Housing Adaptations: Options for Change and Improvement - An Analysis of Consultation Responses

2 views on current arrangements

Introduction

2.1 The current arrangements for undertaking housing adaptations include following the guidelines set by the Chronically Sick and Disabled Persons Act 1970. The Equality Act 2010 sets out duties for local authorities which prevent those ill, older or disabled people from being at a disadvantage in accessing services. Moreover, guidance has been issued through the Housing (Scotland) Act 2006 with further direction for the responsibilities of NHS Scotland. Currently, there are different funding streams for different housing tenures and delivery arrangements vary both locally and across sectors. Existing arrangements may change in the next few years due to policy shifts e.g. the introduction of self-directed support.

2.2 A number of issues have been raised by the adaptations group on topics such as: the complexity of the system; increasing pressure on the system as demand increases; boundaries between equipment and by those which are funded by health and social care; multiple delivery arrangements; and different arrangements according to postcodes.

2.3 Two questions were asked relating to the current arrangements as follows:

Question 1: Do you agree that there are issues with the current arrangements for housing adaptations, which need to be addressed? If so, has the Adaptations Working Group identified the main issues? Which issues are most important to address?

Question 2: Are there parts of the current arrangements that you think work well and should not be changed?

Views on Issues with Current Arrangements (Q1)

Question 1a

2.4 All respondents felt that there were issues with the current arrangements for housing adaptations which need to be addressed as set out overleaf. There was also overwhelming agreement amongst both service users and organisations at the regional events that changes are needed to the systems for delivering adaptations.

Question 1a - Do you agree that there are issues with the current arrangements for housing adaptations which need to be addressed?
Respondent Type	Yes		No		Not sure
	Number	%	Number	%	Number	%
Housing associations (n=22)	22	100	0	0	0	0
Local authorities (n=20)	20	100	0	0	0	0
Care and repair organisations (n=9)	9	100	0	0	0	0
Occupational therapy respondents (n=6)	6	100	0	0	0	0
Other groups & representative bodies (n=9)	9	100	0	0	0	0
Individuals (n=3)	3	100	0	0	0	0
Total (n=69)	69	100	0	0	0	0

2.5 Despite all respondents agreeing that there were issues with the current system, some respondents felt that the current system worked relatively well in certain areas and there were some who felt that significant change was not required. Even these respondents felt, however, that there were some issues to address;

“Our members have advised that housing adaptations for their tenants generally work well. The main difficulties they have relate to the levels of funding made available and detailed process issues. Our members do not regard the present system as having the fundamental weaknesses that are described and would prefer to see targeted actions to improve matters rather than the “whole system” changes that are rehearsed in the current paper.” (Housing Association/Housing Association representative body)

2.6 The consultation feedback suggests, therefore, that the Adaptations Working Group were right to gather views on the future organisation and funding of housing adaptations for older people and disabled people.

Question 1b

2.7 Respondents were asked whether the Adaptations Working Group had identified the main issues associated with the current arrangements. The majority of respondents (over 70%) felt that the main issues had been identified as set out in the table overleaf.

Question 1b - Has the Adaptations Working Group identified the main issues?
Respondent Type	Yes		No		Not sure/unclear
	Number	%	Number	%	Number	%
Housing associations (n=22)	17	77	5	23	0	0
Local authorities (n=20)	14	70	3	15	3	15
Care and repair organisations (n=9)	5	56	3	33	1	11
Occupational therapy respondents (n=6)	4	67	1	17	1	17
Other groups & representative bodies (n=9)	8	89	1	11	0	0
Individuals (n=3)	2	67	1	33	0	0
Total (n=69)	50	72	14	20	5	7

2.8 The care and repair organisations were the only respondent group for which less than two thirds of respondents agreed that the Adaptations Working Group had identified the main issues. The additional issues noted by these respondents included adaptations in new build housing; the technical knowledge of occupational therapists in deciding on suitable adaptations; the duplication of effort between occupational therapists in the community and hospitals; the need for preventative measures and early adaptations; and the lack of funding for adaptations for owner occupiers or private rented tenants.

Question 1c

2.9 The respondents noted a variety of issues which were important to address with the current arrangements. The most common issues noted in order were as follows:

The level and nature of the current funding arrangements (55% of respondents)

2.10 A large number of respondents made reference to the lack of funding available, particularly given the increasing demand for adaptations in part due to the ageing and growing population and a focus on the personalisation agenda. This highlighted the need to plan ahead to ensure that the increasing demand for adaptations is met.

2.11 Others made reference to public sector spending cuts which would further put a strain on the ability of local authorities and housing associations to meet their duties in this regard;

“Most of the main issues have been identified but insufficient funding is not specifically mentioned yet the RSL budget for adaptations has been cut and the local Housing Association had already committed all of its adaptations.” (Housing Association/Housing Association representative body)

2.12 Another theme raised was that it would be beneficial and more efficient for funding to come from a single source, or at least there should be a streamlining of funding arrangements. This included ensuring efficient and simplified funding for individuals;

“…ensuring efficient funding support. Most specifically, a grants system linked to individuals’ ability to pay and access to simplified supplementary funding i.e. loans, equity release, charitable organisations.” (Care and Repair organisation)

2.13 Other funding issues discussed related to the timing of when funding is made available, clarity on the funding criteria for equipment and the limited budgets available to fund adaptations for owner occupiers. Reflecting this, one respondent noted that funding has become the primary concern for many operating within this area as opposed to meeting the needs of individuals. The point was also made that adaptations can be a effective way of maintaining people in their existing homes and preventing hospital admissions which therefore supports the case for investment in this area.

The complexity of the system (46% of respondents)

2.14 The second most frequently discussed issue with the current arrangements related to the complexity and inconsistencies of the system. A number of areas were noted where the current arrangements were particularly complex not only for clients, but also in some instances for funding and delivery partners. These are summarised below.

2.15 Geographical variations - There is often a local variation in what is eligible and a priority for a grant, as well as inconsistencies in funding across local authority areas. This may lead to a ‘postcode lottery’ for the individual in terms of the time taken to deliver adaptations as expressed below;

“There is a local interpretation of what is eligible for grant award - it should be clear what is and what is not eligible otherwise we have a postcode lottery.” (Individual)

2.16 Tenure variations - This involves the different approaches which currently exist across individual tenures, for instance the waiting times for adaptations for those within the RSL sector in comparison to the local authority or private sectors;

“The most important issue to address is the different, complex and inequitable approaches currently adopted for different tenures. Instead the focus should clearly be on ensuring a holistic view of the needs of individuals irrespective of tenure, with prioritisation of cases based upon clear and consistent criteria and funding coming from a single source.” (Housing Association/Housing Association representative body)

2.17 In addition, there are also often differences within tenures for example the varied approaches adopted by different RSLs / local authorities. This is in contrast to a focus on the needs of the individual regardless of their property tenure;

“There are differences across different tenures but also within tenure type e.g. RSL’s do not all apply for funding in the same way - some apply in anticipation of adaptation needs, some after the need is identified, there are variations between different local authorities in how they approach adaptations.” (Local Authority/Local Authority representative body)

2.18 Number of organisations involved - There are a number of different organisations with a role in this area across the health and social care and housing sectors, instead of one service having ownership of the issue and funding, or having a co-ordinated approach across different partners. This can lead to inconsistencies and inefficiencies and not deliver cost effective services;

“There are many operational and organisational issues affecting the delivery of services and there are a number of geographical, sectoral and tenure-related inconsistencies and anomalies in the current system. Multiple delivery arrangements can be overly complex and lead to inefficiencies, inconsistencies and lack of cost-effectiveness.” (Local Authority/Local Authority representative body)

2.19 Impact on time taken to deliver adaptations - The complexities of the system often leads to delays to the funding of equipment maintenance, repair and replacement. This is often the case even for relatively minor adaptations.

2.20 Variety of legislation and guidance - The variety of legislation and guidance covering the current arrangements is confusing for both individuals and organisations;

“There is a variety of legislation and guidance governing the present arrangements and therefore as well as any proposals to revise structures and arrangements for delivery, it is essential that the statutory frameworks are capable of supporting the delivery. It would therefore be helpful to have a simplified legal and policy framework for the provision of adaptations.” (Local Authority/Local Authority representative body)

2.21 The complexity of the delivery systems for housing adaptations and the need for one system for everyone was also raised during the regional consultation events.

The need for better communication, advice and training (15% of respondents)

2.22 Linked to the issue of the complexity of the current system, around 15% of respondents felt that one of the key issues to address is to provide better communication, advice and / or training in the field of housing adaptations. This would be appropriate not only for clients but also partners operating in this area.

2.23 Respondents suggested a variety of forms which this advice, training and communication needs to take including:

• A co-ordinated communication, advice and assistance service for individuals to understand and navigate the system;
• Training for individuals in their responsibilities, use, servicing and maintenance of equipment once adaptations have been delivered;
• Maximising the number of people who receive the necessary tailored assistance to suit their requirements;
• A greater emphasis on links to the self-directed support agenda;
• More communication between all the agencies concerned; and
• Training to enhance the understanding of the law and ensure consistency amongst organisations operating in the area of adaptations.

2.24 The quote below highlights the need for better communication and advice for individuals

“We believe there are a number of current issues to be addressed…. Including: clear information on rights and grants (now and future, improved arrangements); advocacy and trained befriending to assist /steer individuals through complex system; similar information, advocacy and advice for carers; and improved marketing of rights and services available.” (Other group / representative body)

2.25 The quote below highlights the need for a greater understanding of the law on housing adaptations provision amongst organisations operating in the field.

“There needs to be a much better understanding of the law on adaptations provision - a complex area involving both housing and care legislation. We would offer two examples of poor understanding of the law (examples provided relating to housing association tenants being able to apply for a grant under the Housing (Scotland) Act 2006 and the duties of local authorities to provide adaptations under social work legislation notably the Chronically Sick and Disabled Persons Act.” (Other group / representative body)

2.26 The need for a single point of contact, ensuring that people know about their entitlements and who can advise them was also raised during the regional consultation events. Some specific feedback at these events also suggested that it would be good to have showrooms for adaptations or places where people could try out adaptations enabling them to see and experience what is available. A further point raised is that wardens in supported accommodation can be a good source of information and advice to make people feel safe.

Other Issues

2.27 A number of other issues were noted by respondents including those set out below.

• The need for implementation at a local level to reflect best practice relating to self-directed support, rather than simply being an ‘add on’ to existing systems / procedures;
• Ensuring that there is clarity on the boundaries between major and minor adaptations and equipment;
• Ensuring the appropriateness of what is delivered, focusing on listening more to the people who need the adaptation, designing more user friendly adaptations and ensuring that architects have a clear brief about what is needed;
• Prevention needs to be highlighted and focused on as this would save resources in the longer term. This would also have better outcomes for the individual;
• Unrealistic expectations of what can be done to adapt some properties and the difficulties and appropriateness of persuading people to move to accessible new build properties;
• Definitions used, with adaptations classified differently in different budgets in social work and housing and different funding for installation and maintenance;
• The timescales for receiving adaptations; and
• Issues with a number of areas of the assessment process, including inconsistency across organisations in terms of how needs are assessed; a need for a wider range of staff to contribute to the process to ensure that resources are targeted towards those in greatest need; and the need to focus on individual needs rather than adhere strictly to guidance.

Views on Positive Aspects of the Current Arrangements (Q2)

Question 2a

2.28 Despite all of the respondents agreeing that there are some issues with the current system, almost all also felt that there were parts of the current system which work well and should not be changed. This was the case across all respondent categories, with the exception of other groups and representative bodies.

Question 2a - Are there parts of the current arrangements that you think work well and should not be changed?
Respondent Type	Yes		No		Not sure/unclear
	Number	%	Number	%	Number	%
Housing associations (n=22)	21	95	1	5	0	0
Local authorities (n=20)	19	95	0	0	1	5
Care and repair organisations (n=9)	8	89	0	0	1	11
Occupational therapy respondents (n=6)	6	100	0	0	0	0
Other groups & representative bodies (n=9)	4	44	2	22	3	33
Individuals (n=3)	2	67	1	33	0	0
Total (n=69)	60	87	4	6	5	7

Question 2b

2.29 The respondents noted several elements of the current systems which were working well, particularly at the local level through the work of specific organisations, individuals and partnerships. The most commonly noted areas were as follows:

• Instances where a partnership approach or joint working has been adopted to assessing need providing advice and delivering adaptations (39% of respondents). Examples provided of a partnership approach include where care and repair organisations work in collaboration with local authorities, where there are good links between housing and surveying professionals and occupational therapists and where local adaptations partnership / advisory groups have been formed;

“The current assessment process through dedicated Housing OTs is an approach that works well (in our local area). This process allows for better joint working across Health and Housing Services and allows a holistic approach to be taken to the need for adaptations which includes consideration of Housing Options and housing need and demand.” (Local Authority/Local Authority representative body)

• The role of the occupational therapists in the assessment process (32% of respondents). Where the role of occupational therapists was highlighted, it was felt to bring a more holistic understanding of the needs of an individual as it is part of a wider assessment of individual care and support needs. This is highlighted in the response below;

“Assessment by occupational therapists (OTs) work well due to the holistic nature of an OTs assessment and their appreciation of social care and health issues. The use of OTs should be expanded upon.” (Individual)

• The work of care and repair organisations in the process (28% of respondents). The work of care and repair organisations in terms of assisting clients to undertake adaptations and providing information and advice was highlighted;

“The involvement of Care & Repair is essential. Not only do Care & Repair possess the necessary technical skills required to manage the adaptation process but they also have the essential “caring” aspect that customers need and fully appreciate. It cannot be overlooked that Care & Repair are impartial with no budgetary constraints nor waiting time targets having services that are built on the cornerstones of trust, flexibility and choice for the customer.” (Care and Repair organisation)

• Where there is good local knowledge of the individuals needs of clients and a person centred approach is adopted (12% of respondents). Examples were provided where good local knowledge was applied for instance through the work of care and repair organisations or the knowledge of their stock and tenants by housing associations.
• The grant element of the current system, some local approaches to procurement and grant assistance and the grant level of the current system with regards to the private sector.

2.30 A number of other examples were also provided such as instances where there are self referrals for minor adaptations; where organisations have been proactive in front funding a programme of adaptations; where adaptations work with the housing provider’s investment and improvement programmes; and the wide ranging experience of individuals working in this area.