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Wiltshire Independent Living Strategy 2022 to 2027

Appendices

Appendix 1 - definitions

Mental health

This is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community" (World Health Organisation). Mental health conditions - including so-called "common mental illnesses" such as anxiety and depression, more severe affective disorders (personality disorders, for example), eating disorders, and psychoses such as bipolar disorder and schizophrenia, etc - often impact negatively on well-being, but with the right support people can live well with hope and resilience.

Autism

This is defined in Wiltshire's market position statement for whole life pathways as a spectrum condition which affects different people in different ways. Autistic people may experience difficulties with social communication and interaction, repetitive and restrictive behaviour, sensitivity to light, sound, taste or touch, highly focused interests or hobbies, and anxiety and depression. This document uses the term autism spectrum conditions (ASC) in preference to autism spectrum disorders. It also uses the term "autistic people" over "people with autism," as research by the National Autistic Society nationally and by Wiltshire Parent Carer Council locally found this was generally the preferred description.

Learning disability

The Department of Health and Social Care states that a learning disability means the person will have difficulties understanding, learning and remembering new things, and in generalising and learning new situations. Due to these difficulties with learning, the person may have difficulties with a number of social tasks for example, communication, self-care and awareness of health and safety.

Appendix 2 - glossary of abbreviations

Abbreviations and their full phrases
AbbreviationFull phrase
ADASSAssociation of Directors of Social Services
ASCAutism spectrum condition
B&NESBath & North East Somerset
BSWB&NES, Swindon & Wiltshire
CLAChild/Children looked after
CQCCare Quality Commission
CSPCare Support Plus (see Appendix 4)
CYPChildren & young people
CYPDTChildren and Young People's Disability Team
EHCPEducation, health and care plan
GLAGood Lives Alliance
H4WHomes 4 Wiltshire
ICBIntegrated Care Board
ICSIntegrated Care System
ISFIndividual Service Fund
LDLearning disability
LDAsLearning difficulty assessments
MH/LD/AMental health / learning disability / autism spectrum condition
MPSMarket position statement
PAMMSProvider Assessment and Market Management Solution
SARSafeguarding adults review
SENDSpecial educational needs & disabilities
WCILWiltshire Centre for Independent Living
WPCCWiltshire Parent Carer Council

Appendix 3 - needs assessment

A snapshot in May 2022

This is a summary of children, young people and adults who were identified as being ready to move to alternative accommodation, or for whom we should start planning now for independent accommodation in a few years time. It is a snapshot of needs and preferences in May 2022.

There are some gaps in the data, which points to the need to improve data quality to help us plan for the future.

Total

  • 162 customers

Gender

  • male: 99
  • female: 63

Age

  • less than 18 years: 11
  • 18 to 25 years: 82
  • 26 to 39 years: 37
  • 40 to 49 years: 12
  • 50 to 59 years: 12
  • 60 to 69 years: 3
  • older than 70 years: 1
  • not stated: 3

Primary need

  • 92 of 161 have a learning disability
    • of these: 48 are listed as having only an LD; 24 also have an ASC; 9 also have a PD; 5 also have an MH
  • 61 of 161 have a mental health condition
    • of these, 52 are listed as having only an MH conditions; 9 also have an LD and/or ASC
  • 37 of 161 have an autism spectrum conditions
    • of these, 24 also have a learning disability; 6 are listed as having only an ASC
  • 18 of 161 have a physical disability or health condition
    • of these, 9 also have a learning disability
  •  5 of 161 have a sensory impairment

Team

  • Children and Young People's Disability Team (CYPDT): 60
  • Mental health (MH): 52
  • Learning difficulty assessments (LDA): 46
  • not stated: 4

Current location

  • Salisbury: 53
  • Trowbridge: 18
  • Chippenham: 11
  • Devizes: 7
  • Warminster: 7
  • Melksham: 5
  • Westbury: 5
  • out of county (OOC): 25

All other locations have fewer than 3 people living there.

Current situation

  • 62 are living with parents, of these, 21 are in full-time education and 11 have either recently finished or are about to finish an education placement. In 7 cases, it is stated that parents/family can no longer care for the customer (in one case, due to overcrowding); in 5 cases, the customers wants to move out of the family home to become more independent
  • 31 customers with MH needs live in move-on supported housing schemes
  • 18 are in residential schools, college or children's home placements. Most of these are CYP with SEND, with 2 at specialist VI provision, 1 at specialist HI provision
  • 22 are in residential care, 16 of these have a primary need of MH, 5 with LD, 1 is in a respite placement
  • 14 are living in their own flat/house with support - around half want to move elsewhere either to share with others or to stop living with current housemates; another half are being evicted or served notice
  • 8 are in hospital, 6 as long-stay patients (3 of these are in the Daisy unit), 1 as a voluntary inpatient
  • there are also individual customers in hostel, low secure, sheltered housing and foster placement

Support required

Data provided around what levels and types of support people need is very incomplete. 

Of 161 customers:

  • sharing ability/preference is not stated for 41 customers
  • type of property required is not stated for 85 customers
  • night support needs are not stated for 104 customers
  • housing registration status is not stated for 100 customers
  • timescale for move-on is not stated for 79 customers

These very significant gaps in data make it difficult to say comprehensively what support is required. However:

  • sharing: 70 can share, 42 cannot (or do not wish to) share, 9 may be able to share; for 41, sharing ability/preference is not stated 
  • type of property/adaptations: 13 people need wheelchair accessibility inside and outside the property; 13 need adapted bathroom; 11 need adaptations to support with behaviour; 9 need significant outdoor space
  • type of support: 39 people are noted as needing supported living, but it is clear that the vast majority of the 161 customers listed would need SL rather than residential care. 2 need residential care. For 6, both SL and residential have been listed. Shared Lives is needed for 1 person
  • level of support required: Exact hours required are only given for 23 customers. 9 people are stated as needing 1:1 support only (X needing 2:1 at times), 9 as needing shared support only, and 27 as needing a combination of both
  • night support needs: 38 people need sleep-in support, 15 need waking nights, 6 are listed as having no night-time support needs. However, for 104 people night-time support needs are not stated
  • housing registration: for 100 of 161 customers, housing registration status is not stated. For 45 customers, registering them on H4W has not commenced, for 5 it is stated as "not applicable," for 3 the registration process is "in progress," and for 9 of 161 the customer is registered and (in most cases) actively bidding
  • when the property/service is required: 54 people need a service/property in 2022 (some have been waiting to move since before the start of 2022), 4 in 2023, 5 in 2024, 4 in 2025, 7 in 2026, 8 in 2027 or beyond. For 79 customers, it is not stated when the service/property is required

Location required

  • Salisbury: 38
  • Trowbridge: 15
  • Chippenham: 12
  • west: 18
  • south: 10
  • anywhere: 9
  • not stated: 40

All other locations have fewer than 5 wishing to move there.

Appendix 4 - Care Support Plus model

Excerpts from mentalhealth.org.uk Mental Health and Housing report 2016

Definition

Care Support Plus is a model of supported housing, launched in 2012, in response to the need to create supported housing which could accommodate people with a high level of mental health support needs who might otherwise be in hospital or residential care.

The scheme was developed through a tripartite agreement between the housing provider, the local NHS Foundation Trust, and the local authority to develop a new type of supported accommodation specifically geared towards people who had often been excluded from supported accommodation due to their complex mental health needs.

The approach has proven successful on several of levels, including recovery of customers and improved quality of life. There is also a clear economic case to using this model with an overall annual saving per customer estimated at around £450,000.

The scheme was able to tackle a local problem across several areas of concern: A high number of people being placed in expensive out of area care; care that was not particularly suitable for the client group; a system lacking rehabilitation work; as well as concerns over the quality of care being received.

From another angle, the Care Support Plus model also provided an appropriate level of support for people in hospital unable to find suitable supported accommodation which could meet their needs. Although the impetus to develop the scheme was created by local demand, in practice the core elements of building and service can be reproduced to see how they might apply to customer needs across the country.

Building

At present the Care Support Plus model is not widespread. However the principles behind the construction are indicative of what other schemes might look like. Evidence from interviews suggests that the building formed part of the success of the scheme, proving a core element of effective support and may well be for further housing aimed at customers with similar mental health and support needs.

The scheme is purpose built supported accommodation, but to same specifications as private sale housing by the same provider. According to a member of the team:

The organisation has the philosophy that anyone with a mental health problem should get the same quality of accommodation as anyone else.

However, there were specific technical considerations, given that the model is aimed at customers with a high level of support needs:

  • the scheme provided fully self-contained flats with each customer holding their own tenancy
  • the flats contained essential items which might otherwise preclude someone from moving on from hospital, such as a bed, dining table, and cookware
  • regarding physical access needs, the building itself is step-free and fully accessible. This included a lift to all three floors with the first floor containing all wheelchair accessible rooms, so as not to prevent someone with mobility problems needs from accessing the scheme

The effectiveness of the accessibility measures was confirmed by the resident interviewed who felt the building met all their physical access needs.

The safety features of the building comprised an important part of the scheme. There were three elements of the building in particular which contributed: a 'front facing office, airlock doors, and sensitive use of CCTV'. In each of these areas, the safety appeared mindful of the specific concerns of people with high level mental health needs.

The position of the office functioned as a safeguarding feature as it enabled staff to be aware of who is entering and leaving the building and prevent unauthorised visitors from entering the scheme. This was bolstered by the 'airlock' system, which is a two-stage glass entry door, which helps to manage visitors' access to the scheme.

According to staff this has resulted in fewer safeguarding incidents compared to other schemes.

The levels of staffing also mean that visitors can be closely monitored and customers supported in this area; however in lower level supported housing with nine to five staffing it may not be possible to support customers in the same way.

CCTV in the scheme provided a final security feature, however it was set up to avoid being 'too obtrusive' and therefore mindful of the fact that it can make the scheme feel too 'big brother'-like. The building clearly responded to the support needs of customers by installing an appropriate level of security.

The importance of creating the right 'feel' for the building was evident across other areas. The staff member interviewed believed that the physical environment supported the mental wellbeing of residents:

I think having an environment which is non-institutionalised, homely, is quite important, it enables residents to feel part of the project.

Part of this was making sure that information was displayed but would not be too intrusive, drawing away from a supported housing stereotype.

This was reflected in the views of one of the residents, who thought that the physical environment supported their mental wellbeing, and was happy with the look of the flats on first seeing them:

I thought the flats were very nice... I still do think they are very nice.

The building also has a shared lounge and kitchen for customers to use, alongside the self-contained flats. This is a space for residents to socialise if they want to use the lounge, as well as maintaining space for privacy in their own apartments, and the resident interviewed felt that the space made it easy to interact with other residents.

However there were some drawbacks to the current building as highlighted through the interview. There was no private space outside the development such as a garden, although this was not an issue picked up by the resident interviewed.

Concerning inside space, another drawback of the building was the lack of a separate room that would staff space to meet with residents.

These characteristics demonstrate the significant role that the building has to play in the provision of excellent care in supported housing. Understanding the customer needs was evidently central to this building, although shortcomings of the building through experience demonstrate shortcomings to be learned from.

Service

The package of services, put together for the Care Support Plus model, was pioneering in the way it drew together three different stakeholders to provide high level wraparound support for a group previously excluded from supported accommodation.

The principal difference of the arrangement was that it enabled NHS staff to be embedded into the scheme itself, through sub-contracting agreements. Having clinical staff based in the scheme meant that customers can receive a higher level of support, and equally it enabled staff to work with different customers.

The two clear differences in staffing in the Care Support Plus scheme compared to more traditional models were the level of staffing, and the presence of NHS staff on site.

Concerning the level of staffing, this meant that the scheme could work with individuals who may previously have been too high risk for supported housing schemes to manage, for example those with forensic backgrounds. Provisions therefore included double staff cover twenty four hours per day. Staff were also required to have prior experience of working with people with mental health problems, and were also supported by risk management procedures embedded in the scheme.

On top of the higher level of staffing provided by the housing scheme, there was also a higher level of clinical input. This meant that more intensive work could be done with residents and issues could be addressed more quickly than if clinical staff were off site.

Among other clinical staff, the care coordinator, psychologist, and Occupational Therapist would be on site each week:

We can sit down with the Deputy Manager and the psychologist and Care Coordinator and work out a plan. In a traditional model you fire off emails and meet in three weeks' time while people are struggling. We can deal with things very quickly and very effectively here.

The high level of support also enabled staff to work intensively on the skills that customers need to develop in order to move on to more independent accommodation.

Feedback from a staff member suggested that this service provided the independence and rehabilitation work needed to empower people towards more independent living. This included intensive work around areas such as boundaries and safeguarding, to provide customers with the skills to avoid incidents such as financial exploitation when they move to less intensive support. As above, the key difference which complements the intensity of the service provided is the speed with which support plans can be put in place when issues arise.

From the customer perspective the most important element of the service from the interview was the activities:

I just think it's brilliant we do an activity every day.

This reflected the work toward skills for independent living and the personal goals that had been achieved by the customer through the scheme. The activities available in the scheme were also compared to the customer's experience of residential care, where daily activities were not available to the same level. This was also reinforced by the customer as they said the availability of daily activities was the main thing for a future development to bear in mind. This reflected that beyond the essential provision of clinical support, there are a wide range of interventions which support and enhance daily life.

Certain shortfalls were also identified in the services provided by the scheme. In particular this included the need renegotiate the exact level of clinical input at the scheme in order to provide customers with the right level of support.

This highlights the need for open dialogue between partners and the role that a joint commissioning can play in bringing about effective support for excluded groups. Overall the member of staff interviewed said that joint commissioning of the scheme addressed a problem which was both costly, and not serving a community which could benefit from a better level of care in supported accommodation.

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