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

3 views on proposed streamlining changes

Introduction

3.1 The Adaptations Working Group has identified some relatively minor streamlining changes, which could be adopted within the current organisational and funding arrangements. The improvements identified relate to:

• Information and advice;
• Planning ahead;
• Self-help and self-referral;
• Design;
• Maintenance and replacement;
• Links to repairs;
• Recycling of adaptations; and
• Procurement.

3.2 The question which was asked in relation to streamlining changes was as follows:

Question 3: Which of these minor (streamlining) changes do you think would improve the current arrangements for delivery of adaptations? Why?

Do you think these changes would be sufficient to address the issues?

Views on Proposed Streamlining Changes (Q3)

Questions 3a and 3b

3.3 Respondents were asked which of the minor streamlining changes they felt would improve the current arrangements for the delivery of adaptations as set out below.

Question 3a - Which of these (minor) streamlining changes do you think would improve the current arrangements for delivery of housing adaptations?
Improvement	Change referenced in response		Change not referenced in response
	Number	%	Number	%
Information and advice (n=69)	53	77	16	23
Planning ahead (n=69)	39	57	30	43
Self-help and self-referral (n=69)	40	58	29	42
Design (n=69)	36	52	33	48
Maintenance and replacement (n=69)	38	55	31	45
Links to repairs (n=69)	30	43	39	57
Recycling of adaptations (n=69)	37	54	32	46
Procurement (n=69)	36	52	33	48

3.4 Nearly 40% of all respondents felt that all of the changes would improve current arrangements. In addition, all but one of the suggested changes (links to repairs) were supported by over half of the respondents. The most commonly identified changes were: information and advice; maintenance and replacement; self-help and self-referral; and planning ahead.

3.5 Each of the proposed changes are considered in turn, including an assessment of why respondents supported each of these and the benefits which they could bring.

Information and advice

3.6 Over three quarters of respondents felt that information and advice would improve the current arrangements for the delivery of housing adaptations. In particular, a more co-ordinated and widespread delivery of information was considered to be beneficial;

“Improved information and advice is essential in the short to medium term and would help customer awareness and understanding of existing complex arrangements. It is crucial now and will remain so whatever system might eventually be introduced.” (Other group or representative body)

3.7 There were a number of benefits mentioned relating to providing information and guidance, including:

• Providing clarity on the responsibility and process for individuals and agencies and preventing confusion e.g. by having a single point of contact for adaptations services;
• Improving customer awareness about their entitlements and increasing accessibility for those that need the adaptations;
• Ensuring an equitable provision of adaptations across all sectors;
• Helping people navigate their way through the system and be better informed of long term housing options before making decisions;
• Moving control and responsibility to the client (links to the personalisation agenda);
• The benefits of linking more closely with the Housing Options hubs to ensure better quality information; and
• The usefulness of the expansion and roll out of the database on accessible, adapted housing.

3.8 There were a number of views expressed about the nature of the information and guidance to be provided, with common themes including:

Information needs to be more widely distributed (e.g. in hospitals and doctors surgeries);

The information should be consistent in the advice which it provides and ensure that clients have all of the information they require to access and fund adaptations (e.g. standardised advice across a local authority area rather than by individual landlords and a ‘one stop shop’ service); and

• It needs to be more simplified, accessible and easily understood including for people with disabilities and clients for whom English is not their first language.

Planning ahead

3.9 The need to effectively plan ahead including factoring in the principles of good design at the construction or redevelopment stage was considered important by almost 60% of respondents;

“Planning ahead giving due cognisance to the nature of the disability, prognosis and likely changing needs of the individual due to their condition in the medium to longer term is particularly important.” (Local Authority/Local Authority representative body)

3.10 Reasons given for why planning ahead is important include:

• Cost effectiveness where housing providers can deliver adaptations as part of new build or retrofit schemes and as part of an ongoing asset management strategy which will assist in reducing the need for costly adaptations at a later stage;
• Better outcomes for the individual, including preserving service user’s independence, preventing falls and deteriorations in health, ensuring that the property meets their needs over the longer term and helping in the anticipatory care planning for individuals; and
• It would result in a more effective systematic approach, particularly predicting/anticipating needs of those clients with a long term diagnosis.

3.11 Some suggestions were made for how this could be implemented, including involving occupational therapists in the design of new build housing which may prevent design flaws, for instance in homes designed for wheelchair users.

3.12 Other suggestions included housing health checks and a promotional campaign to highlight the issues to be considered when downsizing such as: location; local facilities; type of house; internal and external stairs; bathing; and toileting facilities. In addition, properties with housing adaptations could be promoted in a more positive way by providers, estate agents or solicitors.

3.13 Some respondents were unsure, however, about how achievable this was on a significant scale given the operational and budgetary challenges currently facing many organisations (e.g. funding to meet even priority needs is considered inadequate by some). It may conflict with existing arrangements that place a large focus on targeting resources to those in greatest need rather than a preventative approach. In addition, it was referenced that many people are largely unable or unwilling to plan ahead and therefore move to inappropriate housing.

Self-help and self-referral

3.14 Improvements identified relating to self-help and self-referral were considered important by almost 60% of respondents;

“This suggestion has significant merit and would address some fundamental issues in the delivery of adaptations. Increasing the availability of self-assessment, and the choice of service users to ‘self-help’ would mean that low level needs are met, the delivery of simple adaptations is speedy and efficient, and that Occupational Therapists and other professionals can concentrate on more complex needs and cases.” (Local Authority/Local Authority representative body)

3.15 Reasons given for the self-help and self-referral improving arrangements include:

• Many clients are capable of determining their own needs, particularly with regards to minor adaptations;
• It could reduce pressure on occupational therapists and enable them to concentrate on more complex needs and cases;
• It could speed up delivery and be more efficient, particularly in cases of low level adaptations;
• It increases choice for clients and gives them more control / empowerment over their personal situation; and
• There are close links to the prevention agenda which enables a much more sustainable system over the longer term.

3.16 Two examples were mentioned whereby self-help and referral is already taking place and is working well. Respondents did however suggest that this would bring some resource implications and issues to consider. As an example, it was suggested that a different information and advice infrastructure than is currently available would be required. It may lead to increasing pressures on funding and present management and auditing challenges. In some cases, individuals (for example older and vulnerable adults) may require support and advocacy to help them to develop the capacity and confidence to take account of value for money and long term needs. Finally, any moves towards self-referral need to be weighed against losing the input of the expertise of occupational therapists.

Design

3.17 Just over 50% of respondents identified design as improving the current arrangements for the delivery of adaptations. Reasons provided and points made regarding design included:

• Designs would benefit from greater consultation and advice from the individuals themselves and occupational therapists to improve layout, flexibility and functionality and ensure that properties are fit for purpose to meet the changing demands of clients;
• The design and forward planning undertaken by landlords during new build and retrofit schemes will assist in reducing the need for costly adaptations at a later stage;
• More attractive / aesthetically pleasing adaptations would mean that more people would want them and mean that they are more ‘recyclable’ and are not removed from adapted housing; and
• Correct design would contribute to avoiding unnecessary removal of the adaptation and facilitate early re-occupation.

3.18 Whilst the value of good design was referenced throughout the consultation responses, the importance of value for money considerations in design was also mentioned. This involved the need to take into consideration the funding limitations of customers and service providers.

Maintenance and replacement

3.19 Over half of the respondents felt that changes to maintenance and repair would improve the current arrangements for the delivery of adaptations. The reasons noted for this included:

• The need to eliminate inconsistencies across tenures in terms of costs and processes;
• Reducing waste;
• Ensuring better informed access to the service; and
• Delivering a more cost effective service.

3.20 A recurring theme of these responses was the need to provide better information to make clear the responsibilities of the home-owner regarding maintenance and replacement.

Links to repairs

3.21 Just over 40% of respondents felt that changes to links to repairs would improve the current arrangements for delivery of adaptations - the least for all of the improvements. The key reasons provided were as follows:

• The close links between housing repairs and adaptations; and
• Maintaining the property of clients remaining in their own homes is a key priority.

3.22 A few respondents highlighted the need for these changes to be supported by suitable funding streams, which may include a maintenance loan / national lending unit.

Recycling of adaptations

3.23 Just over half of the respondents felt that changes to the recycling of adaptations would improve the current arrangements for the delivery of adaptations. The key reasons provided were as follows:

It would be cost effective;

It would make use of removed adaptations where there are difficulties in re-housing tenants who require adapted properties.

3.24 The consultation highlighted that there are costs associated with servicing the equipment, cost of removal/re-installation and administration as well as issues relating to storage, appropriateness and who funds the initial outlay. It was also suggested that a co-ordinated national or regional approach to recycling was required and that improved partnership working between RSLs and local authorities and the identification and creation of equipment stores would be beneficial.

Procurement

3.25 Just over 50% of respondents felt that improvements identified relating to procurement would be beneficial. Reasons provided included:

• The bulk purchase of common adaptations could lead to savings;
• It could reduce waste;
• It could ensure better informed access to the service.

3.26 The process of bulk procurement has already taken place or is being considered in some parts of the country for small adaptations e.g. grab rails, ramping, installing and maintaining stair lifts. The consultation revealed some challenges and issues relating to this, including bulk procurement across rural areas and the need to carefully prevent waste and storage issues from developing. One response suggested that improved guidance for how local authorities can bulk procure for adaptations would be helpful.

Question 3c

3.27 The respondents were asked whether they felt that these changes would be sufficient to address the issues within the current arrangements. As set out above, in most cases the majority of respondents felt that the suggested changes would improve the way in which adaptations are delivered with a number of benefits to the proposals. Indeed, some respondents suggested that some of these approaches are already being implemented in their local areas;

“All of the changes mentioned would improve delivery and in our LA areas many have already been implemented with notable results. For instance, due to resource limitations, Care & Repair are only able to project manage OT/grant supported cases. However, we are available for information and advice for self supported adaptations and this assistance enables people to negotiate the system by being suitably informed of procedures and referred to reputable external organisations i.e. contractors, consultants.” (Care and Repair organisation)

3.28 A few respondents also stated that these changes may not be as minor or straightforward as suggested in the consultation paper, for instance a move to planning ahead, and a focus on expenditure on prevention and early intervention would be a major change in some areas and further information on these arrangements would be required;

“The proposed streamlining changes would improve the current arrangements but consideration needs to be given to supporting their implementation which may be complex and require significant cultural change among service providers and the expectations of customers.” (Local Authority/Local Authority representative body)

3.29 Nearly all of the respondents who answered this question, regardless of their background, felt that whilst beneficial, these proposed changes would not be sufficient to address all of the issues associated with delivering housing adaptations. It was felt that there were also wider issues that would need addressing or other considerations that could further improve the way in which housing adaptations are funded or delivered. The quote below provides an example of this;

“There is merit in all of the minor streamlining changes proposed. Each has potential to make minor improvements to existing arrangements…None of these changes, nor indeed any of the others suggested in the consultation, fundamentally address the issues of complexity, inequality and lack of a holistic approach within the current system, but all could go some way to improving the current system and would be essential components in any new cross-tenure approach.” (Other group/representative body)

3.30 There were a number of other fundamental issues noted such as the overall complexity of the current system, the funding arrangements, a greater emphasis on the personalisation agenda, and the issue of access to adaptations based on tenure.