Agenda item

Purpose of the report: This report provides the Adults and Health Select Committee with an overview of the progress made with the delivery of the Adult Social Care’s Accommodation with Care and Support Strategy.

Witnesses:

Liz Uliasz – Deputy Director for Adult Social Care

Adrian Watson – Programme Director, Adult Social Care (Land & Property)

Simon Montgomery – Senior Programme Manager for Accommodation with Care and Support Strategy

Kirsty Gannon-Holmes – Senior Commissioning Manager for Mental Health

Anna Waterman – Head of Commissioning for Disabilities

Maria Millwood, Board Director – Healthwatch Surrey

Dan Stoneman – Head of Commissioning Older People)

Key points raised during the discussion:

1. The Senior Programme Manager presented slides which provided context to the item (Annex 1) and highlighted the importance of the Accommodation with Care and Support Strategy (AwCSS) in integrating residents into the community and having fulfilled lives.

2. The Chairman asked whether the views received in the consultation about sharing with others were expected. The Senior Programme Manager explained that the views varied dependent on the client group. For those with learning disabilities, it was emphasised that they wanted the choice of living alone or living with others. The shared occupancy option would have facilities for social workers to be present for those with higher needs. In terms of those with mental health issues, single occupancy accommodation would be prioritised as per the views of the consultation.

3. A Member queried whether the pandemic had an impact on the progress of the AwCSS and asked about any measures taken to overcome such challenges. The Programme Director explained that the pandemic had minimal effect on the early-stage planning of the programme, as they were still in the preparation stage and conducting due diligence. The greatest impact was on the Pond Meadow site, as procurement of the project was delayed. Acceleration and identification of pipeline sites had continued to take place and the programme was on track to achieve agreed targets. Additional resources to enable this had been secured. In terms of Adult Social Care (ASC) support, the pandemic limited the ability to fully support residents in their new accommodation.

4. A Member enquired about the impact of the cost-of-living crisis on the programme. The Programme Director shared that the rising inflation and increased costs had impacted the cost of construction. Although, financial planning and pre-market testing had included appropriate provision for construction-related inflation. The impact on extra care housing was not known yet. The Senior Programme Manager added that supported independent living was for those with eligible care needs and extra care housing was trying to increase the availability of affordable housing in the sector.

5. In response to a question on the AwCSS’s contribution to the delivery of Surrey Community Vision for 2030, the Senior Programme Manager explained that currently there was too much reliance on residential care which limited independence, especially for those with learning disabilities and autism (LD&A). Therefore, the Strategy linked to empowering communities and tackling health inequalities, as well ensuring no one was left behind. The Deputy Director added that for those with mental health needs, the Strategy involved helping them back into employment and independent living.

6. A Member asked about the affordability of the accommodation. The Programme Director explained that the accommodation would be fully funded through housing benefits, however, each setting would be subject to the local rates. Measures had been taken to make settings as cheap to run as possible, through adopting the Council’s sustainability ambitions. The Chairman asked whether there would be a requirement for external providers to comply with the level of housing benefits. The Senior Programme Manager explained that the providers were already working with housing benefits organisations and the Programme Director added that the market lease arrangements would stipulate it was based on housing benefit levels. If the operating costs of the building were not met through the housing benefits, that burden would be on the Council or the provider to meet. The Head of Commissioning explained that there had been extensive work with providers, social landlords, and District and Borough officers to look at housing benefit levels in respect of the cost of living. Utility costs were built into the arrangements and the work was linked in with the wider housing strategy across Surrey.

7. Responding to a question on meeting a variety of accessibility needs, the Senior Programme Manager explained that in the design process they worked closely with residents and occupational therapists to ensure that settings would be designed to meet a range of accessibility needs. The Member also asked whether there were plans to utilise any of the former anchor care home sites. The Programme Director informed Members that all available Council assets would be explored and proposals utilising a number of existing assets would be brought to Cabinet. At this stage, the specific sites could not be named due to confidentiality.

8. A Member highlighted the benefits of utilising Council-owned sites when receiving planning permission and raised potential issues of going through local planning committees. The Programme Director explained that for extra care sites, they were de-risking by seeking outline planning permission first. A Regulation 3 Surrey County Council planning-led approach was being taken for extra care and supported independent living sites; however, it may not be suitable for every setting. Thus far, there had been a supportive approach from District and Borough councils.

9. A Member asked about the Surrey-wide Support and Care Commissioning Strategy and how this would help to reduce health inequalities. The Senior Programme Manager explained that the Strategy would look at creating a consistent approach across the County to the commissioning of future extra care housing settings. It would cover all aspects involved in the delivery of dedicated Care Quality Commission (CQC) regulated services which provided a 24/7 on-site presence to respond to emergencies and meet the assessed needs of residents. The Strategy would reflect the fundamental purpose of extra care housing of providing support and security to residents to continue to live in a home of their own in a community which was responsive to their needs.

10. The Chairman asked about how it would be ensured that residents could afford the charged, communal facilities. The Senior Programme Manager shared that there were examples of best practice regarding communal facilities and they were working closely to the HAPPI principles. Accommodation would be located in areas with good transport links and in a community, as well as ensuring privacy and space. The Deputy Director explained that the ambition was for residents to be able to access opportunities such as, work and volunteering. The Programme Director added that the housing management function would be provided as part of the service charge. Some additional services would cost extra, such as, the hairdressers. The services which would be included or excluded would be defined in the development stage, following resident focus groups.

11. In response to a question on the collaboration with District and Borough Councils, the Senior Programme Manager explained that the Council worked well with District and Borough colleagues and a Housing Partnership Management role had recently been recruited to. The programme prioritised care needs over housing needs, however, the housing partnership work was critical. The Programme Director explained that structures were in place to deliver the programme. There were some challenges due to levels of resourcing at different Councils, but there had not been blocking. There were healthy and challenging debates at partnership meetings.

12. The Chairman asked about the progress of the procurement process for the support and care provision. The Senior Programme Manager explained that it was on track and the procurement process would be completed within a suitable window. The Programme Director shared that the first phase development was with Pond Meadow Limited, and they were helping to shape the timings and processes to ensure that there was a suitable model in place, and there were no settings without the appropriate care in place. The Chairman queried whether there had been any considerations to build accommodation into the units for workers in Surrey. The Senior Programme Manager explained that at the current stage it was focused on adults with eligible care needs, with the ability for carers to stay but not as a form of permanent accommodation. However, they would look into the possibility of this in the future.

13. Responding to a question on the outcome of the planning application for Pond Meadow site, the Programme Director explained that Guildford Borough Council validated the planning permission on 23 September 2022 and there was a 13-week determination period. Thus, it was expected that planning determination would be received prior to Christmas. The Chairman asked about the time allocated to receiving planning permission in programme timelines. The Programme Director shared that there were short timescales included in the programme because of the outline planning approach. The next stage was based on reserve matters, but this would be known upfront.

14. A Member asked about the decision and impacts of using shorthold tenancies. The Programme Director shared that the decision was based on industry standards. It offered flexibility to the landlord and the tenant, which allowed the settings to feel like a real home. Legal advice was sought for each setting and alternative arrangements would be considered if necessary.

15. A Member asked about the confidence that the delivery of the remaining 50% extra care units would be on target. The Programme Director explained that there were four phases of the extra care programme. During phase 1a and 1b, there were six sites which would deliver circa 368 units. Work was currently underway on phase 2 which involved four to five sites and officers were confident they were suitable and that the number of units in the sites could deliver against the Strategy. 100 to 125 units were required in phase 3 to achieve the target and sites were being identified and engagement had started with District and Borough colleagues. The Programme Director was confident that phase 3 would be achieved. The Member and Chairman noted the importance of proximity to transport links and the geographical spread of sites across the county. The Programme Director reassured Members that settings would not be developed in locations where there were not suitable transport links. The aim was for best geographical spread that could be achieved, relative to site availability.

16. In response to a question on the criteria for eligibility for supported independent living for individuals with LD&A, the Senior Programme Manager explained that the primary cohort was those with eligible care needs. The Programme was intended to reduce the reliance on residential care, thus, individuals in those settings would be prioritised. The Deputy Director added that individuals would receive a Care Act Assessment to understand their needs prior to allocation to a setting. The Head of Commissioning for Disabilities added that following an assessment, a detailed care package would be put out to brokerage. The Deputy Director shared that there would be a review shortly after an individual moved into their accommodation to assess whether the level of need was suitable. There would be constant monitoring through the provider and reviews would occur as and when needs changed.

17. The Board Director of Healthwatch Surrey queried whether there would be differentiation between autism specific needs and learning difficulty needs. The Head of Commissioning explained that they would be considering potential sensory overload and understanding that some autistic individuals would benefit from being around their peers, whereas others would prefer to be alone. The geographical location would be taken into account, such as, being next to a church that produces loud noise may not be suitable.

18. A Member asked about gaining data of the cohort of those with LD&A who were currently supported by their family. The Head of Commissioning for Disabilities explained that the LD&A Joint Strategic Needs Assessment (JSNA) would provide a better understanding of the data available. There had been an increase in need and numbers post-pandemic. There was a separate JSNA on neurodiversity to learn more about the needs of that cohort. Surrey Carers Partnership Board has been refreshed and there was a sub-committee to look at neurodiversity. 

19. In response to a question on the challenges with repurposing residential care settings, the Senior Programme Manager explained that officers worked closely with existing providers of residential care and the challenges were regarding the structure of existing buildings and whether they were suitable to be reconfigured. There was also work with providers around the behavioural piece of adjusting from residential care to supported independent living.

20. A Member asked about whether the increase in the mental health need due to the pandemic had created greater demand for supported independent living accommodation, and what kind of support could be expected for those residents. The Deputy Director explained that there had been an increase in referrals to teams which included increased complexity of needs and new cohorts. This had translated to an increase in requests for supported independent living. In terms of support, this would focus on helping people back towards independence, through finding employment and reintegrating into the community. It would also include teaching individuals to recognise when they were in crisis. There would be collaboration with Surrey and Borders Partnership and the voluntary sector for early identification and preventative work.

21. The Chairman asked about the criteria for providers to be involved in the programme, such as, prior performance records. The Deputy Director explained that there would be contract monitoring and there would be key performance indicators and criteria that they would need to meet. Previously, the Council had supported a provider to close due to poor quality of work. The Senior Commissioning Manager added that it was difficult to get good data on providers, especially if they were new to supported independent living provision. Therefore, officers would visit new providers prior to bringing them onto the framework. Once established, information would be received from frontline staff and there would be quarterly performance monitoring meetings with providers. They were in the process of developing a more detailed quality assurance framework and have visited providers to meet service users and receive their feedback. The Board Director of Healthwatch Surrey explained that it can be difficult for vulnerable clients to know how to report issues. The Senior Commissioning Manager explained that in order for a provider to get onto the framework, they would need to have mechanisms in place to allow users to voice their concerns.

22. A Member asked about how the effectiveness of the partnership working would be determined and whether it would be successful in delivering a patient led approach. The Senior Programme Manager explained that it was about co-designing and co-producing with residents and routinely capturing feedback and outcomes from services. If the programme was delivering outcomes, then that would evidence that partnership working was successful. The Head of Commissioning for Disabilities added that there were meetings every other month with the Learning Disabilities and Autism Partnership Board. There were also mechanisms in place to ensure the work was patient-led, such as, commissioning being linked to Care Act Assessments.

23. A Member asked about the mitigating actions taken to minimise challenges to delivery. The Programme Director explained that an assessment had shown that they needed to improve officer resources to deliver the capital strategy, and this was a key risk area. A mitigating action taken was recruiting the Programme Director. High amount of supplier and provider engagement was crucial for effective delivery. In terms of de-risking the Council assets, they were seeking and achieving outline planning permission. 

Actions/requests for further information:

For Accommodation with Care and Support Strategy Leads at Surrey County Council:

1. To organise site visits for Members of the Adults and Health Select Committee to Extra Care and Supported independent Living Sites.

2. To Hold a meeting with the Chair and Vice-Chairmen of the Adults and Health Select Committee and the Chairman of the Surrey Carers Partnership Board.

Recommendations:

For Accommodation with Care and Support Strategy Leads at Surrey County Council:

1. To ensure that Extra Care and Supported Independent Living Accommodation is genuinely affordable in line with welfare benefits for individuals who qualify for such accommodation, and to provide a future written update to the Adults and Health Select Committee on this.

2. To develop explicit plans on the specific and specialised facilities that will be available within the context of the Extra Care and Supported Independent Living Facilities/sites, and to provide a future written update to the Adults and Health Select Committee on this, including on what is included in the rent and what is chargeable.