Response to West Sussex County Council's Consultation on the proposed cuts to the Housing Related Support budget and reduction of the Local Assistance Network budget November 2018
What is being proposed? West Sussex County Council announced in its Forward Plan that due to extreme financial pressures it proposed to cut its £6.3m Housing Related Support budget and reduce the Local Assistance Network budget from £800k to £200k. Due to lack of Central Government funding and increasing demands on services WSCC have a direct need to make £74m savings. In 2003, funding for Housing Related Support was transferred from the Department for Work and Pensions (DWP) to Local Government under the Supporting People programme. £17m per year was transferred to West Sussex. In 2011, the ring fence was removed from this funding. By 2017/18 it had been reduced to £6.3m.
Around 10 years ago the DWP transferred the Social Fund to Local Government which WSCC used to create the Local Assistance Network (LAN) to provide crisis support. This has reduced over time from £1.4m to £0.8m.
What have we done? As soon as the proposed cuts were announced Turning Tides proactively joined with 16 other Housing Support providers to form a Coalition. The Coalition has issued a collective report on the impacts of the proposed cuts affirming that for every £1 of WSCC's funding there are nearly £7 avoided costs. This doesn't just relate to Turning Tides - it has far reaching demonstrable consequences on a range of services such as; adult and young people services, homeless prevention and offender and domestic violence services. After the initial shock of the announcements WSCC agreed to an extension of Contracts Housing Related Support by 6 months to 1st October 2019 and put in place a consultation process. The Cabinet Member, Amanda Jupp, will make the decision following a debate at the Health and Adult Select Committee held on the 12th December 2018. This document and the information contained herein is our formal response to the Consultation.
What does this mean for Turning Tides? Turning Tides has recently rebranded from Worthing Churches Homeless Projects. Our mission is to end local homelessness. Our core services are in Worthing but we stretch out to Horsham, Littlehampton and Mid Sussex. Our focus is to help anybody who is homeless, sleeping rough or insecurely housed to gain full independence. We have a sophisticated pathway of services from initial engagement in our hubs, specialist supported housing and move on. We have over 100 staff, 300 volunteers and a turnover of £3.5m. We currently receive £271k in Housing Related Support grant for 3 supported housing projects which have 67 beds combined, 53 of which are high support. We use this grant to maximise Housing Benefit income. We can claim higher rates of Housing Benefit if we provide high support. The loss of the grant would effectively leave us with 38 lower support beds – a loss of 53 high support beds and £583k in Housing benefit. That equates to a total loss of £854k – a quarter of our annual income.This would have 2 main impacts: Loss of 53 high support beds will translate directly to increased rough sleeping of our most vulnerable clients and pressure on WSCC, Housing Departments, Police, A&E and mental health services as the majority will have “statutory needs”. It will rip out the heart of our homelessness pathway, destabilising our effectiveness across all our services. The impact will ripple through the sector undermining the coherency of current service delivery.
As an established charity of over 25 years we are exceedingly proficient and efficient. We continue to strengthen and develop our services ensuring that we are cost effective. The weekly rate for one of our beds to WSCC is £78 whereas the cost of residential care is easily over £800 per week. As the following case studies emphasize, there need only be a handful to be dealt with by WSCC to negate the financial benefit of the cuts.
EXTERNAL AGENCIES & COMMUNITY PARTNERS
COMMUNITY HUBS
67 WSCC funded housing support beds
RECOVERY PROJECT MOVE ON PRIVATE RENTAL SECTOR
SOCIAL HOUSING
Impacts of losing ÂŁ271k WSCC Housing Related Support funding Undermines government strategy to end rough sleeping by 2027 and local statutory objectives
c.a £300k grant to Worthing from central government to reduce rough sleeping could be put at risk due to numbers increasing.
Increases demand on limited housing resources Annual throughput of 191 clients across 67 beds funded by WSCC. Cuts would reduce residential beds to 38 with loss of 53 high support beds at a time of a housing crisis with already extensive waiting lists for social housing.
Impairs pathway out of homelessness We achieve 84% positive move on rates within our residential services. Clients are given a pathway out of homelessness to sustainable independent living. Funding cuts will impact service delivery across all our projects.
Saving lives & reducing deaths 13% of our cases hit statutory safeguarding levels. Our intervention avoided 12+ deaths. BIJ reported 449 homeless people died 12 months since October 2017. Increased pressure on adult safeguarding to review every death.
Disability services stretched 14% of clients have a Learning Disability such as autism. Their vulnerability would increase if made homeless, necessitating extensive WSCC funded Social Care services.
Third sector integral to delivery Without third sector providers, public services will have difficulties delivering on statutory duties.
Most vulnerable at greater risk 81% of our clients have mental health difficulties. Majority of which have not been able to sustain engagement or interventions with external services.
Untenable pressure on Police 66% of our clients have offending history. Without our intervention and support criminal and anti-social activity will undoubtedly increase, placing serious demand on overstretched police force. Our residential services reduced offending rates by 77%.
Increased poverty, deprivation & crime
Number of vulnerable homeless individuals will increase thereby placing untenable pressure on existing services, risking public safety. For example, 80% of our clients have an addiction. There is a well known connection between addiction and theft, which will increase if we cannot help people out of addiction.
Health services put under more pressure 42% of our clients have long term health problems. Rough sleepers are more likely to attend A&E regularly or be admitted to acute mental health services. This will cost health services more and increase referrals to WSCC Social Care. The general public will have to wait longer to be treated.
CASE STUDY
CLIENT S MALE AGED OVER 50 PRIVATE RENTAL
Diagnosed bi-polar Long-term alcoholic Liver cirrhosis Periphery nerve damage Reduced mobility Severe chronic pain Double hip replacement Possible recent stroke
External agencies identified high risk of possible death Safeguarding concerns raised by social workers, CGL practitioners and paramedics Repeated hospital admission refusal Failure to take essential medication No engagement with CMHT
Interventions instigated and outcomes achieved A home visit was conducted following concerns raised by his family and Social Work Co-ordinator. This led to a safeguarding concern related to the high risk of death due to the complexity of S's complex physical and mental health needs. Turning Tides worked with his adult children to encourage essential hospital admission. Whilst admitted to hospital an undiscovered brain haemorrhage and undiagnosed blood condition was found, requiring a 3 week hospital admission to receive treatment. A community care assessment in hospital resulted in a package of care being devised. Turning Tides' Social Worker mobilised and co-ordinated a mutli-agency response to S' complex needs. Risks were mitigated by admission to the Recovery Project where he received frequent specialist intervention.
Likely impact and costs to WSCC following budget cuts Likely to have died in private rented due to unaddressed complex health needs. Long-term complex ill health ie possible brain damage and/ or blindness. Statutory duty to provide long-term residential care. Longer hospital admission required if he was unable to access our specialist residential support.
ESTIMATED COSTS TO STATUTORY IF 100% HOUSING RELATED CUTS Social Care Bill for 15 years at £839 per week = £654,420 Longer hospital admission as lack of external support = £6,216 TOTAL TURNING TIDES SAVED STATUTORY SERVICES
= £660,636
CASE STUDY History of alcohol abuse Diagnosis of terminal lung cancer
CLIENT J
Complex health support needs Future need for end of life care
MALE AGED OVER 50 PRIVATE RENTAL
Interventions instigated and outcomes achieved Well known to Turning Tides over a 20 year span, client J presented to Turning Tides with terminal lung cancer, requesting to return to the Recovery Project. He cited it as the only place that "ever really felt like home". Despite this being out of our scope it was considered the right thing to do for the client. J moved into the Recovery Project where the team focused on maintaining his quality of life for as long as possible whilst allowing him the opportunity to die with dignity. Over a three month period his condition and medication was managed by the team, along with the Community Palliative Care Team. This enabled him to engage in the community. Sadly J developed secondary brain cancer which made it difficult to manage his condition towards the end of his life. The time in our Recovery Project gave him the opportunity to reflect on life, play the guitar again and enjoy his music. He rebuilt relationships which his family giving closure to both himself and them. The last week of his life was spent in hospital due to increasing health needs. Staff and clients frequently visited during his final days.
Likely impact and costs to WSCC following budget cuts Our proactive and flexible intervention ensured the client's needs were met but also made considerable savings for statutory care. If the client had not moved into our accommodation those 3 months would have been at the cost of statutory sector provision. The client resided with us for 12 weeks which would have cost statutory services approximately £10,068. There would have been further costs to the NHS in terms of his nursing care and hospital admissions.
ESTIMATED COSTS TO STATUTORY IF 100% HOUSING RELATED CUTS Residential care is £839 per week at 12 weeks
= £10,068
TOTAL TURNING TIDES SAVED STATUTORY SERVICES
= £10,068
CASE STUDY
CLIENT A FEMALE AGED OVER 50
Chronic anxiety and depression Alcohol abuse High blood pressure Osteoarthritis Chronic headaches Limited mobility Diverticulosis
History of repeated trauma History of psychiatric admissions Recurrent anti-social behaviour Anti-Social Behaviour liable to place her and the community at risk
Interventions instigated and outcomes achieved Client A moved into Byron Road hostel which provided a degree of independence with high support. A flexible support plan was devised with the key worker, alongside additional support from Make Every Adult Matter (MEAM). A harm minimisation approach was adopted around alcohol consumption, acknowledging that her alcohol dependence was based around the need to reduce her physical and psychological pain. A's challenging behaviour caused considerable disruption but through careful management conflict began to reduce. Staff ensured the complex prescribing regime was adhered to, whilst also facilitating primary and secondary health care. A's previous history of engagement with health services had been exceptionally poor. A's previous issues around Anti-Social Behaviour (ASB) and the risks she posed in the community completely disappeared. A was supported to maximise her benefits which led to the purchase of a mobility scooter thereby increasing her independence and social inclusion. Support staff facilitated the rekindling of the relationship with her daughter. Staff brokered additional support through mental health services and ensured continual engagement through multi-agency coordination. Local Registered Social Landlords continued to refuse her an interview as they were concerned with historic behaviours, despite her enormous improvements. One year on, with continuous support, A was able to move into independent living within one of our properties. She is in unsupported living on a standard Local Housing Allowance (LHA) rate.
Likely impact and costs to WSCC following budget cuts Likely to have involved repeated emergency services and police intervention for ASB, fueled by continued reliance on alcohol. Physical and mental health deterioration through lack of engagement with health services would have led to the possible need for long term care. Unlikely to have attained sustainable independent living without pathway through our services.
CASE STUDY
CLIENT D MALE AGED OVER 50 SOCIAL HOUSING
4 children with global delay and severe disabilities Emotionally unstable personality disorder Gout Morbidly obese Rstricted mobility Type 2 diabetes Angina
Parent carer for 9 children Multiple suicide attempts Self neglect
Interventions instigated and outcomes achieved D lived in Worthing Homes property since 1990 with his wife and 9 children. D was a full time carer for his children and received little to no support from his estranged wife. D had retired from work due to chronic asthma. D's mental health deteriorated and he received little support from mental health services or Social Services. Following several suicide attempts his children were taken into care. A further attempt resulted in residential mental health involvement where he was diagnosed with an emotionally unstable personality disorder. D was discharged to a Bed and Breakfast in Bognor which was unsuitable due to his poor mobility. He then moved to Hove where mental health teams couldn't decide which county he should receive support from. D presented at St Clare's Community Hub. D was paying for his house with Worthing Homes out of a sense of duty and had very little income. He was receiving a pension and a small amount of ESA which was being spent on bills and rent for his home. In liaison with the local authority's Single Homeless Co-ordinator, he was moved into Manor Road. D ended his tenancy with Worthing Homes and his wife took it over. D was supported to apply for PIP and to an assessment appointment. D was awarded PIP and higher rate ESA. Due to D's increasing mobility issues he moved into Byron Road's annex which is a DDA compliant flat. 24 hour staffing allowed regular welfare checks to ensure he was safe and less isolated. D's medication storage was managed closely as previously he had taken too much to induce a heart attack. Twice daily blood sugar checks were carried out with encouragement to eat more healthily. D overdosed on his inhaler which induced a heart attack, following this he had continuous heart and chest pains which required ambulance attendance. Safeguarding concerns had been lost in the system so they were raised again by us with a request for a Care Act assessment. D was allocated a social worker who passed the case to mental health services. Whilst the services passed his case back and forth our Social Worker and Safeguarding lead advocated for D to ensure the assessment was carried out. Following this an OT provided aids to assist his mobility and a personal alarm should he need immediate attention. D enjoys socialising with staff and benefits from walks to the beach and cafe. Staff assist him in daily tasks which he is unable to do due to limited mobility.
Likely impact and costs to WSCC following budget cuts At critical points D had fallen through the gaps of statutory services, without our tireless efforts on his behalf he would have been unable to secure appropriate accommodation, equipment and support his needs required. Most likely D would have succeeded in committing suicide and is the first to acknowledge this when extolling the virtues of Turning Tides.
CASE STUDY - LAN
CLIENT L FEMALE AGED OVER 40 DAUGHTER 20+ GRANDSON 3 PRIVATE RENTAL
Mother - ongoing mental health difficulties Mother - issues with spine causing pain and limited mobility Daughter - severe mental ill health Grandson - on autistic spectrum Mother carer for daughter and grandson
No means of cooking Mother sleeping on sofa Father doesn't provide financial support Lengthy delays with Universal Credit Struggling to pay for food & utilities
Interventions instigated and outcomes achieved Throughout the 6 months whilst known to LAN L's mental and physical health declined due to the increased caring responsibilities undertaken before and during her daughter's prison sentence. The lack of a bed for herself exacerbated her physical discomfort and mental distress. LAN provided means by which the mother could cook for her family and provided a bed enabling L to reduce the extent of her physical discomfort. Turning Tides provided counselling in light of her emotional distress which helped her develop coping strategies to maintain her own and grandson's wellbeing. A second bed was provided to ensure a carer would have somewhere to sleep should L require respite. L was awaiting a disability reassessment and due to the lengthened process of Universal Credit she was struggling to pay for food and utilities - which LAN subsequently supported.
Likely impact and costs to WSCC following budget cuts LAN provided the means by which the grandson could be taken care of and looked after, the likelihood of the grandson going into care would have been much higher without LAN support. Without LAN enabling and empowering the mother to attend counselling and providing a bed there is a high possibility that the mother would need medical attention with a prolonged need for care due to her incapacity. The support provided by LAN ensured the mother could retain her home which could have otherwise been lost due to increasing rent arrears to cover the cost of essentials such as food, cooker, beds and utility bills. The ongoing face to face support provided by LAN throughout the 6 months provided the stability and continuity the mother needed to continue caring for her grandson as opposed to ending up homeless or presenting to social services as a safeguarding issue.
Local Assistance Network (LAN) We currently receive an annual grant of £185K to deliver LAN across Adur, Worthing and Littlehampton. We could not provide a viable service with just 25% of this income. It would place at risk over 600 households, including families.
Impacts of losing 75% of Local Assistance Network funding LAN is of great social and fiscal value - the impact of which should not be underestimated £185K can support approximately 1,400+ individuals. One case alone saved £8,310 - a considerable benefit to WSCC. LAN interventions continue to negate the need for social services intervention and long term costly solutions
Universal Credit implications Roll out of complex new welfare system has seen a dramatic increase in evictions due to rent arrears. Financial aid through LAN would be severely impaired.
Conclusion The WSCC Housing Related Support grant of £271k enables the core of our charity to function, providing a pathway out of rough sleeping for Worthing and surrounding areas. Its loss would mean the charity could not harness its buildings to help the most vulnerable in our community. 25% of the charity’s £3.5m income would be lost through the Housing Benefit it attracts. The services reliant on those funds, built up over 20 years, are highly beneficial and efficient – costing WSCC £78 per week for a bed which if housed by Social Care would cost over £800 per week. We have an impressive 84% positive move on rate. In addition, the Local Assistance Network provides a vital safety net where we avert crises for over 600 households a year. A 75% cut to the budget would severely reduce the number of individuals we could support. We can fully understand WSCC’s financial position and their proposal is a sign of central funding cuts. Hard decisions need to be made not just by WSCC but all stakeholders affected, whether the District and Boroughs, NHS or Criminal Justice System. Providers such as Turning Tides also need to play our part to look at what we could do differently to attract new investment and change what we do to mitigate the impact. We stand ready to play our part. We would appeal for sufficient breathing space to be provided for all services in the County. This would ensure both providers and stakeholders have adequate time and resources to review service delivery. Preventative services must not be cut only to find increased cost in our acute services. In our view, it will need a minimum 18 months for a considered, managed approach whilst avoiding crises both in the short and long term.