9. Specialist Provision and Independent Living
9.1 The planned integration of adult health and social care brings opportunities to strengthen the connections between housing, health and social care. To improve alignment of strategic planning, support the shift in prevention and to review, as necessary, any current arrangements for housing support and other housing related services. More information on the Integration of the Health and Social Care agenda is available at: http://www.scotland.gov.uk/Topics/Health/Policy/Adult-Health-SocialCare-Integration
9.2 Health and Social care integration covers all activities involved in assessing and forecasting need, planning the nature, range and quality of future services, working in partnership to put these in place and linking investment to agreed outcomes.
9.3 Housing can make a contribution to national outcomes for health and wellbeing at a local level by:
- undertaking effective strategic housing planning
- providing information and advice on housing options
- identifying, facilitating and delivering suitable housing that gives people choice and an appropriate home environment
- providing low level, preventative services which can prevent the need for more expensive interventions at a later stage
- building capacity in local communities.
9.4 Independent living is about freedom, choice, dignity and control for those with a disability or long term health condition, those who have become frail or those in need of support. People should be able to live safely and as independently as possible, in appropriate housing, with control over their care and support. A requirement for support for what may be complex care and health support needs, can occur at any age.
9.5 Wherever possible, independent living should be supported within a person's own home, but in some instances other types of accommodation may be more appropriate. Concern over a person's safety, their ability to cope alone or the level of care and/or support they require, may mean that other accommodation, such as supported accommodation, very sheltered housing or a residential/care home may be the best solution.
9.6 The provision of housing adaptations can assist in the prevention of accidents in the home and reduce the need for care and support services. They can also make a home ready, earlier, for someone leaving hospital or other type of care facility.
9.7 Planning and prevention are key to supporting independent living and the LHS should reflect the policies that are in place to deal with known milestones in people's lives. Allowing preparation and action to be taken before these milestones are reached can help to ensure that the correct specialist provision or support is in place.
Integration of Health and Social Care
9.8 The Public Bodies (Joint Working) (Scotland) Act: http://www.legislation.gov.uk/asp/2014/9/contents/enacted?view=plain
sets out the legislative framework for integrating health and social care, requiring local authorities and health boards to establish integrated partnership arrangements. It will facilitate the integration of budgets for adult services in such a way that 'where money comes from, be it health or social care, will no longer be of consequence'. The Act, from April 2015, will transfer responsibility for some adaptation delivery. The adaptations referred to are those required to make a house suitable for a disabled person in relation to accommodation, welfare or employment under Section 71 (2) e of the Housing (Scotland) Act 2006.
9.9 Whilst the regulations that will determine which services must be included in integration are yet to be finalised, housing representatives should be fully involved in the integration process and take every opportunity to engage and outline the critical role that housing can play in delivering effective health and social care integration.
9.10 Local Health and Social Care Partnerships should consult with housing colleagues at a strategic level and strategic plans should be clear on how they relate in purpose and scope with existing and forthcoming plans for housing, such as those set out in the LHS and Development Plan.
9.11 Joint commissioning plans take an outcomes approach, based on a joint strategic needs assessment and include a Housing Contribution Statement ( HCS). Housing has a key role to play in this agenda and it is essential that housing practitioners have a role in local discussions and in identifying solutions.
9.12 The LHS should be clear on what the integration of health and social care means in terms of providing suitable accommodation and the care and support required to fully support this agenda, whilst enabling people to live independently within their own home for as long as possible. Having the right amount of care and/or support in place can help prevent unplanned hospital admissions and allows people to leave hospital more quickly, benefitting both the individual and the hospital system.
Housing Contribution Statements
9.13 A Housing Contribution Statement ( HCS) is required from each local authority. The initial HCS (2013) will need to be revised, potentially in April 2015, to cover a period of at least 3 years. The HCS should be completed by local authority housing practitioners working in close collaboration with social work colleagues and local health professionals to ensure the statement is inclusive and fully supports the integration of housing with health and social care. Joint working will help to build consensus and a wider understanding and appreciation of each other's needs, issues and resources.
9.14 These publications may provide some useful information:
- Age, Home and Community: A strategy for Housing for Scotland's Older People 2012 - 2021, people http://www.scotland.gov.uk/Resource/Doc/365373/0124256.pdf
- Reshaping care for older people: A programme for change 2011-2021 http://www.scotland.gov.uk/Topics/Health/Support-Social-Care/Support/Older-People/Reshaping-Care
- The Keys to Life: Improving the quality of life for people with learning disabilities http://www.scotland.gov.uk/Resource/0042/00424389.pdf
a) Clearly state what action is required during the lifetime of the LHS to ensure that independent living is supported, taking into account the forecast for the increasing number of people living longer, and who are therefore more likely to require specialist provision.
b) Set out the local authority strategy for providing an environment that supports the integration of health, social care and housing, that allows people to remain in their own homes, through the use of care and support packages, aids and adaptations, and that provides clear links to other relevant strategies as appropriate.
c) Set out clearly the sort of services that are provided across the local authority area for all tenures, in relation to care/support services, handy person services/care & repair and the use of Telecare and Telehealth.
d) Be clear, how planning is helping with future specialist provision delivery and show clear links to the Integration of Health and Social Care agenda and the Housing Contribution Statement.
e) Provide some indication of the current and future need for residential and care homes spaces for when independent living is no longer a viable option.
f) Provide some information on how the better use of adaptations and adapted properties are helping to address need and keep people in their own homes. Provide evidence on local initiatives (including the use of adaptations) that both supports the prevention agenda and allows people to leave hospital after treatment, and return to their home environment as early as possible.
9.15 Specialist provision refers to the wide range of accommodation needs and care and support services (housing support) needed, to allow people of all ages, to live well and independently.
9.16 Delivery of specialist provision housing can be achieved through new build or the re-provisioning or adapting of existing properties. It can also be delivered in non-adapted properties through the provision of aids and/or care and support service through:
- Accessible/Adapted Housing
- Wheelchair Accessible Housing
- Non-Permanent Accommodation
- Supported Accommodation
- Care & Support Services
- Sites and Pitches
9.17 Accessible housing is housing that can be accessed easily from the outside and allow good freedom and safety of movement inside. These homes can be suitable for a person who uses a wheelchair infrequently and mainly outside of the home. Mandatory Building Standards (Standard 4.1 and 4.2) for new buildings set out clearly the accessibility requirements. www.scotland.gov.uk/resource/buildingstandards/2013Domestic/chunks/ch05s03.html.
9.18 Adapted houses can range from those that have received substantial remodelling to accommodate extra rooms and more minor changes to the internal layout to those where small adaptations have been added. www.scotland.gov.uk/Topics/Built-Environment/Housing/access/adaptations
9.19 These are homes suitable for those that need to use a wheelchair most if not all the time to get around both inside and out.
9.20 Non-permanent accommodation will be mainly available in the private rented sector ( PRS), and may appeal to those who know that they will be residing in an area for a relatively short time or who are, as yet, unable to commit to a longer period of residence. The accommodation may be a house, flat or rooms within a House of Multiple Occupation ( HMO). Non-permanent accommodation is likely to be most suitable for students, migrant workers, asylum seekers or refugees.
9.21 Supported accommodation is for those that need to live somewhere where a level of support is available to help them to live as independently as possible. This could include, care and residential homes for both older people and those with a physical disability, mental health condition or learning disability. Amenity, sheltered, very sheltered and extra care housing are the types of supported accommodation that should be considered to allow people to remain in a home environment and a familiar community for longer.
Care & Support
9.22 Housing support can be delivered through a range of care and support services that enable people to live independently in their own homes for a long as possible. Services are available to people across all tenures and are based on need and the resources available. Care and support can be delivered through the care & repair service, social care and other local authority and agency workers. There is an increasing demand for care and support due to the increase in the elderly population. Advice on the use of aids or the installation of adaptations can help to keep a person living in their own home for longer. The integration of health and social care will highlight the need and benefits of specialist provision.
9.23 The availability of specialist provision should reflect the make-up of the local population and the identified need. The HNDA will be a useful source of evidence for specialist provision but this is an area where more locally based information will be of prime importance to help inform strategy and delivery.
a) As a minimum, Specialist Provision should seek to address the needs of:
- Older people
- People with a physical disability
- People with a mental health condition
- People with a learning disability
- Young people - e.g. students
- People leaving supported accommodation - e.g. offenders, looked after children
- People needing supported accommodation - e.g. People fleeing domestic abuse/at risk families, homeless
- Ethnic minorities - e.g. migrants, asylum seekers, refugees, Gypsy/Travellers
b) Clearly set out the current need for specialist provision (accommodation and care/support services) that will help to support people to live independently and the likely requirement for this provision over the next 5 years.
c) Show how current needs are being met using a range of accommodation types and what more is planned to meet future need.
9.24 Gypsy/Travellers have been in Scotland for many centuries and still retain their own cultures and customs. The term Gypsy/Traveller refers to distinct groups, including Romanies, Scottish, Irish and Welsh Travellers, who regard the travelling lifestyle as part of their ethnic identity. Gypsy/Travellers are recognised in Scotland as an ethnic minority.
9.25 Today, many Gypsy/Travellers live on authorised council/ RSL sites, while others live on private sites or in bricks and mortar housing. However, many Gypsy/Travellers still travel, particularly during the summer months, and therefore require access to suitable sites across their travel area. In some instances Gypsy/Travellers use unauthorised encampments as temporary sites.
9.26 The Gypsy/Traveller lifestyle can mean that access to health, education and social services can be difficult for Gypsy/Travellers. Action being taken to address housing related issues should be clearly stated in the LHS.
9.27 Gypsy/Travellers have a requirement for specialist provision that should be identified in the HNDA. Any identified current or future need for appropriate sites or additional pitches should be reflected in and addressed through the LHS and Development Plan process.
9.28 All sites require a level of site management to ensure that the site is maintained at an acceptable level. Site managers may also ensure that residents have access to relevant housing and related information as necessary and provide support as required. This can include supporting those living on sites to access the services and support (such as education and health services) to which they are entitled.
9.29 Unauthorised encampment in a local authority should be managed in line with Scottish Government guidance, available online at http://www.scotland.gov.uk/Publications/2004/12/20417/48825. The number and size of any unauthorised encampments in a local authority area should be taken into consideration when assessing the need for sites and/or pitches. However, due to travel patterns, especially during the summer months, the existence of unauthorised encampments will not necessarily indicate a need for additional year round sites/pitches.
9.30 Sites provide pitches and facilities for use by Gypsy/Travellers, for those who wish to remain on the site and for those that are passing through.
9.31 In the first instance, any findings from the HNDA should be considered through the Development Plan process for the allocation of suitable land for sites. http://www.scotland.gov.uk/publications/scottish-planning-policy/. The development of the sites, provision of the facilities, maintenance and management of the sites should be addressed in the LHS.
a) Provide an assessment of the current level of site and pitch provision and whether the current provision is adequate.
b) Provide an assessment of whether sites and pitches currently provided are of an acceptable standard and of the right type ( e.g. are there a large number of pitches on transit sites being provided, when year round pitches would better meet the needs of the Gypsy/Traveller population).
9.32 Historically, Travelling Showpeople moved around the country, usually between March and October, attending fairs and living in caravans, on the fairgrounds. During the winter months they lived on vacant land, often rented from Local Authorities.
9.33 Many Travelling Showpeople now live on permanent Showpeople sites. These provide a more permanent base to allow their needs to be better met, such as the education needs of their children. Sometimes some family members will live permanently on a site, while others leave during the summer months to attend fairs. The sites are required not just for accommodation but for storage and maintenance of equipment and local authorities should ensure that suitable sites are provided where required.
a) Travelling Showpeople have a requirement for specialist provision that should be identified in the HNDA. Any identified current or future need for appropriate sites should be reflected in and addressed through the LHS (and development plan).
b) It is important that local authorities are fully aware of the accommodation needs of Travelling Showpeople and try to meet them.