Alcohol and Housing: Policy Overview Yvonne Maxwell

1. Alcohol and Housing:Policy OverviewYvonne Maxwell

2. Housing Learning and Improvement Network Is the national network for promoting new ideas and supporting change in the delivery of housing , care and support services for older and vulnerable people. Part of a wider DH Care Networks . Part of the Putting People First Team.

3. National Alcohol Strategy A focus on 18-24 binge drinkers and harmful drinkers. Working together to promote sensible drinking. Long term goal : “To minimise the health harms, violence and antisocial behaviour associated with alcohol , while ensuring that people are able to enjoy alcohol safely and responsibly” Actions : More help for people who want to drink less. Public Information campaigns to promote a new sensible drinking culture. Local alcohol strategies.

4. Why do alcohol services and supported housing need to work together? People who live in supported housing or receive floating support may also have an alcohol problem. This includes people with mental health problems, older people, physical disabilities and learning disabilities. Strategies, access to services and information campaigns will need to address how to reach and engage them. Housing and support can help with this. They need to be involved and informed and ways to reach people developed. Some groups may get missed such as older people or those with a learning disability. Different approaches will need to be developed.

5. Rough Sleepers Strategy Cross Government Strategy lead by CLG. A focus on preventing rough sleeping , moving away from reactive to proactive and preventive services Partnerships at both national and local level, between Government Departments and locally with community groups , health and local authorities and homelessness agencies. Sustainable outcomes and a focus on building people’s skills to maintain tenancies, address underlying issues that have contributed to their homelessness such as mental health, substance and alcohol misuse and routes into training and employment . Improving the health of rough sleepers and their access to services User involvement and empowerment, including using individual budgets There are 15 actions points under 4 chapter headings : Right help, right place, right time Empowering communities Understanding problems/solutions Making it happen

6. Links with alcohol The Strategy identifies that many rough sleepers have problems with alcohol. For example a survey in London found : “Roughly 87% of people contacted by outreach teams are male and many have problems relating to drugs (41%), alcohol(49%) and mental health (35%) with around a quarter having a combination of these problems. People who have been in prison or the care system are overrepresented” There is a commitment in the Strategy to work with the Alcohol Network.

7. Action 3 “We will extend positive activities that motivate and empower people to take greater control in their lives.”Action 4 “We will promote and enable opportunities for homeless people to break out of worklessness.” “For many people getting off the streets into a hostel, or even getting their own flat, will not necessarily deal with underlying problems. Anxiety, depression, low self-esteem, self-harm or challenging behaviour, often exacerbated by misuse of alcohol and drugs, means that people can feel stuck in a life that is damaging to themselves and others.”

8. The strategy wants to increase opportunities for people moving away from rough sleeping to take part in activities that give hope, build skills, increase confidence and self-esteem and above all strengthen positive relationships. • For some people this will be needed before they are able to take more formal steps towards employment.

9. ACTION 5 “We will further improve access to health and social care services for people with multiple needs who are sleeping rough or in hostels.” Among people who sleep rough or who have moved into hostels is a group of individuals with severe, complex and multiple health and social care needs. The nature of these needs and the competing priorities of survival on the streets can mean that, without specialist or targeted help, they often do not access health and social care services at all .

10. Some homelessness agencies report that it can be difficult for people with multiple needs to access services including registration with local primary care services or treatment for alcohol dependency or mental health problems. Better co-ordination of statutory and non-statutory services is needed as well as this group being part of the assessment of need and commissioning process. In some areas promising approaches have been developed such as joint outreach between outreach workers and drugs/nurses/mental health workers and the piloting of ‘wet’ drop in sessions. These are staffed by several agencies who engage with clients who may be excluded from other drop-ins and services due to consistent alcohol use.

11. “Ensuring the engagement of particularly vulnerable and hard to reach to reach groups , those with complex medical and social care needs and those experiencing exclusion will be one of the significant challenges of Joint Strategic Needs Assessment (JSNA). Their involvement is important , since they are more likely to suffer from poor health and wellbeing and from inequalities, and their engagement with JSNA will best shape services to meet their needs . Third sector and local user-led organisations often have considerable experience in identifying need within these groups.” Guidance on JSNA There will be ongoing work around the development of the JSNA process and CLG.

12. Putting People First ‘Putting People First’: A shared vision and commitment to the transformation of adult social care…through personalisation, prevention and early intervention signed by 6 Government Departments, the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS)

13. What ‘Putting People First’ says… Supporting people to live in their own home for longer Concentration on safeguarding adults Universal information, advice and advocacy service Common assessment processes – more self-assessment Telecare as integral not marginal Self directed support as the mainstream – personal budgets for all, direct payments for more people Greater role for voluntary sector and user led organisations

14. What it doesn’t say… Not a prescriptive policy document – there is no detailed roadmap There are many things to decide locally to ensure that personalisation works for us Doesn’t say we’re doing a bad job – this is about building on what we do well already and extending choices to those using our services

15. Why this changes everything… Now... Under Self-Directed Support...

17. Self Directed Support • Personalisation and self-directed support • a common assessment framework for social care, including access to self-assessment when appropriate • mainstreamed person centred planning and self-directed support • personal budgets for all with increased uptake of direct payments • systems which proportionately address risk whilst enabling maximum choice and control • Resource Allocation Systems – want development by LAs together • Guidance on Fairer Contribution – clarifying money that service users may be asked to contribute towards IB – from 0% - 100%.

18. What’s it all about? The process by which state provided services can be adapted to suit users Personalisation Support that is determined and controlled by users, based on an assessment of need by the state. (Includes receiving cash, spending on services that meet user needs, to choosing which hospital you wish to attend) Self directed support Individual budgets Personal budgets Like an IB but solely made up of social care funding Direct payments An indicative amount of money that can combine several funding sources that users can use to purchase services, from the public, private or voluntary sector A cash payment paid directly to users so they can acquire their own services, rather than having them delivered by the council

19. Personalised services • A continuum of options from: A block contract service which is flexible, person-centred and tailored to meet each person’s needs → → through to → → → direct payment of an Individual Budget for person to purchase what they choose (could be either an IB held by the Council or a direct payment to client or an IB held by a provider-but the service user has a key say over how it is to be spent)

20. Is this just about social care? No! Personalisation affects many other public services – housing, education, health. Darzi review confirmed personal budgets in Health. Grew out of small movement in Learning Disabilities, scope is continually growing… Impacts on the wider customer experience

21. Universal services • General support and services available to everyone locally, including: • access to information, advice and support • transport • leisure • education • health • housing • community services e.g. libraries, adult education

22. Early Intervention & Prevention Support available to assist people who may need a little more help, their carers and supporters at an early stage to stay independent for as long as possible, such as to: • recover from effects of illness • safely maintain home and garden • training to get a job • return to work training after a break • start taking some exercise

23. Choice and Control Self directed support, e.g. • services available to meet people’s needs and those of their carers and families • access to information and advice • transparency of resources available • individual’s choose who provides that support and controls when and where the services are provided • help to negotiate their support needs • provide advocates to help people decide

24. Social Capital How society works to make sure everyone has the opportunity to be part of a community, such as: • experience friendships and care that can come from families, friends and neighbours • positive interaction • participating in discussions about community life • volunteering • Community empowerment and user led organisations

25. Supporting People Authorities are spending more on services for people with alcohol problems (£18.5m in 06/07 to £19.5m in 07/08) Services support around 3,500 people with alcohol problems and deliver positive outcomes. In 2007/08: 1,500 able to better manage physical health 1,100 able to better manage mental health 1,650 maintained accommodation and avoided eviction 670 accessed desired training and education Removal of the ringfence on Supporting People funding from April 2009 provides opportunities to develop innovative ways to support vulnerable groups CLG is developing a local toolkit which will provide evidence at a local level on the financial benefits of investing in housing-related support (to be available in Summer of 2009)

26. Characteristics of people with alcohol problems in support services Previous accommodation Move-on accommodation 27% general needs - 40% general needs 16% rough sleeping - 13% private sector/ownership 12% family/friends - 11% supported housing 12% supported housing - 9% family/friends Service type accessed Highest needs 44% floating support - managing substance misuse 36% supported housing - maintaining accommodation 15% direct access hostel - greater choice/control/involvement Highest achievement of needs - maximising income - access to services - greater choice/control/involvement - minimising harm from others

27. Further Information Housing Info - www.networks.csip.org.uk/housing Yvonne Maxwell , Social Inclusion and Equalities Project Manager yvonne.maxwell@dh.gsi.gov.uk