moving to independent living

108 Pages·2003·0.36 MB·English

REPORT ON MENTAL HEALTH BEST VALUE REVIEW

MOVING TO INDEPENDENT LIVING
This report is dedicated to the memory of Nikki Dakin, MIND Service User
Involvement Worker and member of the Best Value project team who died in
December 2002
MOVING TO INDEPENDENT LIVING BEST VALUE REPORT

INDEX

SECTION Page Number

Section 1 Executive Summary – Introduction 1

Section 2 Recommendations 2

Section 3 Service Improvement Plan & Service 5
Journey Chart

Section 4 Best Value Review - Introduction 10

Section 5 Existing Services 18

Section 6 Key Issues and Influences 25

Section 7 Chalenge 29

Section 8 Consultation 35

Section 9 Comparison & Competition 52

Section 10 Related Projects and Their Implications 70

Section 1 Review Outcomes 7

Section 12 Implementation of Service Improvement 82
Plan

Section 13 Appendices
EXECUTIVE SUMMARY

1. Introduction

The Moving to Independent Living Review was undertaken as part of a large cross-
cutting project under the heading “Caring Harrow” which formed part of the revised
Best Value “Changing” programme launched in 2001. The scope of the review
incorporated the following services:

Harrow Assessment Unit
4 residential units managed by Harrow Special Needs Consortium
6 supported housing projects
4 day care services, including Wiseworks
Floating support services

The project set out to reach an assessment of these services based on their overall
cohesion rather than on detailed analysis of individual service units. The purpose of
this approach was to determine:

a) The efficiency and effectiveness of the service journey* through the health and
social care system experienced by people with mental health problems
b) The extent to which the stages of service journey maximised people’s
independence and social inclusion.

* The service journey and known problems with it is illustrated by Chart 1 which can
be seen after the Executive Summary and again in Section of the report.

Work was undertaken within the Best Value framework of the 4 C’s of Challenge,
Consultation, Comparison and Competition. Challenge and consultation were
initiated through a stakeholder conference and followed by numerous meetings with
groups and individuals.

The work on comparison and competition was informed by the use of national
comparative data, extensive research about best practice and exploration with
benchmarking partners. The project also drew on research commissioned by the
Mental Health Local Implementation Team through the Sainsbury Centre and other
projects.

Partnership working was built into the project firstly through the core team which
comprised Local Authority managers, external providers, service users and a carers’
representative and by the involvement, where appropriate, of managers responsible
for joint commissioning, Supporting People and Housing.
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2. Key Findings and Recommendations

2.1 Communication between different agencies, particularly in relation to
the housing needs of service users needs to be improved in order to
promote independence and prevent homelessness and social exclusion.

¾ Recommendation 1: Early discharge planning for people in the acute unit
with housing to be facilitated by prompt liaison with housing.
Resource/Other Implications: Change of procedures on acute ward has
already been agreed but could be further helped by creation of
Accommodation Officer post (See Recommendation 4 below).

¾ Recommendation 2: Housing Assessment to be integrated in work of
residential panel by inclusion of service representative in panel meetings.
Resource/other implications: Could initially be contained within existing
resources but would be significantly improved by Accommodation Officer post
(See Recommendation 4 below).

2.2 More information needs to be provided and available in different
languages and formats about specific Mental Health services but also
about practical daily living issues such as finance, access to leisure and
educational activities and employment. Some progress has already
been made with the development of new leaflets for people admitted to
the acute unit.

¾ Recommendation 3: Set up Mental Health Information Group including
service user/carer representatives to produce leaflets.
Resource/other implications: Staff time could be contained within existing
resources. Estimated printing costs of leaflets: £1000-1500. Estimated cost
for service user payment: not more than £200.

2.3 There is a significant need for improvement in arrangements to facilitate
service users’ transition from hospital/residential units to more
independent accommodation or their own homes.

¾ Recommendation 4: Create specialist Accommodation Officer post focussed
on needs of mentally ill people.
Resource/Other Implications: Estimated cost of £40000 (subject to outcome of
evaluation). Potential for joint funding from Supporting People (promotion of
independent living) and Local Authority invest to save bid based on estimated
savings of not less than £50000 which could be achieved by bringing some
people back from costly out-Borough placements to accommodation in
Harrow.

¾ Recommendation 5: Improve operation of Residential Panel by using the
proposed Accommodation Officer post to carry out work between panel
meeting, by incorporating Housing representation (see Rec1 above) and
considering the adoption of the standardised matrix for matching service
users’ support needs to appropriate accommodation.
2
Resource/Other Implications: Staff time to be contained within existing
resources with exception of potential Accommodation Officer for which
funding opportunities identified above.

¾ Recommendation 6: Develop Rehabilitation Team to work closely with
service users to enable them to develop the skills and confidence to manage
(more) independent living.
Resource/Other Implications: Additional funding of £100000 already agreed
via Supporting People.

2.4 There are some blockages in the system which make it difficult for
people to move from residential care to more independent living. In
particular, there is some evidence of a shortfall in supported housing
with a number of people waiting for places. There is also an unmet need
for specialist provision for the Asian community including a women-only
unit.

¾ Recommendation 7: Develop increased housing capacity in the system by
a) PFI bid for supported housing development with potential to provide 12
MH places per year over 3-5 years. Bid currently being costed by financial
advisors.
b) Exploring options for development of new Asian unit (former Asra site).
c) Undertaking discussions with Housing Associations to develop Asian unit
in partnership with other boroughs.
Resource/Other Implications: Contracts Manager time. Funding bids to
ODPM, Housing Corporation and with other Local Authorities.

2.5 People with mental health problems find it difficult to cope with Locata,
the choice-based lettings system.

¾ Recommendation 8: Provide direct support to mentally ill people with their
applications to the Locata Scheme through the proposed Accommodation
Officer post. (See Recommendation 4).

2.6 There is a need for more specific service provision in relation to
residential provision for Asian people.

¾ Recommendation 9: Develop specialist housing provision. (See
Recommendation 7 with related resource information).

2.7 There is a need for more information for in appropriate languages for
Asian and other BME service users.

¾ Recommendation 10: Improve provision of leaflets and service information
available in different languages and formats. (See Recommendation 3).

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2.8 There is a need to increase training and employment opportunities for
people with mental health problems in the interests of promoting
independence and social inclusion.

¾ Recommendation 11: Support mentally ill people seeking work experience
and permanent employment through creation of Local Employment Co-
ordinator post linked with Mental Health Trust proposed Vocational Services
Manager.
Resource/Other Implications: Funding is already available within HUMHS
from Bridge and Wiseworks Salaries budgets by reconfiguration of existing
posts.

Above recommendation should be developed in conjunction with proposed
new corporate work experience programme for people with disabilities.

2.9 The costs of residential care for mentally ill people in Harrow appear to
be relatively high in comparison with other boroughs although the
authority performs very well in relation to the numbers of mentally ill
people helped to live in the community. Whilst these two indicators
counterbalance one another to some extent, it is necessary to get
behind the figures provided to understand the reasons for them and
confirm that services are providing value for money.

¾ Recommendation 12: Detailed investigation of costs of staffed residential
mental health units to be undertaken and any options for changes identified.

2.10 Conclusion

The recommendations outlined above provide a basis for significant improvement in
the overall provision of services aimed at maximising the independence of mentally
ill people. In so doing they address a number of key Council priorities:

• Promotion of social inclusion
• Maximising the independence of disabled people
• Enabling choice and access to good quality housing
• Combating economic disadvantage

The recommendations have been developed into a service improvement plan which
can be found in Section 12 (page 79) of this report. The full report and service
improvement plan are therefore commended to managers and to Council Members.

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SECTION 3 - MENTAL HEALTH BEST VALUE SERVICE IMPROVEMENT PLAN

Issue Recommendation Action Lead Officer(s) Timing Measurable
(Start) Outcome
Communication & 1 Facilitation of early discharge System to be put in place on Acute Acute Team 1 June 03 Reduction in delayed
joint working planning for people with housing Unit for Housing to be notified of Manager, NPH discharges
across services needs people with housing as soon as
possible after admission.

2 Integration of Housing in work of Housing representative to attend panel 1 Sep 03 Improved partnership
residential panel meetings working

Communication 3 Provision of more written Set up Mental Health Information HUMHS Sector 30 Sep 03 Leaflets produced
with service users information to service users and Group including service user/carer Manager
carers representatives to produce leaflets

Need for better 4 Creation of specialist post Bid for Accommodation Officer via Supporting 30 Nov 03 Reduction in delayed
transition focussed on accommodation needs Supporting People, PCT and Housing People Manager, discharges
between services of mentally ill people to: Joint
& increased ƒ Facilitate discharges from hospital Commissioning More people moving to
independence for ƒ Match people to places in Manager, more independent living
service users residential and supported housing HUMHS Sector
units Manager
ƒ Help users with Locata scheme

5 Improve operation of Residential Review operation of panel meetings in HUMHS Sector 1 Sep 03 More people moving to
Panel the light of the potential Manager (Panel more independent living,
Accommodation Officer post. Chair) improved interface
Adopt standardised matrix for Housing between SSD and
matching people’s needs to Assessment Housing
placements. Team Manager
Ensure Housing are represented at all 1 Sep 03 More people enabled to
meetings. live independently

6 Development of Rehabilitation (Additional funding already agreed via Intensive 30 Nov 03
Team Supporting People). Community
5
Plan reconfiguration of current Support Team
Intensive Community Support Team to Manager
create Rehab Team
Implement new service structure and 1 April 04
publicise changes to link agencies,
service users and carers.

7 Promotion of Direct Payments Work to be done with service users Direct Payments 1 July 03
and carers to build confidence in and Co-ordinator
promote the use of direct payments.

Availability of 8 Development of increased housing PFI bid for new supported housing Contracts TBC Increased supported
appropriate capacity in the system scheme to include specific provision Manager, Joint Housing capacity
accommodation for 12 places for people recovering Commissioning
to meet the from mental illness to be submitted Manager
independent subject to a review of affordability and
living needs of size of scheme with the ODPM.
mentally ill people
Exploratory discussions to be Contracts TBC Needs for women-only
undertaken in relation to Manager, unit met
redevelopment of former home for the Housing
elderly as Asian, women only unit. Development
Manager

Options to be considered for HUMHS Sector 1 April 04 Recommendations
reconfiguration of existing residential Manager, Joint made
provision into Supported Housing. Commissioning
Manager
Additional support posts already
agreed from SP funding to work in ICST Manager 1 April 03 More people enabled to
Intensive Community Support Team live independently

9 Provision of direct support to assist Specialist Accommodation Officer post See 4 above
mentally ill people with applications to be created. (See Recommendation 1 April 04 As above
for Council and private tenancies. 4 above).

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Ensuring that the 10 Development of specialist housing See items under Recommendation 7 Contracts 1 April 04 Specific provision made
Needs of Black provision above. Managers, Joint for ethnic minority
and Minority Commissioning service users
Ethnic Mental 11 Improve provision of information See actions under recommendation 3. Manager
Health Service and ensure availability in different
Users are met languages

12 Draw on experience of BME Best Set up working group to complete Specialist CMHT TBC
Practice organisations to improve visits, look at applying relevant worker
Harrow services and take account approaches within Harrow and develop
of DoH recommendations arising strategies for the implementation of
from Inside Out report Government guidance.
Employment and 13 Increase employment opportunities Develop proposal and bid for local HUMHS Sector 30 Sep 03 Increase in numbers of
Social Inclusion and support Employment Co-ordinator Manager, Joint people with mental
linked with CNWL proposal to create Commissioning illness in employment or
new Vocational Services Manager. Manager work placements
Plan for new work
Work with managers involved with Nominated 1 April 04 placement scheme
development of new corporate work HUMHS manager developed and
experience programme for people with endorsed by senior
disabilities to secure placements for officers and Members.
people with mental health problems.

Cost 14 Ensure that current residential units Undertake detailed analysis of costs of Project Mgr, 31 March Potential for efficiency
Effectiveness and provide value for money 7, 14/15 Kenton Road and identify HUMHS Sector 04 savings identified
Efficiency options for changes, if appropriate. Mgr, Performance
& Assessment
Mgr, Contracts
Mgr

Report outcomes of review of Contracts 30 Sep 03 Potential to reduce costs
Assessment Unit Manager without detrimental
effect on quality
identified
15 Promotion of Direct Payments (See Recommendation 9 above) Direct payments 1 July 03
Co-ordinator
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