together to inform and shape the London Commuter Belt Sub-Region (LCBSR) Housing Strategy which will be delivered in the autumn of 2008. The LCBSR housing strategy will establish the key areas where joint working across administrative boundaries can deliver economic, effective solutions to commonly identified issues. A sub-regional approach has been adopted in tackling homelessness, bringing empty homes back into use, developing more affordable homes, identifying and promoting good practice and achieving savings, by way of joint procurement, where the opportunities arise.

7.6.Recommendation

Ensure the needs of people with mental ill-health are adequately identified within the Sub-Regional Housing Strategy

Ensure that within each District a specific allocation of a number of units for people with mental ill-health are identified when new developments of affordable housing occur

  1. Historical Perspective to Specialist Mental Health Accommodation

8.1.In January 2001 agreement was reached with the Primary Care Trust and Hertfordshire County Council (Adult Care Services) that all secondary mental health services, including social care, would be delivered by a countywide service, Hertfordshire Partnership NHS Trust. The trust gained Foundation Trust status in 2007 and is now known as Hertfordshire Partnership NH Foundation Trust (HPFT).

8.2.Prior to January 2001 mental health services were delivered by four different trusts and this led to services developing in a somewhat piecemeal fashion dependent on local need and available funding.