1. Funding Cuts and personalisation: commissioning and funding services in extra care housing seminar 28 June 2011 Peter Fletcher Associates www.peterfletcherassociates.co.uk

2. This presentation Part 1: how services in extra care housing are being commissioned by Local Authorities Part 2: provider led models independent of Local Authority commissioners Part 3: future service models

3. What is EC about in 2011? Lifestyle choice – private market approach Part of the prevention and well-being agenda Alternative to long-term care and key to rebalancing resources for ASC – your feedback shows little hard evidence of diversion and mostly lower needs profile than planned

4. Key ingredients of extra care Customer base Lifestyle Ethosstyle Social leisure Quality of Life Environment Internalexternal Services

5. Implications of Personalisation Aim to create a lean and outcome focussed public sector Less commissioning/contracting and more market shaping to create range of services that people on DPs want Think Local, Act Personal – progress report updating ‘Putting People First’ published in January 2011 –Importance of councils, health bodies, providers collaborating –Recognising the role of individuals and families. Community action Personal budget managed by the LA Direct payment managed by the individual

6. Commissioning and funding SP funding cuts  Withdrawing or reducing funding for EC Commissioning different service models to take account of personalisation and reduced funding: from inflexible block to  Smaller core service + direct payments  Core hours: night cover or 24/7 direct payments to buy additional services  Block and spot, provider banks unused hours for use in emergencies  Personal budgets to pay on site provider(s) Changes to Housing Benefit

7. Some key questions When does extra care stop being extra care? Does domiciliary care model with range of providers destroy the underpinning flexibility and quality of life that earlier EC funding and service models offered? Or has personalisation opened up more flexibility and individual choice? What minimum 24/7service is needed for social workers to use EC as alternative to res. care? How to meet specialist needs e.g. dementia?

8. Some case study examples Overview from Housing 21research Commissioning perspective from Staffordshire and Newcastle Provider perspective from MHA Private sector model New models being developed by care providers

9. The impact of personalisation on extra care housing: ‘Building Choices’ 2 years on Sarah Vallelly, Intelligence Manager, Housing 21

10. How is extra care commissioned now? Confused? There is little consensus amongst commissioners Housing 21 work with 27 different models at 120 sites Traditionally dependency block Recently core + spot purchased Increasingly night + spot purchase Also no guarantee at all New models being developed

11. Confused? Core (24/7) Sometimes the core is planned care Sometimes the core is background support Sometimes the core is management & activities The core is sometimes funded by Supporting People The core is funded by a tenant charge – ‘wellbeing charge’ The core is funded by Local Authorities The core is part-funded by a PCT

12. Extra Care is not a new concept but has it really evolved? Commissioned service models show that ‘the jury is still out’ but the trend is still to guarantee core service Commissioning trends in 2010

13. Extra care now? (New schemes 2010) 80%Offered on-site or existing provider as first option 19%Offered choice of up to 5 providers including on-site and current provider OR 5 + current provider 1%Provider Selection Open Days How have tenants accessed service providers at the extra care schemes we have been involved in over the past 12 months? 89.8% of all tenants selected the on-site provider 9.5% stayed with their existing provider 0.7% went with a new provider because of price

14. H21 / Greenvale Homes and Lancashire County Council  Lancashire County Council have made a decision to commission in line with personalisation. (Core and top-up model)  Want to commission “the Glue” that holds the key elements of extra care together. This incorporates: –24/7 cover –On site staff –‘housing-related support’ –Emergency alarm services –Development of activities on-site –Liaison with RSL / care provider  Lancs CC funding - £90K. Estimated cost of running service (H21) is £130K  Therefore the ‘core’ is about 70%  Residents moved in during April 2010.  June 2010 - 293 hours of care per week is being delivered on top of the ‘core’ contract. All but one resident has opted for on- site service

15. What are Flexicare services? The services available to residents living in an Extra Care scheme in Staffordshire A ‘core’ element – the glue that holds everything together How to make viable and affordable?

16. Housing Management Housing Support Care Care & Support Care

17. Housing Management Housing Support Unplanned Care Care £Rent from Resident or Housing Benefit £SP funding or Resident £Fairer Charging £?????????? Not compatible with fairer charging

18. Housing Management Care & Support Care Flexicare Grant to part fund. Residents to fund balance (capped)

19. Grant Funding - benefits RPs can get on with providing a full service in their scheme Share costs between Council & Residents Residents get a say on what is spent Maximise economies. Minimal procurement Grant conditions – can still monitor But…..still working on State Aid rules

20. Commissioner perspective: Newcastle upon Tyne New outcomes based contract Block contract up to a threshold Spot hours which can be used in exceptional circumstances Tendering contracts later in the year to reduce costs and take account of personalisation Not clear at present about the core elements of the service

21. Legal & regulatory issues (1) Commissioners need to give providers time to make changes e.g. move from full-time to part-time Scheme Manager Residents need to be consulted about proposed changes to services linked to their tenancy or lease Providers need to set out clear options and/or invite suggestions Tenants are consulted but not asked to vote on proposed changes Leaseholders all need to agree to any changes to their lease e.g. removal of resident manager

22. Legal & regulatory issues (2) Commissioners should explain changes to care arrangements to individuals receiving care and wider stakeholders where there are potential impacts Consultation needs to be thorough Need to take account of legal duties to residents or risk Judicial Review e.g. LB Barnet had not taken account of duties towards people with disabilities CIH Complaints Guide sets out routes for complaints about changes to service delivery in older people’s housing

23. Transforming sheltered housing Lorelei Jarvis – Director, Independent Living

24. MHA Care Group Specialist provider of older people’s services 68 years Services for:  1,500 older people in extra care and sheltered housing  8,000 older people in community projects  3,000 older people in residential care Capital investment programme £20m pa Annual turnover £143m

25. MHA’s sheltered housing Ageing resident population 25 for rent schemes Average age of schemes – 20 years Mix of funding HAG/Charitable Size ranging from 26 to 50 units

26. Taking a flexible approach Conversion to extra care housing Extended service offer to sheltered residents Offering services to the wider community Combining community and sheltered services to create hubs Disposal and acquisition

27. Extra care model Wellbeing charge – Attendance Allowance 24 hour staffing funded by wellbeing charge/SP/rent/service charge Availability of care to purchase Flexible employment contracts Capital works

28. Aldersgate, Nuneaton 34 flats, communal lounge, guest suite, laundry and communal bathroom Residents consulted about introducing extra care service; 24 hour staffing, care team on site, catering facilities Support from MHA’s Charity to enable transition Local authority support

29. Aldersgate, Nuneaton Incentivise, but no compulsion – existing residents choose - converted in August 2009 and now 19 of 34 residents are part of the new service Residents are also receiving 122 hours of care each week from the on site care team Physical enhancements focus on what’s needed to enable people with care needs to remain independent: Walk in showers, assisted bathroom and bistro

30. The bistro, Nuneaton

31. Extending services in sheltered housing Services  Cleaning  Shopping  Handyperson  Laundry and ironing Staff Marketing

32. Local authorities Mixed response Good fit with personalisation SP value for money Some slow to recognise and use effectively Most leave us to get on with it

33. McCarthy & Stone: Assisted Living Accessible flats: 1,2 and larger 2 bedroom Service charge includes:  Estate manager and assistant  Sleeping night cover  Careline monitoring  1 hour domestic assistance  Staff costs for midday meal; meals cost £ Care purchased separately on hourly basis via Echoes Community Care c£15/16 an hour

34. Life Begins Day care service offered by private care home company Minibus transport – early & late pick ups and drop offs Cinema Internet café Shop Dining room option of takeway tea Beauty salon Bathing Garden & patio

35. Select Living 21 one & two bedroom apartments next door to a new purpose built care home Luxury apartments for sale Residents will have access to services & facilities provided in the care home Due to open December 2011

36. Future services Private sector providers of care & support are gearing up for personalisation Opportunities to work in partnership e.g. RSL & domiciliary care agency offering a programme of social & leisure activities in extra care scheme On-site services & activities can be made available to others who live nearby outreach and in-reach Sensitive to local needs for services, employment opportunities & enterprise Falls service - remote telecare in extra care and extend to wider community Tenants enabled to contribute to the community & access other services Assistive technology “Care on Demand” Facilitate on-site diagnostic and health screening services Continuing health-care Carers working with people in hospital settings

37. Wider role with older people Older people are a large potential market for housing providers It’s not just providing services for people in extra care housing It’s not just providing services for your tenants Home owners often unaware of services; think they’re not eligible or put off because they will be too costly – always surprised at low cost and value for money of community alarm services Potential to develop a ‘wider’ offer in partnership with other providers (Orbit Charitable Trust research)

38. Community regeneration: innovation, activities and services  “Club and (be)spoke” –recognising that extra care is part of the broader locality. –On-site services & activities can be made available to others who live nearby. –Sensitive to local needs for services, employment opportunities & enterprise  “Extra care and beyond.” –Falls service - remote telecare in extra care and extend to wider community –Tenants enabled to contribute to the community & access other services –Assistive technology –“Care on Demand” –Facilitate on-site diagnostic and health screening services –Continuing health-care –Outreach and in-reach – neighbourhood strategies –Carers working with people in hospital settings

39. Offering services to the wider community Services  Cleaning  Shopping  Handyperson  Laundry and ironing  Activities Staff Marketing Geographical range 1 to 2 miles

40. Community Services – Live at Home National network of 53 services Funded through charitable income and grants (including SP) Combination of paid staff and volunteers Offering:  Befriending  Lunch/Social clubs  Lifelong learning  Shopping services  Transport

41. Housing as hubs Using the housing base to develop more Live at Home services to share management across housing sheltered housing and community services 14 local managers invited to offer services to people in the communities surrounding our sheltered schemes Services in people's own homes Inviting people from the wider community to join MHA residents for activities in schemes Mix of purchased and free services linking the Live at Home volunteer model with staff to provide housing related support and more.

42. Choice and control Listening to what older people say Offering a range of services in response Making services accessible and affordable Maintaining quality and values