Sheltered Accommodation

Jack Dromey Excerpts

Wednesday 17th November 2010 Westminster Hall

[Jack Dromey (Birmingham, Erdington) (Lab)]

It is a privilege to serve under your chairmanship, Mr Davies.

The House owes a debt to the hon. Member for Stourbridge (Margot James) for raising a series of important issues with her characteristic sincerity and commitment. She is right that we have a sacred duty to look after the most vulnerable, and in particular those who built Britain, ensuring that they have security and dignity in retirement. No party has a monopoly on wisdom and all Governments, including the previous Government, have to reflect on the consequences of their actions. I will pose a number of questions that I hope the Minister will answer, because the issues that have been raised in this debate are of immense importance.

Everyone here takes seriously the importance of housing and support for elderly and vulnerable people, whether they live in their own home, with their family, or in supported housing, such as sheltered or extra-care schemes. The hon. Lady was right to underline the scale of supported housing in our country. The survey of English housing in 2008 showed that 7% of the retired population lives in sheltered or extra-care housing, with more than 610,000 living in sheltered accommodation. At its best, sheltered accommodation provides a sense of community, companionship and security.

I know that the debate is about more than just wardens, but I will focus for a moment on wardens. I know from my experience in my constituency that the elderly and the vulnerable speak warmly of their wardens. Wardens provide much needed support and they help with tasks, big and small, as well providing invaluable advice and support. Wardens often go that extra mile beyond the call of duty. They organise trips, activities, bingo, singing—I have even been asked to sing in one old people’s home, but I am no Pavarotti. Wardens organise supper nights, and provide a listening ear to their residents who are experiencing ill health or other troubles and need a friend in difficult times.

I have seen some remarkable examples of the good and, I have to say, a very bad example of the bad. Remarkable examples of the good, on the one hand, include Waterford Court, where I was but two weeks ago, celebrating its 10th anniversary. It is full of old soldiers and their wives and husbands, still young at heart. They very much regard themselves as the “wellderly”—the hon. Member for South Thanet (Laura Sandys) was right about that—and are looking forward to years of life ahead in what is an excellent community. Also, New Oscott Village is a shining beacon of what care for elderly people should look like.

On the other hand, bad examples include the one mentioned by the hon. Member for Hereford and South Herefordshire (Jesse Norman). In my constituency, one old people’s home in Kingstanding moved from on-site wardens, present seven days a week, 24 hours a day, to floating wardens and a call centre. One woman told me, in great distress, of her experience. She had had a mastectomy and at 3 o’clock in the morning on a Saturday night, her wounds burst open. She tried desperately to get help from the call centre, but was told to ring 999. She said, “But I’m soaked with blood from my breasts to my knees.” She could not make any sense of what was happening at the other end of the line and, ultimately, had to call her son, who lived three miles away, to come and get her, at 3 o’clock in the morning, to take her to hospital. Although we celebrate the examples of the outstanding in all constituencies in Britain, what the debate has highlighted is that other examples, to be frank, shame our country.

Among the developments under our own Government was an unhelpful trend in relation to wardens. I will discuss that in a moment, but first let us look at the policy framework, because it is important to where we go from here. In February 2008 the Government published “Lifetime Homes, Lifetime Neighbourhoods: A National Strategy for Housing in an Ageing Society”, which set out how sheltered housing is often a positive choice for older people who want to remain independent but who value that little bit of support and shelter, as well as the sense of security and community brought by sheltered housing. The paper said:

“extra care and care homes at their best can be vibrant community hubs, tackling exclusion and promoting active ageing, even if the accommodation itself is dated.”

It also said—the hon. Member for Stourbridge was absolutely right—that consultation and needs assessment are critical both to the effective management of sheltered accommodation and to reflect the wishes of service users. That was emphasised in 2007, in the Supporting People strategy paper, “Independence and Opportunity”. Central to that paper was the importance of keeping service users, in turn, at the heart of delivering housing support.

A report by Help the Aged, “Nobody’s Listening”, makes it clear that changes in support services for sheltered housing and the replacement of resident wardens by alternative service models are not new phenomena—such changes have been taking place for two decades. An independent study commissioned by the Department last year pointed to various reasons why that was the case. It found, on the one hand, that there was less demand for sheltered housing, as people tended to move into sheltered housing later in life, and, on the other hand, that a significant number of sheltered housing residents said that they did not require support services because they were defined as the active elderly. As a result, some administering authorities commissioned flexible mobile support for sheltered housing tenants, based on assessment of support needs. They extended the notion of mobile support. There were strengths in that approach, because it offered support for people in all types of tenure, but, clearly, there were weaknesses as well, because some commissioning authorities, under my party’s Government, clearly got it wrong and went too far in changing the provision of wardens in sheltered accommodation.

I will touch briefly on consultation, which has been powerfully raised, including by the hon. Member for Portsmouth North (Penny Mordaunt), who has direct personal experience. Consultation is a vital part of any service. My experience is that, if an organisation consults properly with service users, often changes that may not be threatening are seen to be precisely that—not threatening, contentious or frightening. Consultation before changes are made is, therefore, essential. Unfortunately, too many examples of a failure to consult have been evidenced in the debate today, including successful challenges in Portsmouth and Barnet, where there was a lack of consultation, ranging from a failure to take into account the terms of leasehold arrangements to a failure to act in accordance with disability discrimination legislation.

Having acknowledged the trend under the Labour Government whereby some commissioning authorities, for all that their motives were noble, went too far, I shall now look at where we go from here. The debate must take place against the background, inevitably, of resource constraint. As I will say in conclusion, however, what the hon. Member for Stourbridge has done is to put this vital issue at centre stage in the decisions that get made in the next stages by the Government and the commissioning authorities at the sharp end.

The context in which the debate is taking place is that councils will see a 7.1% cut each year for the next four years. Supporting People funding will be cut by 11.5%, to £6 billion. Yes, it is true that an additional £2 billion of funding has been promised to social care by 2014-15, £1 billion of which will come from the NHS, but, set against that, the sheer scale of the cuts that will be made in the field of social care is immense.

We can look at examples of what is already happening in the here and now. Somerset has approved a £3 million cut in its Supporting People programme from April 2011, representing an 18% reduction on its £16.5 million budget allocation for 2010-11. Big cuts have already been made in Isle of Wight; and Cornwall is due to make a decision on, I believe, 30 November on a proposed 40% cut over three years in its overall Supporting People spending. Reports suggest that elsewhere in the country active consideration is being given to major cuts of that kind: Bournemouth, Swindon, North Somerset, Brighton and Hove, and Surrey are all considering proposed reductions of between 20% and 40%. Against that background, and in the spirit of the debate today—so nobly led by the hon. Member for Stourbridge—I would like to put a number of questions to the Minister.

My first question is about preventive support. The evidence is absolutely clear that preventive support—warden services, in particular—leads to better outcomes for service users and their families, as well as to savings in health and social services budgets. If low-level preventive funding, such as Supporting People moneys, is lost, combined with the end of ring-fencing, that is likely to cost the Government and local authorities more.

My second question relates to the redirection of funding. The Supporting People programme funds housing support services for about 1 million people, but as a result of the dramatic consequences of the reductions in expenditure that are being imposed on them, some local authorities are using it to help fund statutory social care. Does the Minister share my concern that that is likely to accelerate significantly the withdrawal of on-site warden arrangements, in favour of what is all too often an unsatisfactory roaming warden service?

My third question is about social care cuts. The initial relief at the provision of an additional £2 billion for social care by 2014-15 has evaporated in the wider context of the 26% cuts in local government revenue spending. As a result of those swingeing cuts to local government, the extra money promised will do nothing to make up for cuts to social care services. Last year, the Minister of State, Department for Education, the hon. Member for Brent Central (Sarah Teather), who at the time was shadowing the Department for Communities and Local Government, said:

“it is important that ending ring-fencing does not become an excuse for phasing out funding or squeezing budgets, and that local councils do not end up getting the blame for what is, in essence, the removal of money by central Government.”—[Official Report, 20 October 2009; Vol. 497, c. 194.]

Does the Minister agree with his colleague?

My fourth question is on a matter about which hon. Members have spoken eloquently. The Sheltered Housing UK Association, a campaign group, recently wrote to the Deputy Prime Minister because he had said in a pre-election interview with Inside Housing that residents should be able to vote on whether to keep a live-in warden. We have heard that the Deputy Prime Minister has made an initial response, but can the Minister tell us whether that excellent proposal is under active consideration?

On my fifth question, the Minister signed early-day motion 60 last year, which expressed concern about reductions in funding for Supporting People services. It called on the then Government to take action to ensure that the vital service of warden-supported housing was retained, because reductions were having a

“detrimental effect upon the quality of life of many vulnerable people who rely on warden-supported housing”.

The Minister will be fully aware that the Government have announced unprecedented cuts to local government funding. What impact will those cuts have on vulnerable people, and particularly the elderly, who rely on local government services? Crucially, have the Government conducted an impact assessment of the effects on social care services of cuts to local government funding? If so, will the Minister publish it?

In conclusion, the debate has raised a number of serious questions about the treatment of residents in housing schemes and about their concerns over the changes that they face. One strength of today’s debate has been that it has celebrated the good, while expressing concern about the bad. There is concern on all sides to ensure that we maintain the support that the elderly and vulnerable are entitled to expect. I thank the hon. Member for Stourbridge once again for securing the debate, because she is right that this issue is absolutely centre stage in the debate about how we go forward in difficult times. I hope that the Minister will respond to my questions.

[The Parliamentary Under-Secretary of State for Communities and Local Government (Andrew Stunell)]

I am very happy to be serving under your chairmanship for what I think is the first time, Mr Davies. Let me tell my hon. Friend the Member for Stourbridge (Margot James) that this has been a very worthwhile debate on an extremely important question, and I thank her very much for bringing it to the House.

My hon. Friend made some strong and effective points about the problems in her constituency. Like other Members who have raised a significant issue in the House, she has had, if not the pleasure, the experience of finding that people all over the country hope that she will become their champion and write to her accordingly. Although I am sure that she will fulfil that role very well, I hope—indeed, I am sure—that she will be able to channel her resources towards dealing with her own constituents. She and other hon. Members raised some really important questions, which I will do my best to address.

It is worth repeating, as the hon. Member for Birmingham, Erdington (Jack Dromey) properly said in his balanced critique of what went before, that this matter has come before the House previously. There have been two Adjournment debates in the past 12 months or so, which were initiated by hon. Members with concerns about exactly this issue. The Sheltered Housing UK Association rightly has a strong reputation for getting its point across to right hon. and hon. Members.

Let us go back to where the Government stand on this issue. We are clear that housing needs to be there, and that the support needs of vulnerable and older people should be met wherever they live, whether in their own homes, with their family, in supported or sheltered housing, in the extra-care accommodation mentioned by my hon. Friend the Member for Stourbridge—I note her concerns that extra-care homes may be subject in due course to the pressures that she described—or in residential care establishments.

There is a whole range of accommodation. The Government are committed to making sure that people have appropriate accommodation and the support to enable them to live in it. The coalition agreement says:

“people deserve dignity and respect in old age, and…they should be provided with the support they need.”

It also includes a specific commitment on being able to live independently in later life. It says:

“We will help elderly people live at home for longer through solutions such as home adaptations and community support programmes.”

By extension, we will ensure that arrangements are appropriate for people in sheltered accommodation, whether in the private, charitable or public sectors. The Department is looking at how we can help older people to access the practical advice, support and home adaptations that they need to stay in their homes or to move to more appropriate accommodation. We are working with developers and planners to facilitate a wider range of high-quality housing options for older people.

At the heart of what the previous Government did, and what we are continuing to do, is the Supporting People programme. The programme has been protected as far as possible in the spending review. As part of the review, we have secured £6.5 billion for Supporting People over the next four years. The hon. Member for Birmingham, Erdington is not wrong to say that the finances are under extreme pressure or that there will be pressures on local authorities and providers, but I want him to understand that the sum being spent on Supporting People—it will be £1.6 billion this year—will still be £1.59 billion by 2015, which represents an overall reduction of just £46 million over the four years. That shows that we have a very strong commitment, in straitened times and circumstances, to ensuring that the Supporting People programme has the resources that it needs and that front-line services for vulnerable people, including residents of sheltered housing, are protected.

Figures are a little hard to come by, but something like £180 million out of the Supporting People programme goes to support for people in sheltered accommodation at present and, by everyone’s account, that is doing a good job. Hon. Members have rightly focused on the sector’s problems, and I want to discuss those in a minute, but let us not forget that there are 600,000 older people in sheltered accommodation, the huge majority of whom are happy and comfortable there and, in the traditional phrase, would not be anywhere else.

How will the Government approach the matter? We have said clearly and strongly that we believe that local authorities are best placed to identify services to meet the needs and balance the priorities in their communities. It is for local authorities to decide how best to design and commission the services that they believe are needed by all parts of the community, and to arrange for and deliver them—or enable them to be provided, perhaps by work with third sector and private sector providers. Central Government do not dictate to local authorities or service providers the details of what local services to provide or how to do it, and we do not want to be in the business of micro-managing service delivery.

[Jack Dromey]

Have central Government conducted a study of the impact on elderly and vulnerable people of the reductions in expenditure that have been announced?

[Andrew Stunell]

That is primarily a matter for the Department for Work and Pensions and the Department of Health. I am happy to follow it up and to write to the hon. Gentleman and other hon. Members about progress in that respect. We should be quite clear: the Supporting People programme is non-statutory and has always been non-ring-fenced. That has allowed local authorities to draw money into it when they thought it necessary, and to use Supporting People money imaginatively and innovatively to provide good services by bolstering and reinforcing those they already had. It was never a ring-fenced fund and it still is not, and it does not cover a specific statutory duty, but I am happy to follow up on that point by writing to the hon. Gentleman and other hon. Members.

Later this month we will publish a localism Bill to devolve greater powers to councils and to neighbourhoods and local communities. It will return to them control over housing and planning decisions and will help to set the foundation for transforming the relationship between central Government, local government, communities and individuals. The philosophy behind the Bill includes the engagement and participation of residents and communities. Several hon. Members have rightly drawn attention to the fact that in some cases providers of sheltered housing appear deliberately to have sought to frustrate or bypass such consultation and engagement. The Government regret the fact that that happens and would want it to be challenged whenever it does.

[Jack Dromey]

Does that mean that the Government intend to honour the pledge given by the Deputy Prime Minister that residents of sheltered accommodation will have the right to vote on whether wardens are withdrawn?

[Andrew Stunell]

The hon. Gentleman is skilfully gliding over what he said to the House only about 10 minutes ago, which is that the Deputy Prime Minister favoured that approach; he did not give a pledge to introduce legislation, and I am certainly not going to do so. The hon. Gentleman has perhaps slightly gone beyond his very temperate approach, by trying to weave into it something that is not the case.

The localism Bill reforms, taken together, will shift power from the central state back into the hands of individuals, communities and councils. They will give local people, including community groups and residents associations—and why not groups of sheltered housing residents too—more power over local government and how public money is spent in their area, and will ensure that councillors are more directly accountable to them. They will free local government from central control so that it can ensure that services are delivered according to local needs; and they will let local people drive change through a renewal of confidence in a streamlined, more efficient planning system, encouraging them to get actively involved in planning, housing and local services.

Before I return to the matter of sheltered accommodation I should perhaps mention that I probably got slightly carried away before in saying that Supporting People was never ring-fenced, as it was ring-fenced initially but the previous Government de-ring-fenced it and we have continued with that.

Sheltered accommodation, as has been mentioned, has been evolving for decades. Perhaps 30 years ago the model was somewhat institutional, and there is a hangover from that in accommodation that is really just bedsits with oversight. A decade or so ago, local authorities, including my own, went through an elaborate and sometimes painful process of upgrading their sheltered accommodation. The Help the Aged campaign report, “Nobody’s Listening”, which was published about 18 months ago, charted that progress. Part of the evolution of the way that care is provided has been a move to so-called floating support services. The reasons for that are, first, the changes in demand for sheltered housing, which have been alluded to in the debate; secondly, the fact that the standard of much sheltered accommodation is in need of improvement, which requires investment; and, thirdly, the fact that significant numbers of sheltered housing residents do not require support services. They are the “wellderly” or “active elderly”, or are described in other such phraseology. I was interested to hear about the paper entitled “How we keep the new old young” by my hon. Friend the Member for South Thanet (Laura Sandys), and I congratulate her on her practical work.

Other factors are driving changes in the way that services are delivered, including the difficulty in recruiting resident wardens, which can be quite acute and has inhibited schemes in some places. The European working time directive somewhat constrains the hours that wardens work, so that sometimes a 24-hour live-in warden is not, in practice, as one might suppose, on duty for 24 hours seven days a week. Those are the practical realities that must be faced, alongside the direct financial constraints.

My Department receives correspondence from residents of sheltered housing complaining about issues such as being required to pay for services that they do not want. By a twist of fate, it falls to me to answer this debate at a time when I am in active correspondence with one of my groups of sheltered housing residents; they are campaigning against a 24-hour residential service, as they believe that it would not be good value for money or helpful. Perhaps the irony is completed by saying that the organisation that they are campaigning against is Peverel, which insists that they must have residential wardens. We live in a complex world where black is not always black and white is not always white.

Sheltered housing, like all other support services, cannot be immune from the wider demographic, technological and economic challenges and opportunities that we face. We need to encourage innovative ways of caring for and supporting people, so that solutions are more personalised and make the most of emerging technology. There are various ways of doing that, and it does not have to involve bad stories about call centres.

Telecare can bring substantial benefits. It can assist people to remain in their own homes, and it can reduce inappropriate admissions to hospital—although judging by the story recounted by the hon. Member for Birmingham, Erdington, that is not always the case. It can also provide cover to allow for early discharge from hospital and advance warning of deterioration in a person’s condition.

Local authorities are rightly responding to the changes in this market—although market may not be the appropriate word—in care provision. The resources available for housing-related support services are being carefully investigated at the local level, which means that local authorities are reviewing the services that they commission.

I agree with the hon. Member for Birmingham, Erdington that local authorities sometimes get it wrong. My hon. Friend the Member for Stourbridge said that 50 legal challenges are being made against 20 local authorities; and my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) said that that number might be bigger but for the legal barriers and hurdles that people had to surmount. Notwithstanding that, we should recognise that the majority of local authorities are getting on with the job. They are extending mobile support to older people in accommodation in the community, and the Supporting People programme gives them the flexibility to be innovative. Supporting People is tenure-neutral; it can be used to support people in private and charitable accommodation, and in third-sector and social housing. That is important.

What about consultation? Changes to housing-related support services should be designed to meet the assessed needs of service users, and changes to service delivery should take account of those people’s views, with proper engagement and consultation with those affected. There are well established ways of doing that.

The Centre for Housing Support has been active in identifying and sharing good practice. In addition to its code, it works in partnership with TPAS, the Tenant Participation Advisory Service. It has provided deliverers of service with its publication, “Effective Resident Involvement and Consultation in Sheltered Housing: A Good Practice Guide for Providers and Commissioners”. That is the textbook that I would want all providers to use when delivering those change processes. The code highlights the importance of the genuine involvement and engagement of service users—the people who live in the homes, the householders. Indeed, I am not sure that the phrase “service users” quite captures how important the home is to the people who live there.

Change is inevitable. Providers and commissioners need to be aware that, in preparing and reacting to change, they should involve the users of their service. They must ensure not only that the users are happy but that the changes are appropriate and that value-for-money services can be developed. The TPAS report addresses the barriers to effective engagement, and gives a number of case studies and examples of good practice.

My hon. Friends the Members for Stourbridge, for South Thanet and for Hereford and South Herefordshire and others have drawn attention to cases where that engagement is not happening. My hon. Friend the Member for South Thanet was eloquent in her critique of what she called the vertical integration of services provided by a particular company. It would not be appropriate for me to say a great deal about the specifics of that case, but I know that various residents’ groups have approached the Office of Fair Trading on some of those matters. We should await the outcome, and a response, before commenting further. However, if issues of substance need to be addressed in relation to private provision, the Government would obviously want to take serious account of the evidence.

When developing and commissioning services, it is important that local authorities should take account of the views and experiences not only of residents but of best practice around the country. Consultation and needs assessment are critical factors in ensuring that changes in service are well managed and reflect the wishes of users, as well as enabling local authorities to meet the needs of all service users and give them value for money.

The importance of needs assessment and consultation with service users are built into the quality assessment framework for the Supporting People programme. The QAF was introduced in 2003, and it set out the standards that are expected in the delivery of Supporting People services. It also identified methods of producing evidence of achievement. Over the past five years, it has been a successful practical tool for ensuring continuous improvement in service delivery, especially for housing-related support.

The QAF was reviewed in 2008, after running for five years, to bring it up to date and to emphasise the need for high-quality individually focused services that aim to improve the outcomes for service users. The majority of administering authorities—local authorities with responsibility for the framework—continue to use it today. Evidence shows that other local authority services, such as adult social care, have adopted the QAF as the standard tool to measure the quality of services being delivered.

We welcome the fact that we are moving away from the centrally driven, target-directed delivery of local services. It is good to see that a tool is available to administering authorities—social services authorities and others—to allow them to monitor themselves, to ensure that they are accountable to those for whom the services are provided and that their services are delivered to a good standard.

The sheltered housing sector has an independent code of practice. It was developed in consultation with practitioners and service users, and is administered by the Centre for Housing Support. That code was devised back in 1993, and its standards have been continually refined and adapted. It is a way of passporting through the QAF and was the first independent code to receive such an endorsement. The code focuses on outcomes rather than processes—not on how one gets there, exactly, but whether the service is good and whether people are happy with it. It encourages providers to create local solutions better to meet and serve the needs of the community.

I have attempted to respond to the various questions raised during the debate. The Government take seriously the matters that were rightly raised by my hon. Friend the Member for Stourbridge, which were strongly underlined and reinforced by my hon. Friend the Member for South Thanet, backed up by my hon. Friend the Member for Hereford and South Herefordshire and mentioned in a number of interventions. As the hon. Member for Birmingham, Erdington said, there is scope for improvement. It is not the case that the previous Government had a monopoly of wisdom on this issue, although I imagine that the hon. Gentleman would say that neither do the present Government. There is work to do and progress to be made, and it is a key issue. I hope that I have been able to show the House that the Government take the problem seriously and will be listening hard over the coming months to ensure that residents of sheltered housing get the service for which they have paid and which they thoroughly deserve.