Chapter 8: Next steps and summary findings
Next steps in the test sites
The formal AfC initiative period has now concluded but the work and change process is continuing. A brief summary of the work to date and future plans for each of the test sites is set is set out below. As noted earlier, further information on the work they have and will be doing can also be found on Scotland's Housing Network website.
Aberdeen's experience highlights the benefits of bringing representatives from across a range of organisations involved in adaptations and housing together. They are clear that achieving strategic buy-in, and particularly creating links into the strategic planning of Health and Social Care Integration, has been key to taking forward some of their bigger areas of work. The Project Board is now looking at ways of ensuring that the joint-working approach can be maintained and built on going forward.
The Project Board have agreed a cross-tenure Single Major Adaptation Pathway and further work will be looking at procurement and making other links and developing other partnerships.
Another major focus has been Delayed Discharge. A Delayed Discharge Audit and subsequent work has focused on: early identification of the need for an adaptation or re-housing needs in patient's plan for discharge; agreement that if a patient is discharged home to "make do" in their current home, they do not lose their priority for re-housing needs with local authority or RSLs; and in principle agreement to make two interim housing options in the community for those who are medically fit and require no on-going therapeutic input. Other on-going joint work includes producing a housing leaflet for in-patients and multi-agency meetings around housing-related delayed discharge meeting with agreed actions being taken forward. All of this work will continue despite the AfC period concluding.
Falkirk aimed to develop a new service model for adaptations, which was outcome focused, and provided a common approach across all tenures. The new model would be supported by a clear governance framework, robust performance management, and a clearly set out funding framework. They have established a multi-agency steering group, including housing, social work, health and local RSLs. The group has developed a process map of the adaptations and the customer journey, developed definitions of adaptations and a number of standard specifications for different types of work; produced a common referral form and piloted a 'complex cases' panel. This is for cases where very expensive adaptations may be required.
Going forward, Falkirk are finalising leaflets for tenants and owners and working with the ihub to develop training packages and performance management tools. There are plans to begin rolling out the training and implementing the new systems. Looking to the future, Falkirk Council has put in a funding bid for a volunteer peer support system, which would be managed by a third sector partner. The Council is also looking at its Choice-based Letting system to ensure that people who needed to move because their current home is unsuitable for their needs receive sufficient priority. There are also plans to refine the Council's Asset Management system to improve identification of adapted properties. A new project manager was appointed in January 2017 and will be focusing on taking the AfC package of work forward.
Fife has placed a considerable emphasis on fully understanding their local challenges, and developing subsequent, shared solutions to improve the delivery of adaptations. This focus on a single pathway is currently being developed into an adaptations policy articulating expectation, standards and accountabilities across all partners. Several 'tests of change' are in place to tackle local issues, and learning from these will inform the pathways development. Examples include increased support and joint working from hospital to home, the development of early intervention initiatives, improved public information and self-assessment and the establishment of a multiagency decisions panel for complex cases. A priority for Fife in the short term is to evaluate these developments and finalise the associated adaptations policy. In support of this aim, information requirements are being reviewed and a survey to gather the views of service recipients is in the final stages of completion.
There is a recognition that the Adapting for Change principles require both executive recognition, but also influence within the health and social care agenda. To this end a proposal is being finalised to establish a formally integrated adaptations team with single management, to deliver and support this function across the partnership and with accountability to the IJB. Discussions have also commenced at senior level, and with elected members, to promote the value of not only adaptations but housing as a whole in the achievement of the IJBs aims and improve individual and collective outcomes within Fife.
The Lochaber project is local to a specific Highland community planning partnership area - Lochaber District Partnership - with objectives designed to improve the customer offer, experience and outcomes. A tenure neutral one-stop-shop has been developed and is based in Lochaber Care and Repair. It has been branded and promoted with a clear and distinct identity as 'Be@Home'. A single pathway, redesigned by local multi-agency stakeholders, provides service users with direct access to a structured menu of housing solutions: aids and equipment, handyperson services, adaptations, telecare and technology enabled care, housing options advice and information, and dementia home support. An OT has been seconded from the NHS to the project, with responsibilities including helping to connect the new pathway and the Be@Home service to the local integrated team. The OT also developed a competency framework for Handyperson staff, providing them with assessment capability to OT Assistant level.
Baseline research on process and timescales provided evidence to help measure the impact of the Be@Home test model and a number of additional tests of change are in place. The baseline data also helped identify a number of process, policy and practice improvement opportunities which have helped gain Project Board support for the project to continue at a Lochaber level as an on-going work in progress.
Partners in Skye & Lochalsh have expressed an interest in developing existing Handyperson and housing adaptations services using the Be@Home model. More generally, a review of the housing adaptations system in Highland was included as a priority in NHS Highland's strategic plan from April 2016 - subject to the learning outcomes from the Lochaber demonstration project. A findings report on the Be@Home test model will be presented to NHS Highland's Adult Services Commissioning Group seeking recommendations for the future for the Be@Home model in Highland.
Scottish Borders aimed to further develop the Care and Repair service to establish a one-stop-shop approach for adaptations, to which individuals could self-refer direct. The assessment responsibility for adaptations would be transferred from the social work locality team OTs to the Care and Repair OTs.
The Scottish Borders pilot was aimed at developing and refining the existing Care and Repair service. An OT post was seconded from the Council to assess and manage adaptations, initially in three of the Council's five areas. Moving forward, there are plans to roll out the pilot to the other two areas, and carry out the recommendations within their internal evaluation report.
Summary findings for this study
The Scottish Government's decision to commission a process-focused evaluation has proved well-founded, since much of the learning to emerge to date has been around the challenges that may be encountered when looking to improve adaptations services and/or to implement the recommendations of the AWG.
There have been very real and significant challenges and addressing these has often slowed progress within the test sites. Nevertheless, many key stakeholders across all the test sites remain committed to further change and improvement. Many, although not all, are optimistic that a direction of travel has been set and that their area will move forward using a partnership-based approach to drive further change.
The power and potential of a strong, cross-sectoral partnership committed to working together to bring about positive change may be the single greatest achievement from across the test sites. Critically, it is an achievement which may well provide a foundation for driving positive change not only in relation to adaptations, but also for other prevention-focused services. Ensuring that housing adaptations, and preventative services more widely, are seen as key and immediate priorities by the IJBs may be challenging, but a collective approach from across key services can only be of benefit.
It does need to be acknowledged, however, that the partnership-approach has proved easier to build in certain areas than others; there have sometimes been difficulties in getting important stakeholders to engage with the process or indeed with this research. It may reasonably be assumed, therefore, that not everyone agrees either with the approach being taken, or that adaptations should be a priority for change at this time. The sheer scale of other changes underway, and in particular those associated with Health and Social Care Integration may be behind this reticence.
Nevertheless, those who have been working to deliver change generally remain optimistic, not least because they may be starting to see tangible improvements to the services in their area. The pathways mapping and redesign process has been key to making many of these changes and has proved to be a powerful tool. The process has helped identify ways that systems could be improved and streamlined. Positive changes are already being seen and further positive change is expected as new practice is embedded. However, and as with many other aspects of the work being taken forward, it has proved to be resource intensive. The very fact that this and other work is progressing is testament to the enormous commitment and energy that some key stakeholders have invested in AfC.
Email: Hannah Davidson, firstname.lastname@example.org
Phone: 0300 244 4000 – Central Enquiry Unit
The Scottish Government
St Andrew's House