1. Building the right home
Purpose of the workshop:
Share national direction on key areas of housing
Discuss the guidance on housing and areas you’d like it to cover
Identify areas that require more work or further support
Housing LIN London
9th January 2017
12th December 2016

2. Transforming Care Programme
NHS England’s learning disability programme is working to transform the care and support for people with learning disabilities by:
Closing inappropriate inpatient facilities
Building up community capacity to prevent future admissions
Building the right support
This three year programme of work is aiming to reduce inpatient capacity by up to half by March 2019 and build up community capacity.
To achieve this vision, NHS England are working with LGA and ADASS to deliver new, better care options in the community and 35-50% reduction in total inpatient numbers by March 2019.
In 2015, 48 Transforming Care Partnerships (TCPs) were established across England to improve community capacity and reduce the need for specialist hospital care by March 2019.
Building the right support and the national service model state that people should have access to settled accommodation, with choice about where they live and who they live with. This will also help support the reduction in overall inpatient capacity by March This plan set out that each area should come together in larger commissioning footprints made up of CCGs, local authorities and NHS England specialised commissioners. This led to the formation of 48 TCPs across England.
BRS set out planning assumptions which TCPs should look to implement by March 2019 in order to reduce reliance on inpatient facilities and a new financial model to implement the service model (see below).
A new financial framework underpins the delivery of the new care model, in which local transforming care partnerships use the total sum of money they spend as a whole system on people with a learning disability and/or autism (including the specialised commissioning budget and NHS continuing health care) to deliver care in a different way that achieves better results.
For people who have been in hospital more than five years (from 1st April 2016), the NHS will provide a ‘dowry’ – money to help with moving people home.
NHS England is also providing up to £30 million of transformation revenue funding to CCGs, to be matched by CCGs’ own funding over three years. This is to enable commissioners to invest in new community support services before closing inpatient provision.

3. Who are the Transforming Care cohort?
Individuals do not ‘slot neatly’ into any single grouping – they overlap, people’s needs change over time, and often a large part of the challenge for local services will be to understand what combination of factors lies behind an individual’s behaviour.
However, common needs amongst the diversity of the population that Building the right support is about include:
People with a learning disability and/or autism who have a mental health condition such as severe anxiety, depression, or a psychotic illness, and those with personality disorders, which may result in them displaying behaviour that challenges.
People with an (often severe) learning disability and/or autism who display self-injurious or aggressive behaviour, not related to severe mental ill health, some of whom will have a specific neuro-developmental syndrome and where there may be an increased likelihood of developing behaviour that challenges.
People with a learning disability and/or autism who display risky behaviours which may put themselves or others at risk and which could lead to contact with the criminal justice system (this could include things like fire-setting, abusive or aggressive or sexually inappropriate behaviour).
People with a learning disability and/or autism, often with lower level support needs and who may not traditionally be known to health and social care services, from disadvantaged backgrounds (e.g. social disadvantage, substance abuse, troubled family backgrounds) who display behaviour that challenges, including behaviours which may lead to contact with the criminal justice system.
The resettlement programme looks explicitly at the number of long-stay patients, generally people who have been in hospital over five year who are also eligible for a dowry payment to support them to find community-based provision.
Individuals do not ‘slot neatly’ into any single grouping – they overlap, people’s needs change over time, and often a large part of the challenge for local services will be to understand what combination of factors lies behind an individual’s behaviour.

4. National service model
1. I have a good and meaningful everyday life.
2. My care and support is person-centred, planned, proactive and coordinated.
3. I have choice and control over how my health and care needs are met.
4. My family and paid support and care staff get the help they need to support me to live in the community.
5. I have a choice about where I live and who I live with.
6. I get good care and support from mainstream health services.
7. I can access specialist health and social care support in the community.
8. If I need it, I get support to stay out of trouble.
9. If I am admitted for assessment and treatment in a hospital setting because my health needs can’t be met in the community, it is high-quality and I don’t stay there longer than I need to.
Key principles
People should be offered a choice of housing
Choice about housing should be offered early in any planning processes.
Everyone should be offered settled accommodation.
Future needs should form part of local housing strategies.
Where people live needs to be understood from the individual perspective.
I have a good and meaningful everyday life.
My care and support is person-centred, planned, proactive and coordinated.
I have choice and control over how my health and care needs are met.
My family and paid support and care staff get the help they need to support me to live in the community.
I have a choice about where I live and who I live with.
I get good care and support from mainstream health services.
I can access specialist health and social care support in the community.
If I need it, I get support to stay out of trouble.
If I am admitted for assessment and treatment in a hospital setting because my health needs can’t be met in the community, it is high-quality and I don’t stay there longer than I need to.

5. Building the right home
To support the ambition of Transforming Care we need to see :
A significant expansion in housing options
An improvement in the quality of housing options
Housing delivered in the right place at the right time
A significant increase in housing options for people with a learning disability and/or autism will enable people to access the right home and support at the right time. Inevitably, this will also support the reduction in overall inpatient capacity by March 2019.
Settled accommodation does not include:
Long-stay healthcare residential facility or hospital
Registered care home
Registered nursing home
Temporary accommodation/hostel
Housing with occupancy of six or more can quickly become institutionalised
Housing should not create new campus sites, avoid creating schemes of multiple units within close proximity.
People should have separate housing and support contracts

6. Housing Strategy
To support the ambition of Transforming Care we need to see :
A significant expansion in housing options
An improvement in the quality of housing options - inappropriate housing can increase the likelihood of behaviour that challenges and lead to placement breakdown
Modelling suggests that of the estimated1 3,500 adult patients we expect to be discharged between July 2016 and March 2019:
1,100 will be returning to existing accommodation
2,400 would require new living arrangements, mainly supported housing and bespoke housing options.
Region
No. of people requiring new arrangements:
North
880
South
450
London
310
Midlands and East
760
These numbers are modelled from data from March 2015 to July 2016 and projected forward. Probably an underestimate and only looks at those being discharged from hospital between July 2016 and March 2019.
1 All forward projections on discharges are estimates based on historical Assuring Transformation data

7. NHS capital grant
NHS England has £20 million of capital grant to spend per year between 2017 and 2021 (totalling £80 million).
This grant is for settled and short-term accommodation options for children, young people and adults with learning disabilities and/or autism who display behaviour that challenges.
The capital funding can be used for new accommodation, adaptations and remodelling to enable them to live in settled accommodation in the community.
People with learning disabilities and/or autism who display behaviour that challenges will have packages of care and support in place upon discharge from hospital.
Capital funding requirements should be submitted by a sponsoring CCG
Includes chapter on developing the housing marketplace for Transforming Care
Setting the foundations 19
Table 2: Data for modelling housing needs 20
Shaping the housing offer 20
Agreeing key terms - nomination rights, voids, understanding rents