Housing Adaptations: Options for Change and Improvement An Analysis of Consultation Responses
This paper provides a summary of research to analyse responses to the independent Adaptations Working Group’s consultation “Housing Adaptations: Options for Change and Improvement”. This consultation document sought views on the future organisation and funding of housing adaptations in Scotland. It was based around ten questions covering views on the current arrangements, proposed streamlining changes, organisational delivery and funding approaches. The analysis of these responses has been undertaken by ekosgen on behalf of the Scottish Government. The consultation ran from 31st May to 27th July 2012. It received 70 responses, mainly from organisations operating within the sector. Feedback was also obtained from three consultation events involving 50 people from organisations operating in the sector as well as three service user events attended by 40 people. The views obtained from the service user events are set out separately as a stand alone chapter in the report. The findings of the report, however, largely represent the views of organisations and not service users and should therefore be used accordingly.
- The consultation process was welcomed by respondents to the questionnaire – all were of the view that there were some issues with the current system.
- Over 70% felt that the correct issues were identified and there was majority support for nearly all of the streamlining changes proposed, although most felt that these would not be sufficient to address all of the issues.
- Similarly, there was overwhelming agreement amongst service users consulted that changes are needed to the systems for delivering adaptations.
- Whilst there was a consensus that change was needed, opinions varied with regards to the most appropriate arrangements for organisational and funding responsibility. For both organisational and funding responsibility, respondents supported the local authority option, although with only 35% and 39% of support respectively, support did not form a clear majority.
- Amongst service users there was most support for the individual option for the delivery of adaptations.
Views on the current arrangements for housing adaptations (Q1 & 2)
All respondents felt that there were issues with the current arrangements for housing adaptations which need to be addressed. The majority of the respondents (over 70%) felt that the main issues had been identified in the document. Respondents noted a variety of issues which were important to address including: the level and nature of the current funding arrangements; geographical variations in terms of eligibility and priority; the different approaches across tenures; and the number of organisations involved in the process.
Despite the respondents agreeing that there are 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. The most commonly noted areas were instances where a partnership approach or joint working has been adopted; the role of occupational therapists and care and repair organisations in the process; where there is good local knowledge of individual needs; and the grant element of the system.
Views on proposed streamlining changes to improve current arrangements for delivering adaptations (Q3)
A series of streamlining changes were proposed to improve current arrangements for delivering adaptations. Nearly 40% of 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. Over 75% of respondents felt that information and advice would improve the current arrangements, in particular a more co-ordinated and widespread delivery of information. The need to effectively plan ahead and improvements relating to self-help and self-referral were considered important by almost 60% of respondents. Nearly all of the respondents however, regardless of background, felt that whilst beneficial these proposed changes would not be sufficient to address all of the issues associated with housing adaptations.
Views on approaches to organisational delivery (Q4, 5 & 6)
Opinion was varied amongst respondents regarding the most effective approaches to organisational responsibility. The most common approach amongst respondents related to the local authority taking responsibility (over 30% of respondents) followed by the individual and health and social care partnerships. There was some variation to this by organisation. The local authority approach was most popular amongst housing associations, occupational therapists and individual respondents; the health and social care approach was most popular amongst other groups and representative bodies; whilst the individual approach was most popular amongst other groups and care and repair organisations.
The regional consultation events for organisations explored the different options for organisational and funding responsibility. Opinion was divided on the organisational and funding responsibility for adaptations amongst those at these events. However, having the individual at the centre of the process as well as consistent and clearly defined national structures and boundaries were considered key.
The consultation examined the issue of personalisation and the most important elements which need to be put in place to ensure that people are at the centre of the process. The main elements proposed relate to the provision of better information or advice, providing choice for the individual and ensuring a transparent process.
Views on funding approaches (Q7, 8 & 9)
Opinion was varied amongst respondents regarding the most effective funding approaches to deliver housing adaptations. The most common approach favoured by respondents related to the local authority taking responsibility (just less than 40% of respondents) followed by the Health and Social Care partnerships (just over 25% of respondents) and a combination or mixture of approaches. Very few respondents (just 7%) felt that placing the responsibility on the individual for funding the adaptations would be the most effective approach.
There was some variation by organisation. The local authority funding approach was most popular amongst local authorities, occupational therapists and care and repair organisations and less popular amongst housing associations. The health and social care funding approach was most popular amongst other groups and housing associations; whilst the individual approach was most popular amongst other groups and representative bodies.
There were a number of positives and negatives highlighted for each approach. Reasons for favouring the local authority approach included that it would be one of the easier options to implement given their structures and experience of dealing with funding streams as well as their links to the wider strategic housing agenda and housing skills. However, there is also a danger that adaptations budgets and issues may ‘get lost’ within the variety of services provided by local authorities. Similar issues were raised regarding the responsibility being passed to health and social care partnerships. This approach may enable a holistic approach to assessing the health and care needs of the individual and that as adaptations were health related services, it was right that they should be funded through health and social care streams. However, the drawbacks to this option include that it would be difficult to absorb adaptations into the sector at a time of significant change.
Whilst the greatest number of issues were highlighted in relation to the individual approach, this approach was seen to fit most closely with current policy agendas (e.g. personalisation) in terms of meeting the needs of the individuals.
The majority of the respondents believed that the system is not currently fair with regards to assessing the ability of people to contribute towards the cost of their own adaptations. One of the main reasons cited was that it only takes into account income; not considerations such as capital in property. Few individuals felt the current system works well, is simple to operate, and represents a fair approach to assessing the contribution from home owners’ personal resources. The respondents referred to a variety of issues which were important to address such as basing the assessment on individual social and financial circumstances; reconsidering the current grant system; and removing inconsistencies across local authorities.
Views on the consequential changes and other issues relating to the future delivery of housing adaptations (Q10)
The majority (67%) of respondents felt that there were other issues which were not covered. These primarily centred on four key emergent themes: the need to review the current system and provide greater clarity and guidance; concerns over funding; the need for better communication through partnership working; and potentially extending and maximising the role of the care and repair service.
The Views of Service Users
Service users at the regional consultation events also overwhelmingly agreed that changes are needed to the systems for delivering adaptations. They raised a number of issues, notably relating to: communication and information; the assessment process; and the appropriateness of what is delivered. The service users were most in favour of the individual option for the delivery of housing adaptations. Generally, service users did not have a preference with regards to the management and funding of the system as long as the chosen approach provided increased choice and control as well as sufficient funding. A number of general points were also emphasised including that everyone should be entitled to the same service regardless of housing tenure, the need for consistency and clearly defined national structures and boundaries.
With regards to the health and social care option, it was felt that health and social care bodies were still ‘finding their feet’ and there was not yet enough clarity on the integration process for them to assume control of housing adaptations. The point was also raised that the health sector should not pay for adaptations that are not medical and that there are concerns about the development of boundaries between the delivery of adaptations for adults and children. With regards to the local authority housing option, the point was made that currently, most people would look to their local authority (or landlord) if they needed adaptations. The service users were most in favour of the individual option for the delivery of housing adaptations. Generally, service users did not have a preference with regards to the management and funding of the system as long as the chosen approach provided increased choice and control as well as sufficient funding.
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Email: Patricia Campbell