Adapting for Change: evaluation

Chapter 7: 'Tenure neutral' with a single funding pot

AWG recommendation: A strategy for housing adaptations, which is 'tenure neutral' with a single funding pot.

The AWG took the view that access to the financial support associated with adaptations should no longer be governed by the tenure of someone's home and that there should be a move to a single funding pot for adaptations, with the grant funding system revised so as to be tenure neutral. They also suggested that arrangements that allow people to use equity in their homes for adaptations could be helpful in enabling them to plan ahead and ensure their homes meet their needs into the future.

None of the five test sites was looking at an equity-release specific test of change. However, the Scottish Government's Help to Adapt initiative encouraged homeowners over 60 years old to consider making alterations to their property to ensure it continued to meet their future needs. The Help to Adapt scheme was piloted for 2 years and has recently come to an end.

Key research evidence

There was broad agreement from across the test sites that a tenure-neutral adaptations service was a desirable goal and that, as far as possible, people should be offered an equivalent if not identical service irrespective of the tenure of their home. Given this, much of the work being taken forward by the test sites (such as the one-stop-shop option discussed in Chapter 5 and the development of single pathways discussed in Chapter 6) has looked to eliminate unfair variations in practice.

This chapter focuses on views on current funding arrangements and the work the test sites have done in relation to those arrangements.

Particular challenges to be addressed

Current funding arrangements were seen as fundamental drivers of varying practice; almost universally, key stakeholders from across housing, social care, health and the third sector felt there was a need for change. Not only did key stakeholders tend to see funding arrangements as something which needed to be addressed, a number of the current and former users of adaptations services also suggested that this was an area in which they would like to see changes.

The most frequently-held view amongst key stakeholders was also that the overall approach should be refocused so that individual need is the key determinant of the extent of, and any need to wait for, public funding. It was sometimes noted, primarily by housing key stakeholders, that this would require a review of the Scheme of Assistance arrangements, including the legislative framework which underpin those arrangements.

Funding arrangements had often been the subject of much discussion within the Project Boards but were also seen as a particularly difficult area in which to achieve transformative change. For some, such transformative change was seen as being required and this issue is discussed further below. In the meantime, the focus of the test sites has tended to be on considering or making those changes which can be taken forward without the need for a fundamental redesign of the public funding of adaptations in their area.

Housing Association funding of adaptations

The funding arrangements for housing associations were seen as a long-standing issue; this was sometimes because these arrangements were seen as having the potential to disadvantage housing association tenants if the monies available within any financial year are not sufficient to cover the adaptations required by tenants. This was often explained as the funding 'running out' in the latter part of the financial year.

The current funding arrangements were also seen as a potential obstacle to the introduction of a tenure-neutral single funding pot. This was because, unlike the funding associated with private sector or local authority adaptations, funding for housing association adaptations is not part of the delegated budget at the disposal of the IJBs.

There was a range of views both in terms of the nature of the problem and the most appropriate solutions. They included that:

• Most housing association key stakeholders said that the funding currently available (generally reported as Scottish Government provided funding), is not usually sufficient for the whole financial year. Many were concerned that need and demand for adaptations to their stock is rising but that levels of public funding are unlikely to increase accordingly.
• Most housing association key stakeholders reported that their organisation was funding minor adaptations up to a certain value (varying from £100 to £300 per adaptation) and also carried out maintenance and repair work to adaptations from within their repair budget. This form of contribution towards the funding of housing adaptations was generally seen as being reasonable.
• There were mixed views on whether or how any 'housing association-specific' funding deficit should be addressed, with housing sector respondents most likely to have a view. A small number of key stakeholders, including most of those from housing associations, suggested that public funding levels need to increase. However, a small number of other key stakeholders, and particularly those from the local authority housing sector, took the view that housing associations should be looking to make a greater contribution from their own resources.

In terms of changes made to date, one test site has introduced a single pot approach, with housing association allocations held by the local Care and Repair service, with Scottish Government approval. The partners have agreed that priority for funding will be given to those in greatest need. In another of the test sites, a group of locally-based housing associations have discussed but not proceeded with options around making a joint application to the Scottish Government for area-based funding. There were in any case some concerns from housing association key stakeholders that such an approach could simply introduce an additional level of bureaucracy but otherwise make little fundamental difference.

Top up contributions

Along with service users, a number of key stakeholders working in frontline services (including housing, social care and the third sector), raised the issue of top up contributions. These top up contributions may be required from those living in the private sector - people are entitled to a 100% grant only if they have been assessed as needing an adaptation and receive certain benefits. For others, grants are generally for 80% of the cost of the work with the home owner or private renter required to cover the remaining 20%. However, local authorities do have discretionary powers to top up the grant. Each area's approach is set out within their Scheme of Assistance.

Both service users and key stakeholders working in frontline services provided examples of specific instances of people struggling to raise the funds to make their required top up or other contribution. The sums cited varied considerably (from a few hundreds up to many thousands of pounds) but the overall impact tended to be the same in terms of causing anxiety and, in some cases, considerable distress. It was also noted that this anxiety is likely to affect not only the person needing the adaptation but other members of the household and/or their carer(s) as well.

There were both first and second-hand reports of the time taken to raise the necessary funds sometimes being lengthy, with monies coming from a range of sources, including: gifts or loans from family or friends; redundancy or compensation payments; contributions from charitable bodies or funds; and, very occasionally, from releasing equity in their property. There were occasional reports of people's circumstances deteriorating significantly over the time taken to raise the funds and, in one case, someone felt that a lengthy stay in hospital had been the direct result of funding-related delays to having their home adapted.

In terms of the support people had received around raising any top up contribution, reports were varied. In general, where service users had been in contact with a Care and Repair service they had received advice and in some cases practical assistance. In a small number of cases, a financial contribution had been given, although the services involved stressed that they did not themselves have the resources to do this except in extreme cases. Where homeowners had not been in contact with a Care and Repair or other support service, they had sometimes found it extremely difficult to find the money required.

This issue of supporting people to cover top up contributions was one about which a small number of key stakeholders, and particularly those most directly involved in trying to help people who were struggling, often felt very strongly. These key stakeholders, along with a number of others, generally felt that more should be done to support people. However, they sometimes felt that there was a limit to how much more can be done within the current structures and resources, and in some cases, that limit has already been reached. For many, and in particular for third sector and housing key stakeholders, the solution was increasing capacity within the services offering support. However some of these key stakeholders also saw the problems around top up contributions as pointing, again, to the need for a fundamental review of the approach to funding adaptations.

Enabling those who wish to pay for work

Whilst the need to make a financial contribution had caused considerable problems for some, if people had the necessary resources they were often very willing to contribute. In some cases, and particularly in relation to smaller works, this extended to suggesting they would happily have made a larger contribution or would have paid for the works in full if their local system had allowed. There were also examples of people exiting the process because they did not wish to undergo a financial assessment.

A number of key stakeholders, and in particular housing sector stakeholders, expressed frustrations at people being routed through unnecessary and often time-consuming assessment processes when this could be avoided. In one of the test sites, looking at ways to either avoid or at least streamline financial assessments for those happy to cover the costs is part of the on-going pathways redesign process (discussed at Chapter 6).

Works covered by grants

Although discussed only occasionally, a small number of key stakeholders, and particularly social care stakeholders, raised concerns about the types of work that are or are not covered by mandatory and/or discretionary grants. The issues raised tended to be complex and individual to each case; examples cited included cases of families needing major works to an owner-occupied house in order to meet the needs of children with a disability and/or degenerative condition. The more general and underlying concern tended to be that the type and extent of the work which can be funded is dependent on tenure rather than even the most extreme of needs.

As with the top up contributions, it was sometimes noted that review of the arrangements for the types of works covered by grant would most sensibly form part of a more fundamental review of the whole approach to grant funding for adaptations.

Streamlining funding arrangements and single funding pots

Irrespective of whether a test site had been looking specifically at funding processes, there was broad agreement that the current arrangements were not fit for purpose and are a key driver of inequity within the system.

However, there was a very honest recognition from some, particularly within local authority housing services responsible for delivering and funding adaptations, that the current approach is generally working well for them and their tenants. Whilst not necessarily dismissing the case for change, there was a view that any changes should not be about 'averaging out' levels of grant and the associated processes, but should be about considering how the funding arrangements for everyone can be brought up to the level of those for whom the current system works best.

Although views were mixed in terms of the best way forward there were certain key themes which emerged; many of these spoke to the on-going challenges associated with moving towards a single funding pot and to a view that, while smaller, incremental changes in this area may have merit, greater tenure-neutrality is only really likely to be achieved through more fundamental change. Particular issues to emerge were:

• Very much in line with the concerns around whether adaptations and preventative services are already or will be a priority for the IJBs in the short to medium term (as discussed in Chapter 3), there was a concern that existing levels of funding for local authority and private sector adaptations could be vulnerable.
• Concerns about adaptations funding 'disappearing' into the comparatively large pooled budget pot associated with Health and Social Care Integration were common. Staff in council housing, private sector grant teams and housing associations were sometimes worried that adaptations would not be given a high priority relative to the other challenges facing Health and Social Care Partnerships. A small number of these key stakeholders felt that some form of ring-fencing of adaptations budgets would be desirable. However, others were of the view that this was at odds with the fundamental principles underpinning Health and Social Care Integration.

In many ways, the more fundamental concern was that any shortfall in existing levels of funding will not be solved simply by 'evening out the problem' - whether between housing associations through some form of a pooled budget or through a cross-tenure single funding pot - but requires a whole-system review of the resources available and how they can be put to best use. It was also noted that this would be most appropriately carried out as part of a wider review of prevention-focused spend.

The scale and complexity of this undertaking was well understood. It was felt that it was an issue that needed to be taken forward by the full range of health and social care partners. With specific reference to the adaptations-related component, particular issues identified as needing to be considered were: the implications of, and opportunities offered by, Self-directed Support; the Scheme of Assistance and whether it is, or will remain fit-for-purpose; and the return on investment delivered by adaptation-related spend.

On this latter issue, an example given was around making the connection between the resources required to carry out an adaptation compared to the very considerable costs associated with a move into specialist residential care because someone's home is no longer fit-for-purpose. However, whilst it was sometimes seen as the best way forward, those key stakeholders who raised this issue generally did not expect their area to take such a 'whole-systems' approach in the short to medium term. Yet again, concerns about the relative priority being given to prevention-focused services by local Health and Social Care Partnerships tended to be driving these concerns.

Given the range of concerns raised, along with the understanding that significant changes to the funding arrangements are as yet untested, it is perhaps unsurprising that many key stakeholders were looking for support on this issue. In particular, it was a frequent suggestion that the Scottish Government could become involved. Varying suggestions were made including that:

• The Scottish Government should take measures which would enable or even require the ring-fencing of adaptations budgets. However, others noted that while they might have sympathy for this position, it was at odds with the ethos behind and arrangements underpinning Health and Social Care Integration.
• The Scottish Government, supported by a range of other key agencies across housing, health and social care, should continue to send very clear messages about the importance of prevention-focused services. Whilst recognising that this may already be the case, many of those key stakeholders who commented on this issue suggested that this message is not necessarily influencing the priorities being set by IJBs. Those who were aware of the situation in other local authority areas besides their own also tended to the view that this was a common problem across Scotland.

Summary conclusions

Despite the broad consensus that change was required, many key stakeholders also saw funding arrangements as an area in which their own test site had made limited progress; where some changes had been made, these were generally seen as beneficial but as not tackling the more fundamental changes that would be required to create a tenure-neutral approach.

Overall, it was clear that the AfC initiative has 'shone a light' on funding arrangements being at the heart of creating an equitable, tenure-neutral approach. While there have been positive changes - in terms of looking at ways of pooling housing association budgets in particular - more fundamental changes are yet to be tested.

Although views on this issue were both diverse and nuanced, there was a broad agreement that this will be a challenging area to take forward, particularly at a time when budgets are already tight and when people are concerned about the possibility of existing monies 'disappearing' into a Health and Social Care Integration pooled budget. Critically, and as across so many of the issues covered under this evaluation, concerns about the lack of focus on preventative services were central.