supporting people plan – caerphilly county borough council...

‘ Working together for the good of all’

Ccbc/SPOP/Sep05 www.caerphilly.gov.uk/supportingpeople/supportingpeople.htm

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Supporting People Plan – Caerphilly county borough council – 2006/2007

CONTENTS

PART ONE: INTRODUCTION AND SUMMARY INFORMATION 1.1: Introduction Page 4-9

1.1.1. Supporting People Planning Group Page10-12 1.1.2. Consultation undertaken 1.1.3. What people have said Page13-19 1.1.4. Cross boundary issues Page20-21 1.1.5. Supply analysis Page22-23 1.1.6. Developments since last SPOP Page24-26

1.2: Summary list of priorities - new projects Page27-28 1.3: Summary list of priorities - remodelling existing projects Page 29 PART TWO: NEEDS MAPPING 2.1: Summary of the outcome of needs assessment Page 30-34

2.1.1 Women seeking refuge from domestic violence Page 35-37 2.1.2 People with learning difficulties Page 38-44 2.1.3 People with mental health problems Page 45-53 2.1.4 People suffering from alcohol dependency 2.1.5 People suffering from drug dependency Page 54-61 2.1.6 Refugees Page 62-63 2.1.7 People with physical disability who require support Page 64-68 2.1.8 Young single homeless people who require support and

young people leaving care Page 69-75 2.1.9 Ex-offenders Page 76-79 2.1.10 Homeless or potentially homeless people who require

Support Page 80-84 2.1.11 People with chronic illness including AIDS, AIDS related

conditions or who are HIV Positive Page 85 2.1.12 Vulnerable single parents who require support Page 86-87 2.1.13 Older people Page 88-94

PART THREE: SPRG - PROJECT DESCRIPTIONS Page 95 3.1 Grand total SPRG requirements

PART FOUR: SPG – OLDER PERSONS SERVICES Page 96

4.1 SPG funding requirements for New provision 4.2 SPG funding requirements for Existing provision


Ccbc/SPOP/Sep05 www.caerphilly.gov.uk/supportingpeople/supportingpeople.htm

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4.3 Grand total SPG requirements PART FIVE: SPG - COMMUNITY CARE Page

. 5.1 SPG funding requirements for New provision 5.2 SPG funding requirements for Existing provision 5.3 Grand total SPG requirements

. PART SIX: REMODELLING EXISTING PROJECTS Page 6.1 Projects needing additional resources (SPRG and SPG) PART SEVEN: APPENDICES Appendix 1: Needs map and supply map (SPRG) Page Appendix 2: Needs map and supply map (SPG–older persons services) Page Appendix 3: Needs map and supply map (SPG - community care) Page Appendix 4 – Breakdown of Supporting People funding Page Appendix 5 - Mental Health Accommodation Strategy Research Scoping Document

Appendix 6 – Gwent Needs mapping analysis

Appendix 7 – Caerphilly Needs Mapping analysis

Glossary of terms used in the Plan Page


S/HAWTIN/SP/PROJECT/SUPPORTING PLAN/SPOP3 3

PART ONE: INTRODUCTION AND SUMMARY INFORMATION 1.1: Introduction

This is the third supporting people operational plan (SPOP) prepared by Caerphilly county borough council. The format of this plan has been altered to reflect the experiences gained from the first two plans. The major influence on this plan is the 11.5% cut in supporting people grant announced by Welsh Assembly Government for 2005/2006. The reduction in grant amounted to a cut of £715,000 within Caerphilly and has seriously affected the ability of the authority to adequately meet the identified support needs of the vulnerable clients within the County Borough. (See developments section for more information) Accepting that cuts to the supporting people programme remain a threat, it would not be appropriate for the Adult Joint Strategic Planning Group to recommend that the Council make long-term financial plans and commitments. Rather, the Supporting People team will continue its initial reviews of providers and subsequently agree short term contracts until the Welsh Assembly Government confirms that the financial pressures on the Supporting People Programme have been resolved, that funding will be available to meet future local needs and the Supporting People Revenue Grant is transferred to the Council. This Operational Plan more closely addresses the following issues for all client groups.

• Needs Information • Identifying/evidencing unmet need • Supply mapping • Planning proposals

The previous plans were more comprehensive in terms of setting the programme in context and providing background information on Caerphilly and evidencing information on general levels of deprivation. Copies of the first two plans are available on the Caerphilly Supporting People website at www.caerphilly.gov.uk/supportingpeople The ‘Supporting People’ programme offers housing-related support services to vulnerable people. The programme brought together different funding sources into a single grant administered by local authorities from April 2003. The aims of the Supporting People programme include: -

• To promote independence and choice • To create a comprehensive range of more flexible support services • To monitor and review services in order to ensure quality and Best Value • To help deliver other strategies e.g. Homeless Strategy, Community Plans,

Health, Social Care and Well Being • To reduce the complexity of funding for supported housing • To plan the commissioning of supported housing within an agreed partnership

strategy Key to the delivery of Supporting People is the preventative nature of much of the support offered, it can prevent crisis occurring and negate the necessity of vulnerable

http://www.caerphilly.gov.uk/supportingpeople



people being referred to statutory agencies or movement into the primary care system. It is intended in the forthcoming year to undertake work on benefits realization of the supporting people programme which will evidence that low level preventative interventions will increase or maintain independence with a resulting benefit to the individual and the exchequer over the longer term. This is in line with wider Government policy, including recommendations around the preventative health agenda raised by the Wanless report. Caerphilly county borough council is committed to the vision of “Working together for the good of all”. The Council’s strategic and corporate themes have been set within the wider context of the emerging Community Strategy for the county borough. The Supporting People Operational Plan is intrinsically linked to the other strategies being developed by Caerphilly cbc and as takes it’s principal themes from the Health Social Care and Well Being Strategy and the Homeless Strategy. A common theme within the developing strategies is the issue of the provision of support to allow vulnerable individuals to retain, or achieve independence, within their communities. Key drivers of the Supporting People Operational Plan are vulnerable client sub-groups that operate under the Health Social Care and well being partnership. It is expected that the Caerphilly cbc Homelessness Forum will be the key contributor to the continuous review of the Homelessness Strategy, to ensure that prioritised actions are undertaken within the timescales agreed, and to enable a revised strategy to be produced within a five-year cycle. Supporting People will be integral to the successful delivery of many of the aims of all the above strategies and the need to ensure for cohesion between all the local strategic plans is understood and changes have been implemented to the supporting people planning process to ensure greater strategic compatibility.

The Supporting People team now contract with thirty one external agencies and have established Service Level Agreements with both Social Services and Public Housing. The entire budget for Supporting People services in the Caerphilly county borough now exceeds £6 million (includes Supporting People Revenue Grant funding paid directly to accredited providers). Final confirmation of the Supporting People Revenue Grant and Supporting People Grant for 2005/2006 was confirmed by the Welsh Assembly government in February 2005. An analysis of the funding of vulnerable adult services by Supporting People within Caerphilly is shown in appendix 4



The range of vulnerable client categories that are covered by the Supporting People programme are shown on below:

No. Client Group Client Group E1 Women seeking refuge from domestic

violence E7 People with physical disability who

require support

E2 People with learning difficulties E8 Young single homeless people who require support and young people leaving care

E3 People with mental health problems

E9 Ex-offenders

E4

People suffering from alcohol dependency

E10 Homeless or potentially homeless people who require support

E5 People suffering from drug dependency

E11 People with chronic illness including AIDS, AIDS related conditions or who are HIV positive

E6 Refugees

E12 Vulnerable single parents who require support



1.1.1 Supporting People Planning Group Caerphilly cbc integrates the responsibilities of the Supporting People Planning Group within the Adult Joint Strategic Planning Group. This group was formed in response to the introduction by Welsh Assembly government of the strategy for improving the Health, Social Care and Well-Being (HSCWB) of the residents of Caerphilly County Borough. It was felt that this group could better respond to the needs of the vulnerable adults identified within Caerphilly and could closely ally the supporting people programme with other initiatives aimed at vulnerable client groups such as Wanless and flexibilities funding. In 2005 the Supporting People reference group has been formed, The Group is made up of senior officers from housing, social services and health and they utilize their expertise and skills to ensure that Supporting People reports submitted to the Adult Joint Strategic Planning Group have been comprehensively consulted upon and that they reflect consensus of opinion. The Adult Joint Strategic Planning Group has confirmed it’s continued commitment to a supporting people strategy and has identified a number of key objectives to be achieved in the delivery of Supporting People services. The opportunity to progress will rely heavily on the Authority acting in a coordinated way, and developing further its joint planning relationships with other agencies in both the voluntary and statutory sectors. The strategy sets out six key objectives 1. To ensure existing housing related support services are maintained, within

budget and that all are included in a review timetable.

Services and accommodation agreed for funding are: - Sheltered and Extra Sheltered housing and community alarms - Supported shared housing - Supported placements - Hostels and refuges - Independent supported and move on flats - Floating support across all tenures including resettlement

2. To develop flexible support services to sustain and develop people’s abilities to live in their own homes across all forms of tenure.

3. To provide housing-related support and advice services, that promote

independence and choice, for all vulnerable adults.

4. To integrate the Supporting People programme into the existing strategic and planning framework to reduce levels of social exclusion, poverty, institutionalisation, rent arrears, evictions and homelessness.

5. To develop a sustainable consultation and participation system with service

users, providers and other commissioners in order to develop strategic services and monitor performance.



6. All Supporting People services will complement and contribute to the Council’s wider strategic priorities



1.1.2 Consultation undertaken Supporting people will now be operating within the wider consultation programme of the Adult Joint Strategic Planning Group. The consultation period will be extremely important for the partners to continue developing the strategy, action plans and for identifying resources for taking actions forward. Supporting people will form part of this process, in addition, a series of meetings were arranged during 2004/2005 with providers and stakeholders to ensure that the direction of the supporting people programme has widespread support. Previous priorities incorporated in last years plan have been endorsed by the adult joint strategic planning group as continuing priorities. The key strategies that underpin and drive Supporting People have been identified as the Homelessness and Health, Social Care and Well Being Strategies, and those other strategies that inform it. A brief description of these strategies is shown below. Supporting People and Health, Social Care and Well Being ( HSCWB) The HSCWB strategy is characterised by the following:

• It is the product of a Strategic Partnership and is by definition a joint strategy.

• The five strategic objectives that it focuses on, seek to further an agenda that responds to key issues that affect health, social care and well-being:

The relationship between lifestyle and poor health/well-being. The relationship between deprivation and poor health/well-being. The relationship between poor health/well-being and availability of services and

access to them, and the inequalities that exist across communities. The availability of services that enable people to live independently and thereby

maintain their health and well-being. The availability of services targeted at vulnerable people, without which their

health and well-being would be compromised.

• It identifies priority areas for action that support the achievement of the five Strategic Objectives and establishes an action plan in response to these priorities.

Supporting people is now closely involved in this process through its participation in the Adult Joint Strategic Planning Group and supporting peoples incorporation in the HSCWB action plan process. Supporting People and Homelessness The homeless strategy is a 5-year strategy is reviewed annually. It outlines the local authority’s aspirations for public and private housing in the borough and is supported by an Action Plan to ensure that progress is made towards the achievement of agreed targets. The objectives of the strategy are wide ranging and cover many aspirations. Some will be easier to achieve than others, and will rely on a relatively small increase in



resources. However, it needs to be recognised that if some of the objectives are to be realised they will require significant increases in resources and commitment from a wide variety of organisations and individuals. The objectives of the strategy include:

• Ensuring that appropriate support, including access to specialist services, is available to vulnerable people who are homeless or at risk of homelessness, to enable them to secure settled accommodation and to minimise the risk of their re-entry into homelessness

• Ensuring that suitable forms of temporary and emergency accommodation are available to those whose homelessness is unavoidable

• Providing the Local Authority advice and information service to the “Quality Mark” standard accredited by the Legal Services Commission, to ensure the availability of independent and informed advice and advocacy services to this standard

• Developing joint working arrangements with social services and other bodies to ensure that the needs of clients are fully assessed and provided for, and to help people avoid homelessness at crisis points

• Developing policies and services which will contribute to social inclusion, make the best use of available resources and ensure that the supply of affordable accommodation in the area reflects the extent and profile of housing need

Actions were prioritised by Caerphilly cbc’s Homelessness Forum within the homeless Action Plan to be completed during 2005/06. Some are carried forward from 2004/05 because they are not yet complete; others are new actions that have been identified from within that section of the original Action Plan, which had no target dates. Supporting people participate in the homelessness forum and were delegated to undertake work on a number of the action points identified in the plan. Making the connections - Consultation with other agencies Supporting People is just one of a large number of agencies whose primary purpose is the maximised the independence of vulnerable people. The benefits that can accrue from agencies working together and co-ordination of funding streams is realised. Much progress has been made in raising the profile of the supporting people programme and ensuring that staff from supporting people are integrated into the planning structures of complimentary strategies. The following is a brief indication of how the supporting people programme is establishing links into existing planning processes to ensure that this plan reflects the support needs identified within the county Caerphilly Homelessness forum The homelessness forum is a multi agency forum that is now chaired by representatives from the voluntary sector, the forum is the strategic driver in respect of the Homeless Action Plan. The supporting people manager is a member of the forum and provides regular updates on the performance of supporting people within Caerphilly.



The forum has been successful in bids for continuation of the mediation service and for the development of a housing options pilot scheme. Wales Homelessness Network A national network of homeless officers has been established and the Caerphilly Supporting people manager has attended a number of these meetings, the integral relationship between supporting people and homelessness is understood and the proposed legislative changes in respect of homelessness are a concern to the Caerphilly planning group. Care and Repair Caerphilly Supporting people has a close affinity with care and repair and the supporting people manager now sits on the Strategic Advisory Group of Caerphilly Care and Repair. In England care and repair come within the supporting people funding stream. In Caerphilly the linkages are currently being developed to ensure co-ordination of services. Local Substance Misuse Action Team ( LSMAT) Our Local Substance Misuse Action Plan flows from the Caerphilly County Borough Community Safety Plan and the WAG document ‘Tackling Substance Misuse In Wales’. Supporting People are regular attendees when accommodation related support appears on the agenda. In the current year there as been considerable liaison in respect of the Social Housing Grant for a supported housing substance misuse project. Gwent Association Voluntary Agencies ( GAVO) and Voluntary Agencies forum GAVO participate in the Adult Joint Strategic Planning Group and there by provide linkage to the voluntary sector for supporting people issues. It is envisaged that in future the Supporting People team will continue to work closely with the voluntary sector to retain diversity and provide service users with meaningful choice. Caerphilly Learning Disability Accommodation Forum Supporting people sits on the leaning disability accommodation forum which is a multi agency group that has been tasked to develop a strategic plan that will ensure joint working between health, housing and social care services in order to identify and plan for the accommodation needs of adults with a learning disability in the Caerphilly Borough Learning Disability Small Providers forum Caerphilly Supporting people now regularly attend the Caerphilly small providers forum for leaning disability providers. The forum provides an opportunity for providers to comment on issues of administration and best practice in respect of developing supported living projects within the county. Caerphilly’s People First The Caerphilly supporting people team have arranged a number of meetings with Caerphilly People first and clients in various types of supported living schemes to



gauge at first hand the experiences of tenants moving into the supported housing sector, quotes from these clients are utilised in this plan Caerphilly Leaving Care Forum Supporting people are members of the Caerphilly multi agency leaving care forum, accommodation issues are one of the major concerns for young people leaving care. Supporting people works closely with it’s partners within social services to ensure the co-ordination of its existing young person support services and to ensure that the existing identified support needs are adequately catered for. Caerphilly Sheltered Housing Users Forum Caerphilly supporting people host the forum of sheltered housing providers in Caerphilly that includes in house services, United Welsh Housing Associations, Charter, Abbeyfield, Wales and the West and Glamorgan and Gwent. The group is involved in development of the review system to be adopted for supporting people. All providers are being encouraged to seek the Center for Sheltered Housing Studies code of practice or equivalent. Strategic relevance and ‘value for money’ will be dealt with separately by the supporting people review and monitoring officer. Association of Social Alarm Providers and Center for Sheltered Housing Studies Various seminars held by the above organisation have been attended by officers for the supporting people team, where industry benchmarks are established then it is the opinion of the supporting people team that these should allow providers to be passported through many aspects of the initial review process. Strategic relevance and ‘value for money’ will be dealt with separately by the supporting people review and monitoring officer. Health Social Care and Well Being Sub – groups The Health Social Care and Well Being Partnership has established multi agency sub – groups covering the following categories of clients. Older people Mental health Leaning disability Substance misuse Physical disability Young people Where appropriate, supporting people staff have attended all these groups to ensure that issues relating to accommodation related support for all vulnerable groups are fully understood and discussed. It is through these multi agency groups that much of the consultation work as taken place in establishing the needs of the vulnerable client groups within Caerphilly



Caerphilly Income Maximisation Group In line with Caerphilly’s intention to eradicate poverty for older people this group was established, to try and provide an integrated ‘one-stop’ service and maximise income and benefit take-up, e.g. setting up joint working teams, sharing information, training, producing a simple guide to services for the public. Youth Offending Team Supporting People have met with the Caerphilly/Blaneau Gwent Youth Offending team to discuss how existing support services can be best utilised to assist in the rehabilitation of young offenders and to examine options for the development of new support services to meet the needs of YOT. Cymorth Cymru Caerphilly appreciates the important role the at Cymorth play in representing the supported housing sector. Caerphilly is co-operating with Cymorth and Cadarn Housing Association on the development of Sprint, a software system to allow providers to more efficiently run their services and provide the monitoring information required by administering authorities. Valleys Race Equality Council Caerphilly supporting people staff have attended meetings and training sessions organised by the Valleys Race Relations Council, it is appreciated that low numbers of BME groups within the valley can result in this particular group being omitted from the planning process, it is the intention of the Caerphilly Supporting People Team to extend our contact with Valrec to ensure that the needs of BME groups are accurately captured and appropriate support mechanisms are instituted. Caerphilly Young Peoples Forum / Caerphilly’s youth forum These forums are mainly constituted of young people, many who have experienced the leaving care system, they are able to give information on first hand and have assisted the Caerphilly supporting people team in collecting information in respect of the ‘move on’ process in Caerphilly, and have helped in identifying the need for the employment of a ’move on’ co-ordinator post within the county A series of Supporting People Service Development Forums, based on vulnerable client categories have been undertaken in the Spring of 2005 to allow all agencies the opportunity to contribute to the development of this, the third Supporting People Operational Plan presented by Caerphilly county borough council. In addition to the above many meetings have taken place with Statutory Agencies including Gwent police and probation service and the local authorities social services, housing, community safety and corporate policy unit to discuss how the Supporting People programme can link to other strategies to ensure co-ordination and assistance in delivery of support services.



Supporting People Networks Supporting People is a relatively new programme and as such there as been a need to establish support networks to facilitate the introduction of the programme and try to establish a consistent approach throughout Wales. Caerphilly Supporting people has affiliated to a number of groups that ensure that Caerphilly remains focused in terms of the development of accommodation related support. Supporting People Information Network (SPIN) – Caerphilly is a member of the all Wales SPIN, this group meets on a bi-monthly basis and comprises lead supporting people officers and representatives from Welsh Assembly Government and Cymorth Cymru. SPIN has proved to be a valuable sounding board for the introduction and implementation of supporting people within Caerphilly. The Supporting people agenda has undergone many changes since the last supporting people plan and a separate section is attached to this plan that gives a brief outline of the main issues that have arisen in respect of supporting people on both a national and local agenda An Executive SPIN has been formed, made up of the Chair of the SPIN meetings and one representative from each of the 3 regional Supporting People Network Groups, i.e. South, Mid and North Wales. Supporting people has also began development of a website that will allow for news, signposting to useful websites and a discussion forum. The site address can be found at www.allwalesunit.gov.uk The South Wales Supporting People Network ( Mini SPIN) This group meets on a bi-monthly basis and operates as a mechanism to share ideas and good practice, to discuss regional issues and issues to be raised at SPIN meetings with the Welsh Assembly, and to task members with actions to assist in developing common frameworks.

is made up of Supporting People Officers from the following local authority areas: Torfaen, Monmouth ,Blaenau Gwent, Newport, Cardiff, Bridgend, Swansea Neath Port Talbot, Caerphilly, Merthyr, Vale of Glamorgan, Rhondda Cynon Taff Caerphilly also is represented on the supporting people contract officers sub group and the supporting people benchmarking sub group that has been established to look at issues concerning the value for money audit of supporting people services. Caerphilly have identified the following five authorities that have similar sized populations and socio economic characteristics. It is intended to undertake research to benchmark ourselves against the support services offered in these counties and to develop a profile of what needs are being evidenced in these authorities

Rank Authority Name Authority Type SP Funding

1 Flintshire Unitary 7,537,059

2 Calderdale Metropolitan 5,728,115

3 St. Helens Metropolitan 10,462,664

4 Bury Metropolitan 6,825,212

5 Knowsley Metropolitan 7,377,889



1.1.3. What people have said

We arranged a meeting facilitated by Caerphilly People First, where we asked tenants who live in various supported living situations, what they thought of the benefits of supported living. Below is a selection of their comments.

“I use to have 36 hours of support now down to 5 hours” “I like where I am, but one day I want my own flat” “Lived alone in Blackwood for over two years now, still help my parents with their shopping” “ Now, I make the decisions in my life from choosing where I live to what furniture and clothes to buy” “I can afford more outings in the community” “It’s a less regimented regime, I’ve been in institutions and hostels” “Now, I’ve got more money in my pocket to spend”

“My support worker is helping me with respite care for my brother”



1.1.4 Cross boundary issues Caerphilly county borough council works closely with neighbouring authorities to tackle issues where a client needs to leave one area for another or to address a specialist need, we are particularly active in the field of developing services in respect of victims of domestic violence and services for ex-offenders.

People who are most likely to have Cross Border needs are:

• Women and children experiencing domestic abuse • Young people who have experienced abuse • Ex-offenders • People with mental ill-health • Homeless people who have multiple needs

Over coming years there will be a strategy developed to provide a comprehensive profile of existing cross boarder services, assessment of need and commissioning and de-commissioning priorities. All stakeholders will receive appropriate information and will be consulted. This last Caerphilly plan contained a bid for the re-establishment of a Women’s Aid hostel in Pontllanfraith, this will replace a former refuge that was de-commissioned in January 2003. An analysis of the statistics provided by Rhymney Valley Women’s Aid revealed that a significant number of referrals are from out of county; this has been supported by evidence now gained for the Gwent Needs mapping exercise. Sufficient savings were identified from within our Supporting People Grant Programme to fund this particular scheme. The scheme is expected to commence in November 2005. A successful Social Housing Grant submission was made for the development of a Gwent substance misuse project. A task and finish group chaired by the Caerphilly supporting people manager is currently looking at options in respect of what model of supported accommodation will best meet the needs of substance abusers in the Gwent area.

Meetings have been held with supporting people officers in both Merthyr and Rhondda Cynon Taff to discuss cross boundary issues with respect to the West of the County and stronger links now exist for cross boarder services in this area, though it is appreciated that a more formal process needs to be developed to better co-ordinate services in the North of the County. The Supporting People Regional Officers Gwent (SPROG) meet regularly to discuss issues of particular relevance to Gwent, including cross-boundary needs. Gwent has benefited in 2003/2004 from a Pan Gwent bid submitted by Torfaen for the establishment of the intensive forensic floating support project match funded by Probation Grant. (see ex offenders) This project known as the ‘Arms’ project is a floating support scheme being run by Tai Trothwy and caters for 12-14 ex offenders with high levels of support are required. This is a positive aspect of supporting people operating on a regional basis. Joint supply mapping is being is being undertaken by the Gwent group to identify current supporting people services in place within Caerphilly.



A Social Housing Management Grant application has been submitted by the supporting people officers of Gwent for the employment of a Gwent supporting people co-ordinator who will be tasked with developing the needs mapping activities through out Gwent, especially in relation to those most transient of vulnerable client groups. This post will link in with the existing Gwent groups established to look at common issues such as the needs mapping exercise and commissioning issues (see appendix 6) The Gwent Criminal Justice Supporting People Forum as been established in the last year to replace the previous Pan-Gwent Probation Accommodation Forum The group will be the venue for discussing issues in respect of probation and youth offending issues. Historically, there has been a problem with establishing County based linkages with probation, it was therefore considered that a Gwent wide approach would better facilitate the collection, collation and analysis of information on ex offenders. Earl Smith the Probation secondee to the Welsh Assembly acts as the chairperson for the group, again this is one of the areas where a Gwent co-ordinator could contribute to the development of both county and regional answers to the needs of ex offenders. A number of sub groups have been established in Gwent that offers the opportunity for staff to develop best practice and co-ordinate services. Gwent Reviewing Officers Group is attended by the contract and review officers and offers the opportunity for discussion of the contents of a steady state contract and brings greater alignment to reviewing practices. In addition, a number of task and finish groups have also been established, the Gwent Eligibility Criteria Group has established a common basis for eligibility criteria to supporting people services within Gwent and will help providers who manage projects on a regional basis. A Gwent Needs Mapping form has also been produced and was launched in February of 2005



1.1.5 Caerphilly and Gwent Supply Mapping Analysis The purpose of this section is to outline the key themes that arise from the detailed local supply mapping, carried out by the Caerphilly county borough Supporting People Team, in partnership with local providers. In addition to receiving data from support providers on the type and range of services provided we have contacted commissioners and community groups to add to and consolidate this information. The mapping exercise has been an essential part of Caerphilly county borough council’s strategy development process as it has enabled us to establish a picture of supported housing provision across the county borough. By doing this, we have been able to highlight gaps in local provision or areas of oversupply thus providing a rationale for future development decisions. Funding of Supported People Revenue Grant to providers in Caerphilly currently stands at £6,291,289 for both SPRG and SPG schemes. SPRG accounts for £1,677,032, (26.66%) whilst Supported People Grant amounts to £4,614,257, (73.34%) The supply mapping exercise has identified 3,513 supported household units funded by supporting people in the Caerphilly county borough of which 75.6% are accommodation based services and 24.4% are floating support. Community alarm services are well established in the Caerphilly county borough and currently serve over 4270 residents. Supporting people assist in funding 57.9% of these clients. In terms of client groups, 83% are older clients although not primarily through the provision of specialist accommodation but mainly through their use of the community alarm service. Supported accommodation for older people makes up (86.1% - sheltered schemes) of the accommodation-based services followed by accommodation for people with learning disabilities (10.03%). However, in terms of

Caerphilly Supporting People Grants - Vulnerable client groups

Learning disabilit y37%

Ment al Healt h8%

Older person20%

Physical disabilit y5%

Homelessness27%

Vilnerable f amilies3%



Supporting People funding older people account for 20% of the budget, whilst learning disability account for 37%. This reflects the more intensive nature of support offered to learning disability clients The Caerphilly county borough has a growing supported housing sector with over 30 providers working in the county borough. The local authority is the single largest support provider and accounts for 40% of the budget (public housing and social services) The community alarm services are mainly provided by the local authority and the public housing department manages forty of the forty seven sheltered schemes, similarly 40.7% of accommodation based support for people with a learning disability is directly provided by Social Services. Registered Social Landlords, voluntary organisations, charities and private providers receive the remaining 60% of the funding. Access to services is fairly open with few explicit exclusions. Where exclusions do apply these will be looked at in the first scheme review to assess their suitability. We are concerned that exclusions may be inappropriate for some services, particularly if providers are expected to and indeed are funded to put rigorous risk management functions in place to enable higher risk service users to be accommodated and supported. Historically, Supporting People has had it’s basis in the rented sector, however, it is Caerphilly county borough council’s intention to broaden it’s criteria for provision of Supporting People services to include all tenures and to be based on determination of need. The majority of accommodation-based services such as sheltered schemes and supported living are provided with 24 hour on call or alarm support. Caerphilly has with its partners in Gwent been developing Geographical information systems, It is envisaged that in future the use of the GIS information together with needs data will provide a useful tool for evidencing the commissioning or re-modelling of services. The following is an example of Gwent wide mapping of women’s Aid refuges, young person schemes and mental health accommodation based projects.



The following example show the distribution of sheltered schemes in Caerphilly sheltered schemes, a full GIS breakdown of all supporting people projects within Caerphilly can be viewed within the first supporting people plan on the Caerphilly supporting people website http://www.caerphilly.gov.uk/supportingpeople/operationalplan.htm.

http://www.caerphilly.gov.uk/supportingpeople/operationalplan.htm



1.1.6 Developments since the last Supporting People Operational Plan A great deal has occurred in respect of Supporting People since the submission of the second Caerphilly Supporting People Plan in October of 2004. Whilst many of the changes are reflected in the text of the main document, it was considered appropriate to highlights some of the main issues on both a National and County context National Funding issues Most importantly is the cutting of the Supporting People funding for 2005/2006 by 11.5%. This has resulted in a need for Caerphilly to identify £715,000 of savings. Savings have been achieved through various measures and has resulted in no cuts to existing providers in 2005/2006; however, financial constraints have meant that for second year, no inflationary increase was made to providers. It is the view of the Caerphilly Adult Joint Strategic Planning Group that the encouragement of Welsh Assembly Government for local authorities to maximise the support to vulnerable people within the County prior to the end of Transitional Housing Benefit places a moral responsibility on WAG to continue to adequately fund existing supporting people schemes. Caerphilly SPPG also note that the current allocation of supporting people funds throughout Wales does not accurately reflect accommodation related need and has been demand led through the Transitional Housing Benefit system Caerphilly has written to both Welsh Assembly Government and The Welsh Local Government Association that Caerphilly whilst opposing cuts would if necessary, favour distribution of cuts through a formula application, preferably through social services formula or following discussion, developing on the ODPM SP allocations formula Supporting people can now confirm that there will be no cuts in budgets to any support providers in 2005/2006 other than those agreed following initial reviews of services. Unfortunately we are not in a position to agree an inflationary increase in the current year, however, the fact that there has been a freeze on supporting people budgets for two years will be conveyed to the Supporting People Planning Group when funding issues for 2006/2007 are discussed. New Projects 2005/2006 . Supporting people was able to provide funding for two new projects to commence in 2004/2005. These projects had high priority ratings within the first years SPOP.

• Domestic Violence Refuge to be located in Pontllanfraith (4 units) • Highfields extra sheltered scheme, Blackwood (42 units) • Proposal for 7 bed substance misuse supported housing scheme

All the above schemes were approved for Social Housing Grant and as such it was decided by the Supporting People Planning Group that priority should given to their



funding. Whilst no new funding was forthcoming, savings within existing budgets allowed for the first two schemes to be given approval to progress. The substance misuse project was subject to top sliced capital in the form of Social Housing Grant and Welsh Assembly Government have indicated that Supported People Revenue Grant will be available to fund the revenue costs of this project. No decision has yet been taken by Caerphilly cbc in respect of the location of this scheme and the Welsh Assembly Government have been made aware of the possible necessity for the Social Housing Grant to be utilised in 2006/2007. WAG undertake review of SPRG projects for which Caerphilly is ASP Caerphilly supporting people team are the approved support provider for seven support agencies in the Caerphilly area. In November 2004 a Welsh Assembly inspection was undertaken of each of the projects and how the Caerphilly supporting people team was managing them. We are pleased to report that all the recommendations made by the Assembly inspection team are being addressed and that all the agencies will continue to provide support for their vulnerable clients. WAG introduce tariff rates In April 2004 the Welsh Assembly Government announced the rates that would be payable to Supporting People Revenue Grant (SPRG) providers from April 2005. The tariff rates will supersede the current funding that was based on original legacy funding rates. Caerphilly Supporting people team are working to ensure that the introduction of the tariff system will not adversely affect the existing SPRG schemes that operate within Caerphilly. Two appeals have been registered with Welsh Assembly Government in respect of providers of the floating support services. A date for these appeals as not yet been agreed. Delay announced in transfer of SPRG to Local authorities Welsh Assembly Government has announced that the Supporting People Revenue Grant (SPRG) will not now be transferred to the local authority until 2008 at the earliest. Caerphilly will continue to work closely with all Approved Support Providers to ensure that focus is maintained on achieving the strategic objectives of the authority. Caerphilly Supporting People Communications Strategy continues Supporting people remains a government initiative that is often clouded in mystery for both professionals and service users. Caerphilly Supporting people team has introduced a number of initiatives that it hopes will help people understand the role Supporting Poeple can play in helping vulnerable clients within the County. A communications strategy has been developed and the following initiatives have been developed that it is anticipated will raise the profile of supporting people.



1. Caerphilly Supporting People website launched www.caerphilly.gov.uk/supportingpeople/supportingpeople.htm 2. SPIN website launched

Caerphilly Supporting People Review programme continues Caerphilly has determined how it will review the providers of support services for which it has responsibility. In reviewing providers the Supporting people team will be considering a number of issues that could best be described as ensuring that ‘Best Value’ is being achieved.

• Strategic relevance • Quality of the service • Value for money

Details of Caerphilly Supporting people methodology are available on the teams website. Introduction of tariffs for SPG schemes Caerphilly supporting people team are intending to introduce a tariff system based on that used by Welsh Assembly Government for supporting revenue grant projects. The tariff will reflect a more realistic assessment of the actual cost of accommodation related support in these projects. The decision is based on the outcomes of initial reviews undertaken on learning disability supported living schemes. It is anticipated that the exercise of moving onto tariff will be budget neutral with any savings diverted to new clients who have not previously been funded by supporting people. Supporting People Domiciliary service expanded The domically service directly managed by the supporting people team for clients with a physical disability now as in excess of 450 clients. The service is extremely popular and most referrals come form social workers, housing or health staff. The scheme allows individuals to maintain their independence and dignity and has additional benefits such as early identification of clients more acute needs, delaying the need for more intensive support and allowing social interaction with often socially isolated clients. Supporting people performance indicators introduced 2005/2006 has seen the introduction of supporting people performance indicators, three indicators have initially been introduced and the Caerphilly response to the indicators is shown below. Caerphilly supporting people team have submitted comments to the Welsh Local Government Data Unit on both the introduced performance indicators and those it is intended to introduce in 2006/2007.

http://www.caerphilly.gov.uk/supportingpeople/supportingpeople.htm



Most importantly is the need to agree clear, concise definitions that allow little room for interpretation, in addition there is a need to appreciate the potential difficulty that the collection of some data will pose to both providers and administering authorities.

PI Ref

Indicator

2004/05 2005/06

SPP/001 NS8

The average number, per 1,000 head of population, of: i) Units of floating support ii) Bed spaces in direct access iii) Bed spaces in temporary residential

accommodation iv) Bed spaces in permanent residential

accommodation v) Bed spaces in sheltered accommodation for older

people vi) Community Alarm Services

2.4 0.07 0.18 0.94

8.21

27.44

2.5 0.09 0.18 0.96

8.45

27.7

SPP/002

The number of units of support capacity provided to each of the following client groups during the year, per 1,000 population:

i) Women fleeing domestic violence; ii) People with learning difficulties; iii) People with mental health problems; iv) People suffering from alcohol dependency; v) Refugees; vi) People with a physical disability who require

support; vii) Young single homeless people who require

support and young people leaving care; viii) Ex-offenders; ix) Homeless or potentially homeless people who

require support; x) People with chronic illness including AIDS,

AIDS related conditions or who are HIV positive;

xi) Vulnerable single parents who require support; xii) Older people; and mixed

0.21 0.83 0.45 0.08

3.83

0.18

0.03 0.23

0.01

0.46

37.49

0.22 0.85 0.47 0.08

3.85

0.18

0.03 0.25

0.01

0.48

37.50

SPP/003 The number of Needs Mapping Exercise assessments processed per 1,000 head of population

9.11

9.5



Meeting support needs within Caerphilly The following provides a list of those schemes that Caerphilly cbc and its partners have identified has needing to be commissioned or extended to meet the gaps in need identified by the needs mapping exercise, combined with numerous other sources of needs based data. A number of schemes that have attracted Social Housing Grant are prioritised within the programme together with homeless related projects that it is anticipated will assist Caerphilly in meeting it’s statutory obligations under the existing and proposed homelessness legislation. A total of nine new projects have been identified, this includes the need to continue the expansion of the supported living programme to accommodate people with a learning disability leaving institutions and hostels. Eight existing projects have also been identified has requiring expansion to meet the gaps in need identified by the needs mapping and associated processes. The funding constraints imposed on the supporting people budgets will clearly restrict the ability of Caerphilly to adequately identify funding for any of the schemes identified in this plan, in addition the difficulties being experienced by the existing supporting projects within Caerphilly will need to be discussed by the Supporting People Planning Group. The details for the costing for schemes relate to Supporting People Revenue Grant tariffs, others to actual costs. In some instances the full cost calculation details have not yet been finalised. Not all providers have yet been identified and in some instances a tender process may be used Caerphilly county borough council feels that in the allocation of any future growth funding, factors such as population size and socio-economic indicators should be considered and that the Welsh Assembly Government should produce a transparent process in terms of the allocation of growth funding.



: Summary list of priorities - new projects - 2006/2007 SPOP

Priority Funding type

Name of project Type of project No of units

Client Group Estimated Annual Revenue costs

Comments Providers

1 SPRG Caerphilly Substance misuse Rehabilitation Project

Rehabilitation Project

7 Substance misuse

£125,000 7 million of SHG available in Wales

TBA

2 SPRG Gwent Substance misuse Rehabilitation Project

Rehabilitation and Detoxification Unit

12 Substance Misuse

£25,000 Consultancy needs survey to be commissioned

TBA

3 SPRG The Bon Marche Project’

Floating Support 9 Units Ex Offenders £90,000 Project out of county in Abertillery

Tai Trothwy

4 SPG Supported Lodging

Supported accommodation

4-6 units

Care leavers 13,000 New project being developed to assist care leavers in transition to independence

Various

5 SPG Star House Accommodation based

4 units Homelessness – Young mothers

£20,000 Former refuge in process of being purchased by the authority

LA and support from voluntary floatingsupport providers

SPRG Direct Access Hostel - Homelessness

Accommodation based

4-6 Homelessness £75,000 Identified in Homeless action plan, not proposed until 2007/2008 in SHG bids TBA

SPG High intensity floating support and Jubilee House

Floating support TBA Mental health 142,000 Prevention of readmissions to Ty Sirhowy, 4th highest MH rate in Wales and only small funding by SP TBA

SPG Peripatetic warden service

Floating support TBA Older people 30,000 Mobile warden who would respond older people concerns who are connected to community alarm Local Authority

SPG Various Supported accommodation

12 units Learning disability

140,0000 Part of re-settlement programme from Tair Erw TBA

SPG Older person Floating support TBA Older person

Total £660,000



Summary list of priorities – remodelling/extending existing projects – SPOP 2005/2006

Funding type

Name of project Type of project No of units Client Group Revenue costs

Comments Providers

SPRG Women’s aid outreach

Floating Support 10 Women fleeing Domestic Violence

£35,000 Helps people who leave refuge and prevents people needing to utilise refuge

Rhymney Valley Women’s Aid

SPRG Floating Support – young ex offenders

Pilot out of hours floating support

4-5 Young Vulnerable

£40,000 May involve remodelling of existing schemes

Tai Trothwy / Llamau SPRG Barnardo’s Open

Door Supported living 4 Young people 30,000 Waiting list of

young people for this type of project– lots of evidence for this project from Housing advice center and leaving care team Barnardo’s

SPG Advocacy – learning disability

Floating support TBA Learning Disability

£20,000 Advocates who act for clients in supported accommodation to get their voice heard or exercise their rights as an individual

TBA – On going discussion with social services on funding of this project.

SPG Home from Home Supported accommodation

4 units Mental health £62,000 Limited supported housing for mental health clients

Home From Home SPRG Vulnerable families

support worker Floating support TBA Vulnerable

parents £40,000 May link into

funding for Star house when available TBA

SPG Learning Disability Floating support scheme


£40,000 funding fro scheme to provide support to learning disability clients TBA

SPG

Adult Placement Scheme

Supported living TBA Learning Disability

£20,000

Local Authority

Total

£287,000



PART TWO: NEEDS MAPPING For the first time the Caerphilly Supporting People Operational Plan contains a section on the identified needs within Gwent. Details of the Gwent needs mapping can be found in appendix 6 Needs Mapping Analysis - Gwent In February of 2005 the Gwent supporting people officers launched the Gwent needs mapping exercise, A single needs mapping form is now utilised by all five Gwent authorities successfully launched at a conference in January 2005 which was attended by 72 delegates from 46 organisations, the form was phased in by each authority by the end of March 2005 and the total number of returns for the first full quarter (April – June 2005) was 954 Analysis of the returned forms is shown below Age groups by gender:

• The highest percentage of returns from males (36.4%) was in the age group 25-39 years old, which is not unusual, whereas for females the highest number was in the age group 18-24 years old. This gives cause for concern together with the fact that more females than males completed returns in the age group 16-17 years old.

• This trend is replicated in most of the Gwent local authorities and has implications for the development of supported housing projects including whether to commission schemes for women only, for young women only or for young men and women. At present there are only four schemes in Gwent specifically for women other than Women’s Aid refuges and floating support schemes for women fleeing domestic violence.

• Women again predominate in the age groups 40-59 and 60+ years old, which is unusual. This could be partly explained by the number of forms returned from Women’s Aid groups but will need further research.

Current accommodation:

• A surprisingly high number of people (over 10%) indicated that they were sleeping rough, probably as a result of the Wallich-Clifford Section 180-funded scheme in Newport assisting rough sleepers with a ‘Breakfast Run’

• A similar number were living with friends or ‘sofa-surfing’ and unable to access accommodation and support matching their needs

• Again a similar number were living in hostels or refuges with a number of people accommodated from outside the local authority area where the scheme is situated

• A high number of people continue to live with parents and other relatives pending a move to alternative accommodation, with or without support. This is an increasing problem throughout the region with the shortage in good quality rented housing. This skews the figures of the true number of homeless people in Gwent who see no chance of accessing permanent accommodation and do not want to declare themselves as homeless.

• Trothwy Cyf’s Prison Link scheme accounts for the 3% of returns from prisoners who are near to release and need to secure accommodation and support. Bridging the link quickly between prison and local



homelessness and support services is crucial if ex-offenders are to begin to re-build their lives and not re-offend. More schemes for ex-offenders are needed in Gwent to cope with the ever-increasing number of people released from prison and other custodial sentences who have no accommodation available on release.

Lead need:

• The high numbers of people indicating homelessness as a lead support need (50%) is to be expected as this figure is consistently replicated throughout all the Gwent local authorities. More rigorous analysis is needed to identify the real support needs of service users beyond the need for (any) accommodation e.g. any underlying high support needs also indicated.

• A high number of returns show people with mental health problems in Gwent. Although a number of supported housing schemes exist in Gwent, the recently published Wales Audit Office draft report “Adult Mental Health Services Baseline Review” states that the lack of supported housing schemes is a key issue that needs to be addressed, especially crisis and dual-diagnosis accommodation.

• The number of returns indicating domestic violence/abuse as a lead need is comparatively high and may be reflected in the good working relationship between SP teams and local Women’s Aid groups.

• An interesting figure is the number of people stating that frail elderly was their main need. The recent growth in the provision of extra Care schemes for the frail elderly in Newport and Caerphilly, as an alternative to residential accommodation, can be seen as partly addressing the needs of this client group. The full impact of the telecare or assisted technology revolution is yet to be tested, but will undoubtedly help elderly people to remain independent in their own accommodation for much longer.

• Smaller, but significant numbers of returns were received from people indicating substance misuse, physical disability, young and vulnerable and learning difficulties as lead needs. Each of these groups will require additional supported housing schemes to be developed in Gwent to address the shortfall in provision.

Housing-related support needs by age:

• Help setting up and maintaining a home is consistently the highest support need across all age groups and particularly between the ages of 16 and 39.

• Help finding other accommodation, assistance with benefit claims and budgeting also scored highly across the age ranges; less so with people aged over 59.

• There is a broad range of housing-related support activities needed for all age groups, with the age range 60+ concentrating on monitoring of health and well-being, community alarm services and personal safety and security.

Disability:

• The returns show arthritis to be the primary disability problem with diabetes, heart, respiratory and mobility problems recorded highly. Sensory impairment also featured as a major problem with concerns of increased isolation that inevitably accompany the gradual loss of sight and hearing.

• Over a fifth of all the forms returned indicated some degree of disability which needs more analysis e.g. by age, as there are very few supported



housing schemes in Gwent for people with physical disabilities under the age of 60.

Ethnic Origin:

• As the latest Census figures show there are very few people from ethnic minority groups in Gwent with the exception of Newport, which has the second highest percentage in Wales after Cardiff. Less than 5% describe themselves as of non-UK or European origin. Interestingly 53.1% prefer to indicate that they are Welsh as opposed to British (37.3%)

Current and future accommodation needs:

• Although most returns indicated that people only wanted ordinary housing without any support both now and in the future the next highest category was for ordinary housing with support for both now and in the future. This demand indicates the preference for the floating support model of supported housing, bringing the support to the person’s own accommodation.

• Floating support schemes developed at different speeds in Gwent so that there are some authorities with large schemes e.g. Caerphilly and Torfaen and some where a large expansion is needed for a range of client groups as well as a generic service e.g. Newport, Monmouthshire and Blaine-Gwent.

• Some client groups may only have small numbers needing supported accommodation and it is in these cases that regional commissioning and development of specialist cross-authority schemes could take place e.g. for people with substance misuse, AIDS/HIV+ or dual-diagnosis problems and for high risk/high needs ex-offenders or gypsy travellers.

Summary:

• The figures for Gwent as a whole mirror to a greater or lesser extent the returns from last year for each local authority.

• Regional variations do exist and can be partly explained by the SP teams working relationships with specific agencies and organisations, or lack of them. Figures can be skewed locally and as a result can affect the overall picture of need in Gwent.

• Accurate figures for inward and outward migration are at an early stage and more detailed work in this area will be undertaken this year.

• SP teams in Gwent are endeavouring to increase the rate and accuracy of returns from existing providers, agencies and service users and are working hard to expand the use of the GNME more widely to build a more comprehensive picture of support needs across the region.



CAERPHILLY NEEDS MAPPING PROCESS AND ANALYSIS Past plans have given detailed information on national and regional trends, accepted best practice and examined models of support utilised within the County. It is the intention of this plan to concentrate on identifying gaps in support need within Caerphilly for each vulnerable client group and providing evidence to support these proposals. Previous plans can be accessed on http://www.caerphilly.gov.uk/supportingpeople/operationalplan.htm Caerphilly county borough is in the process of introducing the needs mapping exercise (NME) as outlined within the National Assembly guidance document on the implementation of Supporting People within Wales The mapping assessment form has been the subject of consultation and has been modified to reflect the planning needs of other directorates within Caerphilly county borough council. Caerphilly county borough council has worked in partnership with the other former Gwent authorities in respect of the introduction of a Gwent NME. The form has been developed on Snap software that will allow for analysis of the questionnaires results. The Gwent NME has been implemented since March 2005 and is in use by the authorities housing advice centre and other agencies in contact with potentially homeless clients.

All tenants in local authority sheltered schemes have also completed a version of the NME and these results are currently being analysed. The fact that the NME has only recently been introduced has meant that the needs assessment for this, the third Supporting People Operational Plan has needed to also rely on information collected in a variety of formats and from numerous sources to produce an initial indication of need within the Caerphilly county borough. These alternative sources have included census data, information from the social services and housing databases, national and regional surveys and monitoring information gathered from the voluntary sector. The picture in respect of need is incomplete and needs further development and it is envisaged that the introduction of the Gwent NME will allow for the creation of a more comprehensive picture of accommodation-supported need within the Caerphilly county borough. Historically, Supporting People has had it’s basis in the rented sector, however, it is Caerphilly county borough council’s intention to broaden it’s criteria for provision of Supporting People services to include all tenures and to be based on determination of need. Of particular concern to Caerphilly Supporting People team has been the need to ensure that Protection of Vulnerable Adult issues are universally understood and adequately responded to. We have therefore made POVA a major issue in respect of the initial reviews undertaken of providers of services, and will be closely monitoring the situation in respect of schemes in receipt of Supporting Housing Grants. The following table shows the number of POVA contacts in the Caerphilly area fro 2004/2005, this is significantly higher than previous years and evidences the increasing

http://www.caerphilly.gov.uk/supportingpeople/operationalplan.htm



Caerphilly POVA contacts 2004/2005 Details of the Caerphilly needs mapping exercise can be found in appendix 7 Within Caerphilly the needs mapping has been confined to those oraganisations that deal specifically with homelessness, information in respect of the community care and older person projects has principally been obtained from other sources such as social services, health and housing. Analysis of Caerphilly Needs Mapping for period 01-04-2005 to 30-06-2005 is shown below Age Groups by Gender

• Of returned forms, analysis shows females (73.3%) in the 25-39 years of age range were the highest percentage, whereas Males in the age rage of 40-59 has the lowest rate of return at just 20%.

• Women also predominate in the age groups 18-24 (79.2%) and 40-59 (80%). This could be partly explained by the number of forms returned from Women’s Aid groups but would need further research.

• This raises issues around development of supported housing projects including whether to commission schemes for women only or for young women only. At present there are only four schemes in Gwent specifically for women other than the Women’s Aid refuges and floating support schemes for women fleeing domestic violence. A young mothers project has been prioritised within this SPOP.

Current Accommodation

• The surprisingly high number of people (63.8%) currently lives in ordinary accommodation such as rented property or are owner-occupiers. This could be due to training issues as all people completing this form are receiving some sort of support to end up completing a needs assessment!

• 16% of people completing the form are currently living with parents/partner or other family pending a move to alternative accommodation with or without support. This is an increasing problem throughout the region due to a shortage of quality rental properties. This also does not help with “real” homeless figures, as they are not accessing/declaring themselves to the homelessness services.

Lead Need

• The high number of people indicating Domestic Violence (56.5%) as a lead need may be down to the good working relationships between SP



teams and local Women’s Aid groups, It is recognised that the high number of returns of NME’s by women’s aid can lead to distortion of the picture of support needs within Caerphilly.

• A significantly high number of people are indicating homelessness (24.4%), as their lead support need. More rigorous analysis is needed to identify the real support needs of service users beyond the lead need, if any for accommodation e.g. underlying high support needs also indicated

• A high number of returns show people with mental health problems in Caerphilly, which concurs with the Caerphilly HSCWB strategy and also a recently published Wales Audit Office draft report “Adult Mental Health Services Baseline Review” that states there is a lack of supported housing schemes for those in crises and dual-diagnosis clients in need of accommodation. A bid is included in this plan for a high intensity floating support scheme specifically to break the cycle of clients leaving hospital, only to return following their first significant crisis.

• Smaller but significant figures were reported from young and vulnerable people who require additional supported housing schemes to be developed addressing the current shortfall in provision. The Caerphilly supporting people reference group and a number of its partners is exploring the possibility of developing schemes that allow projects to provide support to young people in evenings and weekends.

• For age groups 18-24, 25-39 and 40 - 59, emotional support and counseling was the most needed service.

• For age groups 16/17, 18-24, 25-39 and 40 - 59, help setting up/maintaining a home and help with benefit claims were the most requested, closely followed by requests for advice/liaison with other agencies support type

• For the age group 60+ advice and liaison is the most requested service with all other needs of similar figures.

Disability

• Due to Caerphilly sending out forms only to those services relating to homelessness issues there are a rather low number of people who complete this section of the form.

• However from the small but substantial information we glean from the figures arthritis is the primary disability problem followed by respiratory issues. Both indicative of the heavy industry that has previously provided most employment in the County

Ethnic Origin

• Mirroring the latest census figures we can show there are very few people from an ethnic minority group in Caerphilly. Interestingly however is that 48.5% of people prefer to indicate they are British as opposed to 45.5% Welsh. The supporting people team intend to develop their links with Valrec to ensure that no BME group is exhibiting support needs that have not been identified in the needs mapping process.

Current and Future Accommodation Needs

• Again due to the good relationship between SP and local Women’s Aid group we see the highest number of current accommodation need is refuge for DV.



• Although a high number of people (25.6%) need ordinary accommodation without support a similar number (16.5%) have reported a need for ordinary accommodation with support.

• The significantly high number of people indicating a preference for ordinary accommodation with support for future needs (40.2%) shows the continued need for floating support models of supported housing bringing the support to the person’s own accommodation.

• The need has been identified for temporary supported accommodation for ex offenders, that will allow them to develop their independence, encourage the rehabilitative process and eventually move them onto more permanent accommodation.

• The Housing advice center and social services have both highlighted the need for a substance misuse supported housing scheme, that will again allow clients to rehabilitate, gain greater independence and eventually move onto permanent accommodation.

Health Warnings

• Not all information is verified • Not all questions are answered by the service user • We are endeavouring to increase the rate and accuracy of forms returned

from existing providers, agencies and services users and are working hard to expand the use of the GNME widely to build a more comprehensive picture of support needs.



2.1.1 Women seeking refuge from domestic violence Nearly 1 in 4 women experience at least one physical assault by an intimate partner during adulthood. That is disturbing, but domestic violence is not just about physical violence. Domestic violence is a pattern of controlling abusive behaviour – emotional, sexual, or physical. It is a pattern that can be prevented and it can be stopped. It is something that can happen to anyone. Caerphilly has only one organisation that provides support for women suffering from domestic violence. Rhymney Valley Women’s Aid currently manages three refuges in the Caerphilly county borough, The 3 refuges can accommodate 4 families in each property, and a further refuge is due to open in September 2005. The additional refuge will raise the total number of bed-spaces within the Caerphilly county borough to sixteen Rhymney Valley Women’s Aid were also able to develop an outreach service to assist in the resettlement of women who had moved on from a refuge or had sought support from Women’s Aid. This has been a particularly successful service and a waiting list has developed in respect of clients for this service. An initial review of the service undertaken by Supporting People as confirmed the urgent need for this service and consequently it is again included within this plan for the extending of an existing service. PROSIECT SAFF has been established, this is a Domestic Violence Abuse Service for Caerphilly County Borough. PROSIECT SAFF provides support and advice for those who are victims of domestic violence. PROSIECT SAFF works in partnership with the additional support services, which are currently available for victims of domestic abuse both within and outside Caerphilly County Borough. PROSIECT SAFF is the umbrella project for tackling domestic violence in Caerphilly Borough. The clear message is zero tolerance to domestic violence and abuse. Caerphilly Borough also has a full-time Domestic Violence Co-ordinator, who works very closely with the Crown Prosecution Pilot Project (and is currently housed with the Advocate and the Dedicated Police Officer), and whose role it is to develop and co-ordinate services for PROSIECT SAFF. In additional the Co-ordinator will be delivering awareness raising training for multi-agencies throughout Caerphilly Borough as from September 2004. The issue of domestic violence is a regional issue and all the Gwent supporting teams have worked collaboratively to ensure that existing support services are sufficient to meet the particular needs identified for this vulnerable client group.



There are currently nine refuges covering the Gwent region of which four are within Caerphilly County Borough. The following table exhibits information supplied by Rhymney Valleys Women’s Aid, the significant increase in referrals and higher occupation of bed-spaces since the closure of the Pontllanfraith refuge clearly evidences the need for an additional refuge.

Information - Refuges 2001-2002

2002-2003

2004 -2005

Families accommodated in refuge 154 146 136 Total number of children in refuge 236 173 176 Total number of nights occupied 3014 3268 3688 Number of families from CCBC area 44 36 38 Number of families from outside CCBC Area 110 110 98 Families rehoused by CCBC 11 8 4 Families rehoused by UWHA 2 2 1 Families rehoused by other agencies 29 28 Families moved to other refuges 42 46 Families returning home 22 25 Families destination unknown 41 25 Families still in refuge at end of stats period 7 12 Ages of children in refuge - 0-1 years 24 15



1-5 years 12 70 5-10 years 72 50 10-16 years 38 38 Number of children statemented or on at risk register 8 7 14 Number of children in care/elsewhere 37 106 82 Number of families with Social Services involvement 47 61 49 Number of referrals not accommodated 250 445 Number of children included in these referrals 377 569 Number of referrals from CCBC area 94 159 209 Number of referrals from outside CCBC area 156 286 261 Total 4827 5685

Information – RVWA Floating support 2004 -2005

Number of referrals 76 Number accepted 53 Number of children 95 Length of support Up to 1 month 18 1-6 months 10 6-12 months 5 Over 12 months 2 Ongoing 18 Households found to be eligible for assistance, unintentionally homeless and in priority need during 2003/2004and 2004/2005. A person fleeing domestic or threatened with domestic violence Single parent

household with dependant children

Female applicants no dependants

2004/2005 54 37 2003/2004 31 33

WHO12 WAG Form

The Caerphilly Supporting people Homeless forum as identified the following issue with regard to Domestic violence within its action plan. “Review the number and location of hostel places available in an emergency, including the need for additional refuge places for women escaping domestic abuse” Similarly, the Caerphilly Health, Social Care and Well Being draft strategy identifies within its action plans as strategic objective 5.2. Develop “Domestic Violence Project (Pilot)" aimed at; bringing offenders to justice; Improving victim and witness satisfaction and safety, integrating the needs of children as victims and witnesses.



Key Strategic Links Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, homelessness Strategy, Communities Safety Strategy

Conclusion:

• Additional outreach worker required to augment existing outreach service – forms part of initial review process.

• Need to provide a continuing service for in-county and cross authority

purposes



People with learning difficulties

"Learning disability" is a generic term encompassing a wide range of learning and/or social difficulties. Such difficulties/disabilities may include one or more of the following areas:

• Understanding, remembering or producing language (e.g. speaking, writing, reading, listening, spelling)

• Reasoning • Motor co-ordination • Noticing and remembering social information • Emotional maturation • Processing information • Organisation of things, time and/or space

Concerns about the residential service models have led to the rapid expansion of housing supports labelled as supported living in the UK. The supported living model is based on a set of procedural principles rather than a set of physical characteristics. Fundamental to supported living are the separation of housing and support services with increased tenancy and ownership rights, and an emphasis on designing individualised ‘natural’ community supports to meet the choices, aspirations and needs of a person with learning disabilities acting as an active citizen rather than a passive recipient of services. Due to the importance of individual choice, examples of supported living are likely to be small scale and unregistered. Caerphilly county borough council have been keen to follow the Supported living model and currently have eight major providers of supported living projects within the county providing support to 142 clients. There are wide cost variation within supported living schemes, largely accounted for by resident needs and this issue has been addressed by the Supporting People review programme which as recommended the implementation of a tariff rate for all supported living schemes that mirrors that utilised by Welsh Assembly Government for Supporting People Revenue Grant projects. The move to introducing a tariff system to fund supporting living placements will result in a further five providers and 21 clients being funded through supporting people grant Caerphilly County Borough Council Learning Disability Accommodation Task and Finish Group – has a remit to develop an Accommodation Strategy that would identify the housing and support requirements of people with a learning disability living in the Caerphilly Borough. The supporting people manager is a member of this group. Alongside the identification of need, the strategy will attempt to give some indication of how the needs will be met. It is envisaged that this group will be the principal driver in future development of the housing related support needs of people with a learning disability. The principles of the Accommodation Strategy are that people with a learning disability have –



• A right to ordinary patterns of life within the community – ordinary housing in

an ordinary setting • A right to be treated as an individual • A right to additional help from the communities in which they live and from

organised services in order that they are enabled to develop their potential

The Strategy will require a plan that will –

• Identify the detailed needs of individuals who have expressed a wish to move from their current accommodation.

• Identify individuals who may potentially need to have a change in accommodation due to their main carers situation. For example, an individual living with an elderly carer who is unwell.

• Co-ordinate the resource requirements of support and housing.

• Commission the services necessary to meet identified needs. Caerphilly county borough’s identified the need to develop advocacy services that were independently financed. In response to this a scheme is presented as part of this document to meet the identified needs of supplying an advocacy service to clients with a learning disability. It is envisaged that such services will also prove particularly useful in the review process adopted by Caerphilly for Supporting People projects. Caerphilly currently has only limited floating support services provided by the voluntary sector for clients with a learning disability. It is envisaged that additional resources will be identified either through this plan or via savings to assist in the further development of existing floating support services. As well as people with a learning disability, there is also another group of potentially vulnerable adults who undoubtedly have a requirement for housing, and also appropriate support. These individuals have what can be considered a specific learning difficulty, and these would include asperger’s, dyslexia, dyspraxia and attention deficit hyperactivity disorder (ADHD). General awareness of the needs of individuals with learning disabilities has grown over the past few years. However, understanding of specific learning difficulties is still at a relatively early stage. People who experience learning difficulties often don’t have an obvious ‘badge’ of disability but may continually perform sub-optimally as the ways they learn are not fully understood. The majority of individuals who would fall in to this category are unlikely to be receiving a service from Social Services, as it is doubtful they would fit the eligibility criteria for existing services, despite the fact that they are in need of support. It is possible that the Unified Assessment Process will provide the opening for this particular group of people to have access to appropriate support services, especially in relation to housing, as the risk to their independence in some cases is likely to be substantial if support is not provided.



It has been noticed in the Caerphilly Borough that young people with exactly these types of difficulties have been identified to Adult Services through the Leaving Care Team. It is likely that the group of people with these needs will increase. Caerphilly is also responding to the Welsh Assembly Government consultation document ‘Through Many Eyes’ and has developed and is consulting on a joint supported living contract that will embrace supporting people and social care services. Social Services contract officers and supporting people review staff are also developing a joint approach to undertaking reviews of supported living services to minimise disruption to providers and service users, but also ensure that the welfare of tenants in supported living schemes is protected. Key Strategic Links Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, homelessness Strategy, Fulfilling the promises

Conclusion:

• Need to provide further supported housing as part of resettlement programme

• Need to extend existing adult placement scheme

• Need to expand independent advocacy service

• Need to develop the learning disability accommodation strategy

• Need to expand potential for provision of floating support to persons in their own homes

• Identified needs for learning disability clients include daytime opportunities

in particular adults with autism and those with challenging behaviours.



2.1.2 People with mental health problems Mental Illness is on the increase within the UK (source: World Health Organisation, 2001). Statistics demonstrate that 1 in 4 adults will develop a mental illness at some point in their lives (source MIND, 2000). 1 in 6 adults of a working age will have a mental illness (source: Mental Health Foundation, 1999). Research estimates the average sum of years of life lost to premature mortality caused by mental illness in the UK population is 20 years. The average number of years lived with a mental health disability is 43 years (source: World Health Organisation, 2001). Caerphilly County Borough has the 4th highest ranking for poor mental health in Wales (source: Welsh Office survey, 1995 and Welsh Health survey, 1998). Taking into account socio-economic factors, estimates applied to the population of Caerphilly County Borough reveal between 17,000 and 26,000 adults of working age could have a mental health problem. The prevalence rate within the borough has increased from 13.2% in 1995 to 18.7% in 1998. The Wales average is 13.6% (source: Welsh Health survey, 1998). 22.4% of the population have a long-term limiting illness, the 5th highest ranking in Wales, the majority of whom will have a mental illness (source: Census, 2001). The secondary statutory services receive 2,600 new referrals each year (source: Gwent Healthcare Trust, 2001).

People with a mental illness are amongst the most socially excluded in the community due to discrimination, stigma and marginalisation and face the real and daunting problems of unemployment, low income, poor housing, loneliness, isolation and social deprivation The Caerphilly County Borough Needs Assessment identifies people with mental health needs as a priority vulnerable group within the local population” (source: Caerphilly County Borough Health, Social Care and Well-being Needs Assessment, 2003) The principles underpinning mental health services within Caerphilly County Borough are:

1. Prevention 2. Early intervention 3. Crisis resolution 4. Service user participation/involvement 5. Recovery

6. Capacity to deliver Existing services Approximately 8% of the supporting people budget is allocated to mental health schemes, the following projects currently receive supporting people grant or are financed through section 180 funding.

• borough-wide housing advice scheme run by Gofal Cymru

• a borough-wide homelessness worker employed by Gofal Cymru



• Four bedded supported house run by Gofal Cymru

• Gofal Cymru Floating Support service, a Supporting People borough-wide scheme and scheme linked to United Welsh Housing Association (approx 44 clients)

• Home from Home – 8 bed supported living project

Key Action 29 of the National Assembly’s National Service Framework gives a commitment that the Care Programme Approach (CPA) will be introduced across Wales for all people with a serious mental illness and/or complex enduring needs. The National Assembly quotes evidence that demonstrates the benefits of providing well co-coordinated care to people with mental health problems to address the needs across health and social care boundaries. CPA provides a framework for the comprehensive assessment, care planning, care co-ordination and review of an individual’s mental health care that places the individual service user at the centre of care planning and delivery. The Care Programme Approach will be the basis of all mental health services within the County Borough. Service gaps Many essential components of a comprehensive mental health service are being provided by the NHS Trust but on a Pan Gwent basis without services having a specific county borough focus. 1. Rehabilitation

Accommodation based services provided to enable individuals recovering from an acute episode of mental illness to have an intensive period of support and re-training. As most of the work is focused on re-integrating the individual into the community, it would make sense to have a locality-based service so that the re-integration can be carried out within familiar surroundings. There is a particular need for this service to focus upon young men with mental health problems as a group. Links to the Early Intervention Service would prove beneficial in this case. It would require the identification of suitable premises in the county borough. 2. Co-occurring substance misuse and mental health problems

The problem of substance misuse amongst people with mental health problems and its associated difficulties in treatment continues to rise as an issue. Specialist staff are required who can work across the spectrum of mental health and substance misuse services to ensure that individuals with a co-occurring problem have access to a range of provision and interventions.

3. Accommodation strategy

In line with the National Service Framework, a range of high medium and low supported accommodation is needed in the community to prevent in-patient admission facilitate discharge and provide for both rehabilitation and continuing care needs. At present there is a range of floating support to people with mental health problems in their own homes and a four bedded supported accommodation in the



Llanbradach area. Those individuals currently requiring high support placements are placed out of the county borough area. A Mental Health Accommodation Strategy scooping document has been produced and can be viewed in appendix 5 The supporting people manager will be a member of the mental health accommodation reference group. 4. Transition Services for Children and Adolescents with mental health

problems

Evidence within the county borough reveals a need to develop services for young people under the age of 25 years and in particular for young people aged 16 –17 years who are coming to the attention of the adult mental health services. Providing timely and effective interventions at this stage could prevent inappropriate referrals into adult services and could also intervene within a critical period of any early onset, having a major influence on the long-term course of any illness. Stronger links with the Child and Adolescent Mental Health services (CAMHS) are required and services developed especially in respect of those young people with social conduct disorders that do not have a clear diagnosis of a mental disorder. 37% of Looked After Children fit into this category. The Way Forward Introduction of the Day Opportunities Service

If the new integrated Day Opportunities Service assumes responsibility and care co-ordination for most of the Standard CPA packages, it gives the opportunity to refocus the work of the CMHTs to see how they can address the issues of crisis intervention, home treatment and outreach.

The emphasis of the new Day Opportunities Service will be on assisting the recovery and discharge of individuals to ensure the increased demand for services over the next three to five years can be met. Refocusing Community Mental Health Teams

The introduction of the Day Opportunities Service will allow for greater capacity to be developed within the existing CMHTs, giving the opportunity to focus more intensive enhanced packages of support for those in the greatest need. Incorporating an outreach and crisis resolution service will see a reduction in hospital admissions, less use of the Mental Health Act and the engagement in treatment of the most vulnerable and difficult to engage. They will also be able to focus on providing services to people with a personality disorder and those with a forensic background. The CMHTs will be able to act as a realistic alternative to hospital admission. The creation of the First Access Team will strengthen this new role of the CMHTs. Introduction of a First Access Team The First Access Team will provide skilled assessments and a range of short-term limited interventions such as brief therapy, motivational interviewing, counselling, and cognitive behavioural therapy. The Team will assess referrals from Primary Care, signposting individuals to more appropriate services and ensuring referral to the CMHTs when appropriate. In addition, the Team will work in partnership with Primary Care acting as a valuable resource to educate staff in primary care on current mental



health issues. The First Access Team will undertake the work currently being directed at the CMHTs from Primary Care services. Accommodation strategy

An assessment is required of the need for supported accommodation services in the

county borough. Using a Mental Illness Needs Index, Caerphilly County Borough would appear to need 17 high support places, 33.5 medium support places and 17 low support places within the county borough. In fact there are considerably higher floating support places within the county borough and no medium or high support placements currently available. However, before any decision on the numbers of placements to be developed, other components within the mental health model need to be considered to ensure that any review of supported accommodation is placed in the context of the whole service system. Key Strategic Links Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, Homelessness Strategy,

Conclusion:

• Need to develop an accommodation strategy for mental health services - see scooping document Appendix 5

• Need to increase number of supported living bed spaces

• Need to establish High Intensity floating support and review exiting floating support arrangements

• Need to better integrate the voluntary sector support providers with work

of Caerphilly Mental Health Team



2.1.3 People suffering from alcohol and drug dependency

Increasingly the prevalence of substance misuse has been identified as an issue of growing concern to all statutory agencies operating within Caerphilly county borough. The Caerphilly Health, Social Care and Well Being Needs Assessment (The Needs Assessment) and the alcohol mapping/scoping exercise undertaken by Gwent Alcohol Project, identified that 17% of men and 6.5% of women drink above the recommended weekly levels. The Welsh Health Survey 1998 identified Caerphilly County Borough level of excessive drinking at 14.2% to be slightly higher than the Welsh average of 13.8%. The Needs Assessment concluded that, in general, men are more likely to drink excessive amounts than women. In the past few years the issue of the linkage of alcohol abuse to anti social behaviour as been consistent, particularly in light of the proposed relaxation of the licensing laws. Local data on the misuse of drugs are limited. However, there are clear links between crime and disorder, criminal activity and drug misuse. Recent figures set out in the Social Exclusion Reports on Mental Health and Social Inclusion (July 2004) estimates costs of drug misuse per person is around £35,000 a year. The Caerphilly “ Communities that Care study “ reported that substances most likely to have been experimented with by young people, was Cannabis 17%, followed by sniffing glue 10%. Reported drug use increased with age. Pupils in year 9-11 were more likely to report that they had taken any drugs than those pupils in year 7-8. Unfortunately, no detailed mapping of drug misuse has been undertaken within the county borough to date and information in respect of drug misuse amongst adults and older people is limited. However, the Substance Misuse Action Team (SMAT) have noted an increase in the number of people presenting themselves with either Heroin and/or alcohol problems over the last two years. Service users regularly have difficulty in accessing primary health care, specialist medical appointments, paying bills and resolving other domestic problems. Resulting problems include poor physical and mental health, unpaid bills, rent arrears and other housing issues.

Excess alcohol consumption is higher in more deprived areas within the County Borough for males, but decreases with deprivation for females. In addition, research shows that certain groups are at risk of harmful drinking, including young people between the ages of 18 and 24, homeless people, people using illegal drugs, people with mental health problems and males from lower socio-economic groups. The Community Safety Strategy is a three-year commitment from all partners in the Community Safety Practitioner Group to address the issues and key priorities from the community safety Audit. The community safety audit aims to describe and where possible explains, the pattern of crime within the communities of Caerphilly county borough. The objectives will be achieved through joint working and a wide range of initiatives across the county borough. Ultimately, these objectives will contribute towards reducing crime and disorder, and making Caerphilly county borough a safer place to live



One of their key objectives is

1. To take action to divert ‘at risk’ groups from lifestyles linked to crime • Young People (under 25 years) • Drug misusers • Alcohol misusers • Persistent offenders

Our Local Substance Misuse Action Plan flows from the Caerphilly County Borough Community Safety Plan and the WAG document ‘Tackling Substance Misuse In Wales’. This Action Plan is aimed at those who misuse substances or at risk of misusing, families directly affected by substance misuse, elected members, communities and partner organisations; it communicates our commitment to improving Caerphilly County Borough’s services designed to tackle substance misuse which, in the context of the document and its resultant plans, will embrace both drug and alcohol misuse (as defined in ‘Tackling Substance Misuse in Wales – a Partnership Approach’). Under the Plan, we highlight our support for young people, particularly those at risk or disaffected, to help them achieve success in school, further education and employment. Well-established links with the proposed Substance Misuse structure and the Children & Young People’s Framework and respective Partnerships will ensure that information is shared between agendas effectively. We plan to address specific community safety concerns, such as drug misuse through partnership and to work with partners to reduce the proportion of young people using the most harmful substances*. Substance misuse services are also a major focus for the County Borough’s overarching Health, Social Care and Well Being Strategy that is currently being developed between local planning partners. The plan contains the following information that shows the high preponderance of young people who were arrested for drug possession. The Local Substance misuse action team Action Plan is founded on the belief that all users should have easy and ready access to a range of local treatment services when they are needed. Within the county borough, partner organisations are committed to working together in order to tackle substance misuse issues. Such issues, historically, have included a shortage of available prescribing places and waiting lists being operated when users are in crisis. Action will be taken via the Action Plan to reduce the impact of this situation. In line with local and national strategic policies, this Action Plan will not just consider treatment and rehabilitation issues, but place greater emphasis on the preventative agenda through the implementation of innovative and evidence-based interventions to prevent the uptake and misuse of substances throughout the local population.

This development of this Action Plan has been informed by the needs assessment undertaken recently within the county borough as part of the Health, Social Care and Well-being Strategy writing process. The information collated in relation to substance misuse via this exercise has been utilised to scope and prioritise local current substance misuse issues, examine service/intervention provision and identify any ‘gaps’ in meeting needs and explore ways by which these identified needs may be met.



As well as being driven by the Welsh Assembly Government guidance, the Caerphilly LSMAT has developed three additional local aims: (i) To ensure that there is a thriving independent sector provision in Caerphilly County Borough for relevant aspects of the Action Plan; (ii) To ensure that there is a well trained local workforce to deliver the services; (iii) To commission the best range of treatment and social provision based on best value and evidence based research in order to promote individual choice.

In the Spring of 2002, the then Gwent Health Authority, in conjunction with the Gwent Drug and Alcohol Team, and Local Action Teams, undertook an extensive needs analysis review of substance misuse services within Gwent and its individual Boroughs. The result was not only a Gwent-wide perspective, but also a multi-agency view of what was needed within each Borough to provide effective, accessible and efficient services. The following paragraphs detail the perceived gaps at each of the four Levels of service provision in relation to the residents of Caerphilly County Borough. Gaps in Service provision. Through the development of the SMAP, the following gaps (relevant to the work of supporting people) have been identified in current local service provision. • Limited, and difficult to access domiciliary support. • Insufficient resources to support home detox and opiate detox. • No supported or respite accommodation within the county borough at

level 3 • No residential rehabilitation service at level 4 in Gwent. • No ring fenced monies for rehabilitation services. • There is no local detoxification unit in Gwent. As a way of dealing with the above issues LSMAT has put in a bid for capital funding for drug and substance misuse projects. The aims of these projects are to:- • Provide individuals with accommodation for a fixed term to allow them to

undergo rehabilitation programmes and address their substance misuse. • To provide 24-hour support within the project and to link individuals to

existing local substance misuse rehabilitation programmes. • To provide accommodation for homeless clients with substance misuse

problems or those living chaotic lifestyles who require a period of stability. • To support clients in moving towards independent living and to remain

free from substance misuse problems. • The project also links to the following objectives and actions of the

council’s local housing strategy 2004/09 and homelessness strategy:- • To address need for supported accommodation for clients with particularly

high or complex needs. Recent figure set out in the Social Exclusion Reports on Mental Health and Social Inclusion (July 2004) estimates costs of drug misuse per person is around £35,000 a year. The multi-agency Caerphilly Substance Misuse Team (SMAT) established under the auspices of the Caerphilly Community Safety Partnership, works to oversee the



planning, commissioning and implementation of substance misuse services and interventions within the county borough to tackle the identified problems. There are currently 15 projects, which are being funded through Welsh Assembly Government Community Safety Partnership funds, principally delivered by Drugaid and Kaleidoscope. The Caerphilly Local Substance Misuse Action Plan (LSMAP) 2005/06 has set up a number of targets and objectives that are being actioned to improve current substance misuse service/intervention provision. This action plan is aimed at those who misuse substances or at risk of misusing, families directly affected by substance misuse, elected members, communities and partner organisations; it communicates the SMAT’s our commitment to improving Caerphilly County Borough’s services designed to tackle substance misuse which, in the context of the document and it’s resultant plans, will embrace both drug and alcohol misuse (as defined in “Tackling Substance Misuse In Wales – A Partnership Approach”). Under the plan, support is highlighted for young people, particularly those at risk or disaffected, to help them achieve success in school, further education and employment. The SMAT will aim to address specific community safety concerns, such as drug and alcohol misuse through partnership and to work with partners to reduce the proportion of young people using the most harmful substances. This in line with the county borough’s overarching Health, Social Care and Well Being Strategy that is currently being developed between local planning partners. This plan identifies the need for the development of more inclusive services for people with a substance misuse problem, the actual development of new accommodation and support services for people with such potentially disruptive support needs, remains a challenge, not only to supporting people but Drug Action Teams and Crime and Reduction Partnerships. Gwent Probation Service supervises clients who are subject to Drug Treatment and Testing Orders (DTTOs). These are community penalties for offenders with substantial drug treatment needs, whether as a result of drink, drugs, mental health or a learning disability. Orders are made in respect of offenders who wish to engage in treatment aimed at the reduction or elimination of drug use, and are an alternative to a custodial sentence. In addition to regularly reporting to a Probation Officer/Drugs Worker, clients must undergo regular random and observed drug testing to ensure compliance with the Order. Currently people must travel to Newport for drug testing and observation as there is not a DTTO facility in the Caerphilly county borough. The DTTO office in Newport confirms that this can cause difficulties for clients due to the distance and expense of travelling. The Criminal Justice Intervention Programme (CJIP) is currently being rolled out within Wales with a national funding programme of £5m. The programme is intended to ensure that expansion of individual interventions is part of a beginning to end support system for dealing with drug misusing offenders. CJIP interventions will cover throughcare and aftercare. Whilst CJIP monies cannot be used to meet direct housing support costs, the additional resource additional resources could fill the gaps in throughcare and more importantly aftercare once offenders are` released back into the community Drugs and Family Support (D.A.F.S) offers support and information to the families and friends of substance misusers throughout Gwent. The service is based in Blaina



and Nantyglo District Hospital in Blaenau Gwent, but appointments can be arranged in venues in the Caerphilly county borough. The Gwent Specialist Substance Misuse Service is a Gwent Health Authority service for the whole of Gwent. One element of the service covers the Caerphilly county borough. It is based in Ystrad Mynach, and operates peripatetic clinics in Caerphilly and Aberbargoed. The service provides treatment for people with substance misuse problems. This involves a range of services such as needle exchange, education, advice, information, counselling, relapse prevention and a prescribing service Victory Outreach is a charity that runs a number of houses in England and Wales for ex-offenders who wish to address their substance misuse. The Caerphilly county borough project is a 3 bedroom house and small holding in Crumlin for single men and is staffed 24 hours a day, usually by people who have previously been assisted by the programme. Residents are from outside of the Caerphilly county borough in order to be away from the influences of substance misusers known to them. Victory Outreach staff have usually visited prospective residents in prison before they move to the house. There is a strict regime in the accommodation in order to assist residents to address their substance misuse or to maintain a lifestyle free of substance misuse. Although the accommodation is available to people aged over 18, the most common age range is 18-30 and residents are encouraged to engage in training and education opportunities as a way of helping them to gain skills and self-esteem. There is no set time limit to resident’s stay at the project as this is determined by their needs. Usually people move out of the area when they move from the house Our Draft Local Substance Misuse Action Plan flows from the Caerphilly County Borough Community Safety Plan and the WAG document ‘Tackling Substance Misuse In Wales’. The Plan highlights support for young people, particularly those at risk or disaffected, to help them achieve success in school, further education and employment. Well-established links with the proposed Substance Misuse structure and the Children & Young People’s Framework and respective Partnerships will ensure that information is shared between agendas effectively. It will address specific community safety concerns, such as drug misuse through partnership and to work with partners to reduce the proportion of young people using the most harmful substance. Substance misuse services are also a major focus for the County Borough’s overarching Health, Social Care and Well Being Strategy that is currently being developed between local planning partners The LSMAT Action Plan is founded on the belief that all users should have easy and ready access to a range of local treatment services when they are needed. Within the county borough, partner organisations are committed to working together in order to tackle substance misuse issues. The action plan contains the following aims and targets. AIM TARGET To protect families and communities from anti social and criminal behaviour

Reduce the levels of re-offending by substance misusing offenders by 25% by 2005

To enable people with substance misuse problems to overcome them and live healthy and fulfilling lives and, in the case of offenders, crime free lives.

Increase the number of substance misusers participating in substance misuse programmes by 70% by 2005



Caerphilly Substance Misuse Action Plan

In response to the identified gaps in provision of specialist supported accommodation, Caerphilly County Borough Council were successful in the bid for Social Housing Grant in 2005/2006 from Welsh Assembly Government. The grant was to develop a supported housing scheme of seven bed spaces for clients with a substance misuse problem, which would provide 24 hour support for a period of 3 – 6 months before tenants would; be moved onto a more permanent accommodation. A property has been provisionally identified in Blackwood, although the suitability of the site is still awaiting a decision of the Community Safety Partnership and local consultation. Should the current location prove unsuitable, then a request has been made to the Welsh Assembly Government for the grant to be utilised 2006/2007. In addition to the above, a Gwent bid for a substance misuse supported housing project was also successful. A Gwent wide ‘task and finish’ group has been established to determine the model and location of supported accommodation needed. Initial moves have been made to employ a consultant to undertake a needs mapping exercise within Gwent of the accommodation needs of substance misusers, again, a request has been made for the social housing grant for this scheme to be transferred to 2006/2007.

Key Strategic Links Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, Homelessness Strategy, Communities Safety Strategy, Caerphilly Substance Misuse Strategy

Conclusion:

• Bid for Social Housing Grant for drug rehabilitation scheme within Caerphily and joint Gwent bid

• All agencies are reporting an increase in the number of referrals received

• Serious health problems due to long term alcohol use.

• Need for additional support workers to provide practical accommodation

related support

• Need to contribute to the development of the Local Substance Misuse Action Plan

• There is a need for more data collection and sharing between the

community safety partners, particularly in terms of repeat offenders, alcohol and drug related offences, domestic violence, hate crimes and commercial crime. Despite the lack of data, these issues are seen as a priority by the partner agencies. A tender has now been prepared that will allow for the employment of a consultant to map the accommodation needs of people suffering from substance misuse problems within the Gwent area ( completion anticipated in February 2006).



2.1.4 Refugees

Black and Minority Ethnic Groups only make up 1% of the total population of the Caerphilly county borough. There is a lack of knowledge and awareness of the needs of Black and Minority Ethnic people within the Caerphilly county borough. In publishing the recent Black and Minority Ethnic Housing Action Plan for Wales (2002) the Welsh Assembly has sent out a clear message that housing providers need to develop wider understandings of the needs of Black and Minority Ethnic groups. To this end the Caerphilly supporting people team is seeking to develop links with Valleys Race Equality Council to increase awareness of the needs of BME groups within the Caerphilly area. The new Race Relations Amendment Act 2000 (RRAA) came into effect In April 2001. It places both a general and specific duty on public authorities to promote race equality and prevent unlawful racial discrimination. The Act requires the National Assembly to publish a Race Equality Scheme (RES) explaining how it will meet the necessary duties. Proposals fro this scheme is contained in the consultative document ‘Promoting race equality’ that places a particular emphasis on the need for local authorities in respect of BME housing issues. In recognising the fact that people and communities do not choose housing in specific geographical areas or administrative boundaries, Caerphilly county borough council has formed a regional partnership to produce a wide-ranging and coherent Black and Minority Ethnic Housing Strategy. The South East Wales Black and Minority Ethnic Housing Partnership have commissioned the production of the strategy. Caerphilly county borough council’s consortium partners are: Blaenau Gwent, Torfaen and Monmouthshire, Eastern Valley, Wales and West, United Welsh, Glamorgan and Gwent, Gwerin and Charter. Caerphilly has now introduced a racial equality scheme STATEMENT OF COMMITMENT “Caerphilly County borough Council is opposed to discrimination in any form and is committed to ensure that all sections of the community have access to and benefit from the full range of services it provides, irrespective of colour, ethnic origin, sex, age, marital status, sexual orientation, disability, religion, language or nationality.”



GENERAL DUTY The general duty requires public authorities, such as CCBC, when carrying out their functions to aim to: • Eliminate unlawful racial discrimination • Promote equality of opportunity • Promote good relations between people of different racial groups

The duty’s aim is to make race equality a central part of the way public authorities work, by putting it at the centre of policy making, service delivery, regulation and enforcement and employment practice. The term ‘functions’ means the full range of the authority’s activities, duties and powers. It includes both existing and proposed policies.

SPECIFIC DUTY Under the specific duty public authorities must prepare and publish a Race Equality Scheme (RES) by 31st May 2002. The council’s RES was published in May 2002 and is available on the council web site and intranet. The council is treating its RES as part of its more general equality strategy but it must be capable of easily be identified as meeting all the statutory requirements for such a Scheme. The Scheme should state the functions and policies that are relevant to meeting the general duty to promote race equality and set out the arrangements for meeting this duty by: • Monitoring policies for any adverse impact on race equality • Assessing and consulting on the likely impact of proposed policies • Publishing the results of their assessments, consultation and monitoring • Making sure that the public have access to information and services • Training staff on the general duty

The council has yet to identify all its policies and functions in its RES and this is something that is required to be done, along with carrying our Equality Impact assessments. The RES sets out the arrangements that Caerphilly County Borough Council is putting in place to meet the requirements of the Race Relations (Amendment) Act 2000 to promote race equality and improve public services for everyone. Its RES is effectively a strategy and action plan. It summarises our approach to race equality and corporate objectives and says how we plan to meet each part of the duties, i.e. the arrangements for assessing, consulting, monitoring, training and employment. In fulfilling its race equality duties we will adopt a mainstreaming approach to our policymaking, service delivery, regulation and enforcement and employment practice. We will ensure that the principles of our RES are included in our Corporate Plan and all Service Improvement Plans. We will work in partnership with appropriate bodies in the voluntary and public sectors and ensure that our Community Plan takes on board all equalities issues and continue to support the Multi-Agency forum to combat racial harassment. We will endeavour to promote equality by means of race equality audits and action plans covering both employment and service delivery. We will integrate into divisional



work programmes effective monitoring and evaluation of the implementation of action plans, including ethnic monitoring of all policies, employment practices and service delivery to establish how different racial groups are affected. A draft strategy has been produced and it is intended to offer the draft consultation and finalise it by the end of 2004. Relevant information relating to the experiences and needs of Black and Minority Ethnic households and individuals in accessing housing and support will feed into the Supporting People Operational Plan to be produced for September 2005. By March of 2006 it is anticipated that we will also have collected more comprehensive data through our Needs Mapping Exercise to assist in the analysis of this needs group. Caerphilly supporting people is a member of BMESpark ( Black minority ethnic supporting people action research and knowledge) The BMESpark website will provide access to research and is a place to share good practice. This will enable services to respond to the users needs and help people to live independently. www.bmespark.org.uk

Key Strategic Links Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, Homelessness Strategy

Conclusion:

• There is extremely limited information on the housing and support needs ofBlack and Minority Ethnic groups in the Caerphilly county borough.

• There is no dedicated provision in Caerphilly county borough for Black and

Minority Ethnic Groups.

• We will continue to work with our partners to understand, identify andrespond to the housing and support needs of Black and Minority EthnicGroups.



2.1.5 People with physical disability who require support The 2001 Census places Caerphilly county borough as the fifth highest authority in respect of people who suffer from limiting long term illness, perhaps even more significant is that Caerphilly county borough was sixth highest out of the 376 English and Welsh authorities with a number of 44,604 people identified with a limiting long term illness which comprises over 26% of the County’s population.

English and

Welsh ranking

Welsh Ranking

Limiting long-term illness 44604 6 5 General health 'not good' 25442 6 5

Census 2001

Many of these people are elderly and their ill health is often the result of the former heavy industries that operated in the valleys and lifestyle issues within the county. It already is evident from research (e.g. Nuffield Institute 1997) that services to older people and people with a physical disability are under-funded by a factor of 50% across Wales. This picture has been reinforced by a further report by the Nuffield Institute in September 2001 indicates a shortfall of between 51% and 58% for services to adults with a physical disability across Wales Social Service referral data shows a large proportion of referrals are from people with a physical disability with 34% of referrals from people with a physical disability. It is also estimated that a large proportion of the older person referrals also relate to a physical disability (52%).

The Joint Review and the Service Improvement Programme identify the need to change and provide services to Younger Physically Disabled and Sensory Impaired people. The Health, Social Care and Well Being strategy also prioritises the need to further develop a Unified disabled adaptation process through strengthened working links across Housing, Social Services and Health. Another recommendation relates to the need to investigate the use of “smart home” technology for disabled and frail older people and community alarm scheme to incorporate telemedicine e.g. movement sensors to support independent living and hospital (see older person section) The local authority social services now have a dedicated occupational therapy team and a future reorganisation will result in a dedicated team for younger physically disabled and people with a sensory impairment. The Health and Social Needs in Caerphilly County Borough (Stage 3) report highlighted a range of health and social care needs among the population in comparison with the former county of Gwent:

• Caerphilly accounted for 9 of the 10 electoral divisions in Gwent with the highest incidence of people with a limiting, long-term illness.

• The 10 electoral divisions across Gwent with the highest percentage of people who had a permanent sickness were all located within Caerphilly County Borough.



• Five electoral divisions within Caerphilly County Borough were among the top 10 across Gwent for the percentage of people claiming attendance allowance.

These figures suggest a high level of vulnerable people living in the community who are at some risk of losing their independence unless support mechanisms for individuals, families and carers are in place. Enabling people to remain living independently in their own homes, in control of their own lives, is a key element in maintaining their health, social care and well-being. Another area identified within the Health, Social Care and Well Being Needs assessment is the issue of transition planning for younger adults with a disability, as many disabled young people receive inadequate support to access activities that would promote social inclusion. Service users and their carers need guidance in order to access relevant health and social care support services that can make a positive difference to their lives. The floating support scheme, administered by the Supporting People team, also provides support to younger disabled people by agencies such as Llamau and Tai Trothwy, however there is a realisation that further work needs to be undertaken to identify the support needs of younger people with a disability. Social Services have also identified the number of citizens within Caerphilly county borough who have sensory impairment

Number of persons on Register at 31 March 2003



Deaf with speech

70

107 104

Deaf without speech

107

71

71

Hard of hearing

102

101 98

Blind

552

411 410

Partially sighted

467

368 396

General classes (1)

0 0 0

Total

1,298

1058 1,079

Social Service disability register 2005 A block contract has been agreed with Gwent Association for the Blind which puts in place a much-needed floating support scheme for partially sighted and blind people. The need for a similar service to assist the deaf has been identified and



supporting people are working closely with Social Services to examine how best these needs can be met. The Health Social Care and Well Being Plan has identified a number of development objectives in respect of disability and it is the intention of the Caerphilly Supporting People team to work closely with Social Services and Health to contribute to the ‘ Whole Systems’ approach.

Development Objectives

Progress

• Further develop the provision of

equipment to persons with physical disabilities and sensory impairment.

• Extend the Direct Payments Scheme

to additional service users including those with a learning disability and the elderly.

• Develop access to information for

persons with a sensory impairment.

• Continue to seek improvement in

Health and Social Care across County Borough. Future targets set.

• Scheme extended in partnership with

the Voluntary Sector providing support service to new users and scheme extended to all service user groups.

• Communications Development Plan

has been presented to Corporate Equalities Group to improve communicating with public.

Hospital discharge is another key issue identified in the HSCWB Needs Assessment. The previously high levels of delayed transfers of care from hospital within Caerphilly have been substantially reduced over the past two years. The availability of appropriate community-based health and social care services is a crucial factor in achieving timely discharge. In addition, the freeing up of hospital beds will be enhanced by the availability of such services as intermediate care; these services, in turn, are an important element in sustaining a community-based approach to health and well-being.

Graph 41: PI 3.9 The number of Delayed Transfers of Care per every 1000 75 year olds

(April 2004 - March 2005, Prediction for 2004/05)

0

20

40

60

80

100

120

Monmouthshire Bleanau Gwent Torfaen Caerphilly Newport



Numerous factors have been identified as accounting for the reduction in DTC, but Supporting Peoples funding contribution to Age Concern in respect of it’s hospital discharge service and other low level preventative support schemes that have operated since April 2003 may have made a contribution towards this reduction. The Supporting People team have identified a number of services that are targeted at disabled people of all ages. A domestic cleaning service was commenced for people in supported accommodation who are unable to undertake domestic cleaning tasks because of physical disability. This as proved a particularly popular service, which as enabled people with a disability to remain in their homes and live with dignity and independence With over 450 clients it has become apparent from feedback from the agencies providing this service that benefits are also being accrued in respect of social inclusion and identification of potential problems at an early stage with numerous referrals being made to social services, housing and health. Feedback from clients is also highlighting the need for further services that are peripheral to supporting people such as gardening and shopping services. A clear need is being identified for these services yet how they are to be funded remains unclear. The Supporting People team is currently working with the Social Services community services team on developing a gardening service for disabled people. Whilst traditionally this has not formed part of the Supporting People remit there is a growing realisation of the benefits such a scheme could provide for the disabled, both in enhancing their own self esteem and assisting in issues with neighbours and landlords. This is a new initiative and resources to fund it are limited. Key Strategic Links Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, homelessness Strategy Older Person's Strategy for Wales; Fundamentals of Care;

Conclusion:

• High levels of physical disability within Caerphilly

• Social exclusion identified as major issue

• Gap in services for deaf people identified.

• Need to further increase existing SP services such as domestic cleaning and hospital discharge

• Need for further work to identify where Supporting People can work with

Social Services and Health

• Need to create new services to facilitate shopping, prescriptions, etc

• Need to further developing befriending scheme for older people



2.1.10 Young single homeless people who require

support and young people leaving care

Caerphilly Homelessness Forum was set up in 2001, in response to guidance from the National Assembly for Wales regarding the importance of developing an inclusive Homelessness Strategy. It is a development of the Caerphilly Single Persons Housing Forum, which had been meeting in order to identify and develop accommodation and services for single people under the age of 60 years. The Single Persons Housing Forum had developed a single persons housing strategy to prioritise resources and focus on outcomes, and this strategy has been incorporated into the inclusive homelessness strategy and incorporated within the Homeless action plan. The Homelessness Forum consists of members from the statutory and voluntary sectors who have an interest in homelessness issues, and has set as its priority the development of strategies that will assist homeless people in accessing appropriate accommodation and support. The Local Authority and its partner agencies recognize that homelessness is not just a housing problem, and that if levels of homelessness are to be permanently reduced, there is a need for a wide range of support and other preventive services for homeless people. A range of statutory and voluntary sector agencies provide housing and support services in Caerphilly, but these are limited and not spread evenly across the Borough. The principal aim of the strategy, and the associated action plan, is to provide a strategic framework to meet the long-term accommodation and support needs of homeless people in Caerphilly, through the co-operation of all relevant local agencies. It highlights the importance of a needs assessment to evaluate the current and likely future levels of homelessness, an audit of current provision, including temporary and permanent accommodation, support and preventive services, an analysis of gaps in service provision and the identification of resources which might be available for filling these gaps. Housing and Social Services authorities have various responsibilities to 16-17 year olds whether or not they are homeless, as outlined in The 1989 Children Act, The Children (Leaving Care) Act 2001 and the Homelessness Act 2002 The Leaving Care Team was set up to meet the responsibilities of the social services authority towards children in the looked after system. This responsibility extends to children who have been looked after for 13 weeks between the ages of 14 years and 16 years, as well as those still being looked after at the age of 16 years. The Children (Leaving Care) Act 2001 introduced a duty to provide each young person with a Pathway Plan, and the concept of a Personal Advisor. Young people must be supported up to the age of 21 years (24 years in certain circumstances) and the legislation sets out the financial requirements the Social Services Authority has to meet in respect of these young people. Section 1(2) of the Homelessness Act 2002 states that Social Services Departments shall provide reasonable assistance in carrying out the Homelessness Review and that they shall take the Homelessness Strategy into account in the exercise of their functions. Similarly the duty to produce a strategy to prevent and tackle



homelessness is imposed corporately on the whole authority and not simply the Housing Division. This corporate responsibility extends further in the case of young people in the looked after system, with both the Directorate of Social Services and the Housing Division, being a part of the “corporate parent”. A small number of these young people have exceptionally high needs, but, even if they cannot be managed in supported accommodation it is virtually impossible for them to return to residential care, for which demand exceeds supply. This is partly because standards for residential care provision are very high, not only in terms of the physical environment, but in relation to staffing ratios and access to specialist services. Supporting People are working closely with the leaving care team to identify suitable alternative placements for these young people. Social Services confirm that they have in excess of 100 young people for whom they continue to have a duty to provide services (including accommodation) under the Leaving Care Act 2000.

2003 2004 2005 Eligible 74 35 27 Relevant 28 30 12 Former Relevant 31 62 54 Total 133 127 102

Under the Children (Leaving Care) Act 2001 an Eligible child is one who is aged 16 or 17, has been looked after by the local authority for a period of 13 weeks since the age of 14 and remains looked after. A Relevant child is one who was previously an eligible child but who is no longer looked after and is under the age of 18. A Former relevant child is a young person who was eligible or relevant prior to the age of 18 and will remain a former relevant child until 21 or until they have completed their higher education. The need to provide further assistance to these young people is recognised by the bid for additional supported housing units by Barnardo’s, in addition there is a bid to establish a supported lodgings schemes for those leaving care. The introduction by the National Assembly of the OC3 which records accommodation of Care Leavers on their 19th birthday should also assist in building up the picture of need. Latest statistics reveal that a number of these care leavers have been identified as living in inappropriate accommodation including bed and breakfast. It is noted that Social Services are having to place young people out of the area or keep them in SSD provided accommodation such as foster care, past the time when they are ready to move on. The ‘out of county’ placements are particularly expensive and during 2004/2005 a number of these young people have been accommodated in supporting people projects, thereby achieving significant savings to social services resources In the last year a number of young people out of county placements have been brought back to live in supported living with supporting people funding with an eventual plan to move them onto independent living with floating support.



Information provided by the Local Authority Housing Advice Centre shows that:

• 58 applications from single people age 16-17 were received in 2002/2003, and 69 in 2003/2004.

• 134 Applications from single people aged 18-24 were received in 2002/2003, and 142 in 2003/2004.

Eligible homeless and in Priority need 2003/2004 2004/2005 Female 16-17 31 26 Male 16-17 23 25 Female 18-24 101 94 Male 18-24 44 27 Total 199 172 Single People Placed in Hostel Accommodation by CCBC Year 16/17 yr

olds Care leavers Prison

leavers Total

2001/02 13 0 4 17 2002/03 9 7 9 25 2003/2004 15 2 5 22 2004/2005 7 0 6 13 Single people placed in B&B Accommodation by CCBC Year 16/17 yr

olds Care leavers Prison leavers Total

2001/02 10 0 8 18 2002/03 13 6 21 40 2003/2004 22 5 18 45 2004/2005 14 10 25 49

The latest statistics for 2004/2005 continues to show that young single homelessness is a growing problem with more being placed in bed and breakfast than either of the previous two years The Homelessness Action Plan has identified a number of areas of particular concern that to relate principally to young single homeless. ‘Examining the options for establishing a direct access hostel for single people’ There is no direct access emergency accommodation available in Caerphilly, It is noted that Tai Trothwy in the period January 2001 to June 2003 interviewed over 200 people of whom over 60% receiving advice and assistance would have benefited from access to emergency accommodation. Referrals to the new bond scheme also show that approximately a third were of no fixed abode. It is noted that some people would prefer to remain sleeping rough than present to hostels in Cardiff, Newport or Merthyr Tydfil



However, evidence from Cardiff would suggest that the lack of a direct access hostel is pushing some individuals towards the capital, with Cardiff City Council claiming that 22% of clients in direct access hostels were originally resident in Caerphilly. Another priority identified within the homeless action plan relates to the need for further preventative work particularly with regard to young people. “Encouraging the development of mediation and reconciliation services to minimise family breakdown” In response to the above a section 180 grant as been utilised for Llamau to establish a mediation service which works with 16 and 17 year olds who are homeless or at risk of homelessness. The service is also looking to pilot working with 14-16 year olds and their families who are in conflict with the aim of preventing homelessness at an earlier stage. Referrals are accepted from all agencies, schools, colleges, training providers, statutory services, family members and the young person themselves Research shows that many young people face homelessness as a result of relationship breakdown between family members. The Mediation Service aims, where appropriate, to help young people and their families find some common ground on which to rebuild relationships. From this, the Mediation Worker, will explore the possibility of a return home, with on-going support, leaving home in a planned and supported way, or at the very least rebuild support networks with family members. This service clearly demonstrated its value, was subject to a further successful s180 bid for 2005/2006 and has been awarded by the Chartered Institute of housing for its success. In addition, supporting people funding is now being utilised to administer a SAFE (Supported Housing, Advice, Family Mediation, Empowerment) project of 7 units for young people in Risca. The capital cost of this project was financed by Social Housing Grant and now provides safe and secure temporary accommodation to homeless 16 & 17 year olds in a supportive environment to enable quick assessment of housing and support needs leading to appropriate move-on. It also provides the opportunity for family mediation to enable young people either to return home or maintain supportive family links. However, the restricted range of accommodation available to young people within the social rented and private sectors makes move on accommodation difficult to secure within appropriate time scales, which leads to a further action of Investigating the options available to increase the range of accommodation available to single people by

• Converting existing stock • Acquiring new stock suitable for conversion • Re-designating existing accommodation for older people

The identification of ‘move on’ accommodation for single people is a major issue within Caerphilly County. It has been recognised that the administration and co-ordination of developing move on process has become both more urgent and complex.



In recognition of this fact it is therefore intended to employ a ‘move on’ co-ordinator, who will be responsible to the ‘move on’ steering group and will principally co-ordinate the movement of young people from supported accommodation to more permanent accommodation with the council, RSL’s or private landlords. Some older persons housing may be suitable in design for a different client group, and this may be an option in areas where demand for such accommodation is low. However, re-designation has implications for the Community Alarm and Warden Services that are commonly linked to older persons housing, and the transition from one client group to another poses management problems which would need to be sensitively handled. Offering incentives to existing residents to speed the transition from one use to another also has resource implications, although it might be economic in the longer term, if there was a resulting reduction in void periods, turnover and expensive placements in emergency accommodation. The Caerphilly Homeless forum in terms of tackling the ‘move on’ issue is investigating a number of options.

• Setting housing allocation quotas for housing young people with local authority and Registered Social Landlords and ensuring they are effectively monitored. Quotas have been established for local authority allocations.

• Utilising the Bond scheme currently managed by Tai Trothwy to encourage further private sector letting of properties to young people.

• Assisting providers to set up management agreements with local landlords – subletting to young people with limited support attached to tenancy

• Focusing floating support on those in greatest need utilising a possible out of hours option to provide limited support in evening/weekend

• Influencing the Social Housing Grant programme to reflect the need for single person units

• Investigating the option of single people sharing an assured tenancy with limited support

• Creating additional funding through SPRG tariff in 2005/2006 • Creating direct access hostel • Supporting People liasing closely with Caerphilly’s move on panel • Remodelling the ‘support matter’ schemes in collaboration with Tai Trothwy

However, any scheme that accommodates single people with high support needs, such as those within the priority need groups, will require intensive management Input to ensure that the tenancies are sustainable. The authority is concerned that the review of Supporting People Revenue Grant tariffs should reflect the fact that these intensive small schemes should be adequately funded. Llamau Ltd manages in addition to the SAFE project, has 3-shared staffed houses in the borough which are primarily for 16-17 year olds (although people aged up to 24 years old occasionally stay in them). There is a 24-hour staff presence in each property, and they are located in: Senghennydd: 5 self-contained flats in a shared house providing low to medium support Llanbradach: 6 bedrooms in a shared house providing moderate to high support Bargoed: 5 bedrooms in a shared house providing high support.



Llamau has also identified a bed within it’s Bargoed project as an emergency bed which is available to young people in priority need, however, issues concerning the effectiveness of this bedspace need to be investigated. There can be difficulties for the residents of Llamau schemes in securing suitable permanent move on accommodation after staying in one of these schemes. Llamau also operate a floating support service under the administration of the Caerphilly Supporting People team. This project has a capacity of 12 units and works closely with the housing advice centre and the leaving care teams. Barnardo’s Open Door Project offers supported housing in 3 single person flats provided by United Welsh Housing Association in Caerphilly, Hengoed and Blackwood. The flats are available for young people leaving local authority care who have been assessed under Section 17, and eligible under Section 24, of the 1989 Children Act and the Children (Leaving Care) Act 2001. The average stay of each young person is approximately 9-12 months after which he/she moves to a permanent home. During their stay in the flats the young people are supported to enable them to gain the skills to manage in a permanent home, but it is often difficult to secure suitable Move On Accommodation for this client group. A bid for a further 4 bed spaces are made in this plan. Within Caerphilly there is now only a single bond scheme, this is an amalgamation of two previous Tai Trothwy schemes into a single project. Key Strategic Links

Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, homelessness Strategy, Children’s Services Plan 2002-2007, Children First Management Action Plan 1999-2004,Children and Young People’s Framework Partnership, the Framework and Young People's plan.

Conclusion:

• Demand for accommodation from homeless single people who are eligible for re-housing is significant, and this group has been identified as particularly at risk ofhomelessness

• There is no Direct Access hostel provision which may result in individuals having to

sleep rough, this is exacerbated by the existing homeless hostel unable to cope withdemand and continued utilisation of Bed and Breakfast is unavoidable - IN SPOP

• There is a lack of supported housing beds which may result in young people

particularly, being inappropriately housed in independent accommodation with anadded risk of tenancy failure - IN SPOP

• There is a lack of provision for those with particularly complex needs which may be

related to substance misuse and mental health issues

• There is a lack of mainstream ‘move on’ accommodation available for single personhouseholds, which severely restricts choice and may result in individuals spendinglonger periods in emergency accommodation

• Young single homeless are more likely to suffer tenancy breakdown – Proposal to

develop more flexible floating support services

• Single person households who do not fall within the priority need groups will find itincreasingly difficult to access accommodation through the housing waiting list andare more likely to become homeless as a result

• High cost of ‘out of county’ placements by social services could be improved by

utilising supporting people accommodation and floating support projects – Seesupported lodgings scheme within SPOP.



2.1.6 Ex-offenders

The Home Office has recently launched a national action plan aimed at reducing re-offending. The new National Offender Management Service (NOMS) will be responsible for reducing re-offending and managing the budget for offender services at a regional level. Its main objectives are to punish offenders and reduce re-offending by a target of 10% over the next five years. Recognising that the cost of re-offending by ex prisoners alone is at least £11 billion per year, the Government states that it is committed to reduce re-offending through greater strategic direction and joined up working.

One of the ‘pathways’ identified within the plan is recognition of the fact that appropriate and accessible accommodation is vital to successful rehabilitation. Research cited in the report suggests that addressing accommodation problems can make a difference of up to 20% in terms of a reduction in re-offending. Currently only a third of prisoners return to some form of settled accommodation on release.

Many prison establishments now operate some form of housing advice and support for pre release planning. Tai Trothwy is currently running such a service with a number of Welsh prisons called Prison Link.

The Youth Offending Teams (YOT) are key to the success of the Youth Justice System. There is a YOT in every local authority in England and Wales. They are made up of representatives from the police, probation service, social services, health, education, drugs and alcohol misuse and housing officers. A YOT Manager who is responsible for co-ordinating the work of the youth justice services manages each YOT.

Because the YOT incorporates representatives from a wide range of services, it can respond to the needs of young offenders in a comprehensive way. The YOT identifies the needs of each young offender by assessing them with a national assessment. It identifies the specific problems that make the young person offend as well as measuring the risk they pose to others. This enables the YOT to identify suitable programmes to address the needs of the young person with the intention of preventing further offending.

The joint Blaenau Gwent/Caerphilly YOT was set up in April 2000 in partnership with Gwent Police, Gwent Probation Service and Gwent Health Authority. Led by the Youth Offending Team Manager there are nine social workers and three support workers.

The YOT employs an Accommodation Officer with responsibility for ensuring that all clients are appropriately accommodated and the supporting people team is working closely with this officer to ensure that access to supporting people services is available for utilisation by YOT. YOT have set a target for 2004 of 100% of young people supervised by YOT to have satisfactory accommodation to go to either at conclusion of the community intervention or release from custody. However, the experiences in 2004 are that between 20-30 young people were not suitably accommodated and direct access hostels in other authorities have been utilised on a regular basis.



YOT will develop mentors to assist and guide young people toward independent living competence. Probation in Caerphilly is part of the National Probation Service, a statutory criminal justice service. As a law enforcement agency we have a clear role to ensure the proper punishment of offenders and to rehabilitate offenders. We work together with the Police and Prison services, Courts and Crown Prosecution Service. The probation service serves local people - building safer communities, reducing crime, ensuring public protection and fewer victims. We work in partnerships with many agencies in the county. Probation's role is to:

Protect the public Reduce re-offending Enforce punishment of offenders Rehabilitate offenders to law-abiding lives Uphold the interests of victims of crime

The local authority has a duty to secure suitable accommodation for “a former prisoner homeless after being released from custody.” The draft guidance issued by Welsh Assembly Government states “Priority need arises where the applicant is a former prisoner who has been homeless since leaving custody and who can establish a local connection with the area”. In practice, the Housing Advice Centre generally expects former prisoners to present as homeless within five days of being released in order to remain within this priority need group. There is the potential for conflict between practice and the spirit of the legislation, and this is driven by a lack of resources for this client group, and for single homeless people generally. The homeless action plan identifies this as being an area for further investigation “Reviewing the assessment process for offenders leaving custody presenting as homeless, including the use of the 5 day restriction” and “Establishing a protocol with the Prison and Probation Services regarding offenders leaving custody to ensure that a comprehensive homelessness assessment is undertaken to identify those prison leavers who are genuinely at risk of homelessness on release” It was noted that the 5-day restriction was never enforced and that a Greater Gwent Protocol has been developed, which is waiting for Cabinet approval. Tai Trothwy had submitted a bid under S180 to undertake a homelessness assessment of offenders in custody so it was agreed that this target would be achieved through this project There is a protocol between the five Gwent authorities and The National Probation Service (NPS) in relation to housing former prisoners who are homeless. In the Caerphilly county borough there are 3 Probation Service offices, in Caerphilly, Bargoed and Blackwood. Probation staff supervise offenders carrying out community punishments within the terms set by the Court and they oversee offenders who are released on licence from prison. They work with offenders to reduce their re-offending and to protect the public. Each prison has its own Probation Team and all prisoners have a home Probation Officer. Probation Officers engage with longer term prisoners between three and six



months before their release date, which makes planning for their release more straightforward. NPS intends to ensure that all offenders who are genuinely homeless upon release apply for rehousing within the five-day time limit, which has been set by the Housing Advice Centre. This process will be facilitated through Tai Trothwy, with whom the Probation Service contracts to provide its clients with housing advice and bonds in appropriate cases. However, this is difficult because many offenders serve a sentence of less than 12 months and receive minimal support from NPS. Those serving more than 12 months are released under license, but, because time spent on remand is counted towards the overall sentence, and the period in custody is often shorter than the sentence itself, opportunities to address issues such as housing and homelessness are limited. Gwent has benefited in 2003/2004 from a Pan Gwent bid submitted by Torfaen for the establishment of the intensive forensic floating support project match funded by Probation Grant. This project known as the ‘Arms’ project is a floating support scheme being run by Tai Trothwy and caters for ex offenders with high levels of support are required. This is a positive aspect of supporting people operating on a regional basis. During June of 2004 Gwent authorities have again worked in partnership to prepare a joint bid for Social Housing Grant in respect of a drug rehabilitation project (see section on substance misuse)

Arms Project – July 2004 Client area during support Number being supported Caerphilly 13 Newport 10 Monmouthshire 3 Torfaen 2 The Home Office has made available funding for Throughcare and Aftercare, as part of the Criminal Justice Interventions Programme (CJIP). £5 million has been devolved to the Welsh Assembly Government for implementation of Throughcare and Aftercare schemes in Wales for each of the years 2004/05 and 2005/06. The Aftercare element of the package of support that needs to be in place after a drug misuser reaches the end of a prison-based treatment programme, completes a community sentence or leaves treatment planned/unplanned. It is not one simple discrete process, which involves only treatment but includes access to support with other issues such as managing finance, family matters, accommodation support and education, training and employment and constructive use of leisure time Supporting people will co-operate with any initiatives undertaken either within Caerphilly or Gwent wide in terms of this programme. Information provided by the LA Housing Advice Centre shows that the arrangements currently in place for identifying prisoners in custody who are likely to be homeless on release from custody need to be reviewed to ensure that all those who are eligible, unintentionally homeless and in priority need present upon release from prison. Formal protocols between the Housing Advice Centre, the Prison Service and the National Probation Service regarding such prisoners would facilitate this.



Numbers Average length of stay Prison Leavers placed into emergency accom 2003/2004

18 25

Prison Leavers placed into emergency accom 2004/2005

25 35

Prison Leavers placed into emergency accom 01.04.05 – 12.08.05

14 35

The above information form the Housing Advice center only counts the Prison leavers who actually take up the offer and spend at least 1 night in the B&B provided. The age range is very varied from YOT clients to 1 or 2 OAP prison leavers Recent figure set out in the Social Exclusion Reports on Mental Health and Social Inclusion (July 2004) show that young offenders institution costs £75,000 per person per year and prison at £54,000 per year YOT clients and offenders aged 18+ are in direct competition with 16/17 yr olds and care leavers for the available accommodation for single people and that if we cannot meet the demand for single person accommodation for priority groups then single people who do not fall into a priority group are more likely to become homeless, and having no entitlement to accommodation, to become the next generation of homeless/roofless people Supporting People within Caerphilly currently provides limited funding for schemes specifically for ex-offenders; we believe it is an area where working closely with the YOT, probation service and housing agencies, Supporting People can play a productive role. You will note that one of the priorities identified within this plan is the development of a supported living project for ex offenders in Abertillery. Considerable discussion has taken place with partner agencies in Tai Trothwy and United Welsh Housing Association to seek avenues of funding to move this proposal forward, however, at the time of publication of this plan discussions were still proceeding. Key Strategic Links Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, Homelessness Strategy, YOT Plan, Communities Safety Strategy

Conclusion:

• General lack of accommodation for ex-offenders – See homelessness proposal on private renting and proposal for The ‘Bon Marche Project’

• Difficulty in identifying move–on accommodation

• Working with probation on developing the forensic floating support scheme

• Working closely with Youth Offending team regarding remodelling floating support

services.

• Need to improve liaison with probation service

• Need for more emergency accommodation for offenders ,both for those in the community where relationships and therefore housing breaks down

• More housing with support for those coming out of prison,especially after longer

sentences



2.1.10 Homeless or potentially homeless people who

require Support

The Homelessness Act 2002 placed a statutory duty on local authorities to carry out homelessness reviews and to formulate strategies to tackle homelessness. The Act came into effect on 30th September 2002 and placed a duty on local authorities to write and publish an initial review and strategy by 30th September 2003. Welsh Assembly Government Draft Guidance to local authorities in Wales issued in October 2002, highlighted the need to review and update the existing Homelessness Strategy for Caerphilly county borough council. Multi disciplinary and multi agency working and co-operation will be essential to deliver the new strategy. Over 2,000 Households were accepted as homeless by local councils in Wales between April and June 2003 compared to 1500 during the same period in 2002, a 20% increase. The number of households living in temporary accommodation in Wales has risen by almost a fifth in the last year, the statistics show that there were 3,349 households in temporary accommodation at the end of March 2005 compared with 2,890 at the end of 2003/2004 – a rise of 16%. The number of households living in bed and breakfast accommodation also rose by around 10%. There are a number of reasons for the growth in recorded homelessness one certainly is that in Wales the Assembly quite rightly extended the homeless safety net to a number of vulnerable groups in 2001, but this cannot explain the whole of the increase. Living for any length of time in temporary accommodation is not good for people, particularly when there are families with children involved because of overcrowding and poor facilities Bed and Breakfast accommodation in particular is the most unsuitable accommodation for homeless families resulting in emotional trauma and uncertainty. There are no direct access hostels or night shelters in Caerphilly county borough, for people needing emergency housing in the borough, and virtually all of the agencies contributing to the development of the Homelessness Strategy, including the Local Authority’s Housing Advice Centre, identified that emergency accommodation for homeless people is needed in the borough and has been for many years. Households Placed in Emergency Accommodation by CCBC Year No

households placed in B&B

Average length of stay in days

No households placed in hostel

Average length of stay in days

2001/02 30 15 69 28 2002/03 71 18 70 38 2003/2004 117 28 77 30 2004/2005 117 33 73 34 The total number of applications to the Housing Advice Centre for housing as homeless has increased from 702 in 2001/2 to 860 in 2002/3, whilst the total number



of households who were eligible for re-housing as homeless has increased from 295 in 1999 to 407 in 2002. Ty Croeso, the council owned hostel in Newbridge, provides 8 bedrooms for single people and families who need emergency accommodation. Although the maximum number of people who can be accommodated is approximately 25, the more usual average is 10 –15. The building has undergone refurbishment and provides a good standard of accommodation. It has facilities that enable a person with physical disabilities to stay in the building and it is usually fully, or close to being fully, occupied. However, it is the only hostel for statutory homeless people in the borough, so some homeless households will not accept a room there, because of its distance from their home area. Public housing will be working closely with the supporting people team to enhance the support services offered at the hostel. In 2005 an enhanced support team has been established that will be based at the Hostel but will offer an outreach service to those homeless applicants who have been placed in temporary accommodation by the local authority. A small number of bedrooms in Bed and Breakfasts hotels are used to accommodate homeless households. Two hotels are in the Caerphilly county borough, three in Rhondda Cynon Taff and three in Newport but they are not managed by the local authority and are not for the exclusive use of the local authority. This means that they are not always available, adding to the difficulty in finding emergency housing for statutory homeless households. The Code of Guidance discourages the use of bed and breakfast hotels to discharge a duty to secure accommodation for all homeless applicants, and does not regard this type of accommodation as an appropriate way for the Local Authority to meet its duty to provide interim accommodation”. It also states that placements in Bed and Breakfast accommodation for families with children “should be for no more than six weeks”. A press release from the Office of the Deputy Prime Minister in December 2002 stated that “The Government intends to outlaw the use of Bed and Breakfast hotels for homeless families except in emergencies…by strengthening homeless legislation”. Welsh Assembly Government have indicated that they want to see a cessation of the use of Bed and Breakfast as temporary homeless accommodation. Targets are being set in terms of evidencing the move from utilising such accommodation, unless the Local Authority with its partner’s addresses this problem then the targets will be unachievable and there may be a consequent loss of additional resources, which are only going to be made available to those who meet the targets. Proposed new targets in WAG Strategy

� Reduce homelessness presentations by 10% from 04/05 by 04/08 � Prevent homelessness for 75% of households contacting for advice � Reduce numbers in B&B by 50% from 04/05 by 04/07 � Reduce average length of time in temp accom by20% from 04/05 by 04/08 � Reduce rough sleeping by 20% from 06/07 by 04/10 � Reduce repeat homelessness by 20% from 06/07 by 04/10

In addition, the use of Bed and Breakfast hotels can be an expensive option. In the Caerphilly county borough, the Bed and Breakfast bill for homeless households for



2003-2004 was £120,000; current indications are that expenditure in 2004/2005 will exceed this amount.

In early 2003 Foundation Housing began a new service for statutorily homeless families. This involves leasing properties from private landlords and temporarily accommodating and supporting statutorily homeless households until more suitable accommodation becomes available

Although it is difficult to anticipate future trends, it could be expected that the following trends in homelessness in the Caerphilly county borough will occur during 2003/2004:

• Homelessness presentations overall are likely to remain at similar, or higher, levels.

• There will continue to be similar, or higher, levels of presentations to the local authority from people in the new priority needs categories (particularly 16-17 year olds, former prisoners, and households experiencing or threatened with domestic abuse). This will result in increased demands on the local authority to find appropriate accommodation for these households. The demand for accommodation in young people’s supported housing projects (e.g. Llamau) will increase

Information on the area of origin of homeless households has been collected to identify those areas of the borough which generate most applications for housing on the basis of homelessness, and which groups are most represented amongst homelessness presentations. Within the Caerphilly cbc area, homelessness seems to be concentrated in the Caerphilly basin and this may be linked both to the fact that accommodation in all tenures is in high demand, and to the location of the LA Housing Advice Centre in Ystrad Mynach, where it is more easily accessible to those resident in the local area. The LA’s own Waiting List figures indicate that demand for 1 and 2 bedroom properties is highest in districts covered by the Caerphilly Housing Office, while demand for 3 and 4 bed houses is highest in areas covered by the Risca Housing Office. Information provided by Charter Housing Association, which has no properties in the Caerphilly basin, indicate that demand for all property types in areas around Blackwood/Pontllanfraith exceeds demand for areas around Risca/Newbridge. “Developing protocols to ensure that RSL’s share the burden of rehousing homeless households in a way that is proportionate to their stock, and includes households who would otherwise be excluded from consideration” – Homeless Action Plan A quota has been agreed, of 50% of the LA’s total nomination entitlement from the 3 main RSL’s. The quota will be monitored and it is intended that it should commence from April 2004. The numbers are fairly small, and the quota may be sub-divided on an area or household type basis, to avoid an over concentration of homeless households in particular localities. Key Strategic Links Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, Homelessness Strategy.



Conclusion:

• The demand by homeless families for accommodation will remain at similarlevels or increase, and there will be a need to ensure there is sufficientsuitable interim accommodation for them.

• There is no Direct Access hostel provision which may result in individuals

having to sleep rough, this is exacerbated by the existing homeless hostelunable to cope with demand and continued utilisation of Bed and Breakfastis unavoidable - see young single homeless section - IN SPOP

• Difficulties for the local authority in fulfilling statutory obligations may lead

to increased caseloads for Shelter Cymru, CAB, Women’s Aid and TaiTrothwy’s Probation Accommodation Advice Service if homeless householdsfeel they have not received the service they expected.

• The requirement to reduce the use of Bed and Breakfast Hotels for

homeless households will result in other emergency accommodation oremergency arrangements being sought. The involvement of a range ofagencies (particularly Registered Social Landlord s and the voluntary sector)could play an important part in enabling the local authority in fulfilling itsduty.

• According to the Housing Needs Survey carried out in Caerphilly, three out

of 10 households contained someone with special needs which limited theirhousing choices, and 11% of those households expressed a need to move toa more suitable home. 2% needed respite care for a carer. It is difficult todetermine whether this increases the risk of homelessness, but it ispossible that householders unable to secure the accommodation andservices they need to maintain their caring role, would require the disabledfamily member to be placed in specialist health or social servicesaccommodation, if the situation became unsustainable.

• Effectiveness of existing homeless supporting programmes will need to beexamined through the Supporting People review process



2.1.11 People with chronic illness including AIDS, AIDS

related conditions or who are HIV positive

A Chronic Illness describes a long-term medical condition and a Chronic Illness can be defined as a condition of prolonged duration that may affect any aspect of the person's life. Symptoms may come and go. Usually there is no cure; but there are often things that can be done to maintain and improve quality of life. Examples of Chronic Illness are:

Arthritis; Asthma; Multiple Sclerosis; Cancer; Diabetes; Hepatitis; Kidney Disease; HIV/Aids; Chronic Bronchitis; M.E;

• A long-term medical condition One in three people in the UK is currently living with a long-term medical condition.

• Two thirds of UK residents aged 75 and over have a long-term medical condition.

• 34% of UK residents over 75 have more than one long-term medical condition.

• NHS health care in the UK focuses on acute and emergency care rather than the needs of those living with long-term medical conditions.

• Support for people with long-term medical conditions is a major part of the work of social services departments.

Chronic disease management - the level of the burden on individuals, communities and the health and social care services of chronic disease is being addressed. People with chronic disease consult their GPs on average ten times annually (against an average of four times), occupy ten percent of acute hospital beds at any one time and need ongoing access to coordinated health care and advice across primary, community and secondary care to maintain their health. The Health protection Agency estimates that currently there some 50,000 people in the UK living with HIV-The highest number ever, there has also been a substantial rise in the number of people with sexually transmitted disease and there is an expectation that the rate of growth of HIV/Aids infection could accelerate. Key Strategic Links Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, homelessness Strategy.

Conclusion:

• More extensive work needs to be undertaken to identify the needs of the chronically ill within the Caerphilly county Borough. This will form part of the Health, Social Care and Well Being Strategy.

• Closer links being forged by Supporting People with Health in working to

achieve the Whole Systems approach



2.1.12 Vulnerable single parents and families who

require support Census 2001 data as revealed that within the Caerphilly county borough there are 5651 lone parent households within the Local Authority, which ranks the Caerphilly county borough within the top quartile for single parent households. Lone parent households: Welsh Ranking with dependent children 5651 5 with non-dependent children only 2477 7 There has been a realisation that these vulnerable families need support to ensure that they retain their independence and that circumstances are not allowed to deteriorate to the point where family breakdown occurs. The local authority has reacted to this issue and has supported a number of agencies in respect of the provision of support services to individuals who are experiencing difficulties. The Health Social Care and Well Being strategy supports the development of a whole systems approach and identifies a number of areas where developments in services for children and families are required as part of the achievement of the key strategic objectives that form the core of the HSCWB strategy.

‘To enable independent living in local communities, though appropriate support mechanisms for individuals, families and carers’

Links to Health, Social Care and Well Being Objective 4 Enable independent living in local communities, through appropriate support mechanisms for individuals, families and carers The Health Social Care and Well Being needs assessment shows that the electoral divisions of Twyn Carno, Aberbargoed and St James have over 40% of children aged 0-15 living in families that claim income support. The latter two electoral divisions also have over 40% of children aged 0-15 living in households where a person is claiming Job Seekers Allowance. These figures reinforce the conclusion that there are pockets of deprivation in Caerphilly County Borough resulting in health inequalities for the local population. Consultation undertaken as part of the preparation of the Children’s Services Plan for Caerphilly identified the following issues concerning the provision of community based services: • The requirement for family based/community based services targeted on families in need rather than in crisis. • The need for more services in the community to support families. • The need for community based services rather than buildings. Two Homestart agencies operate within the County and provide invaluable support to vulnerable families. Home-Start volunteers provide emotional and practical support and friendship to families in their own homes. By doing so they represent a lifeline for many families when things are difficult. This support can be enough to



prevent things getting worse and so can possibly help avoid family breakdown or child abuse.

Right from the Start is another local organisation established in 1996 that aims to empower parents and carers, raise self-esteem and increase motivation. Right from the start also offers intervention and preventative work to improve parents and carers emotional and physical health and safety.

Both of the above agencies have undergone inspection by Welsh Assembly Government in 2004, and it was noted that they contributed significantly to improving the ability of vulnerable families to maintain their accommodation and further develop their independence

The authority sees these organisations as providing a valuable service to many who come through the leaving care and intensive supported housing services. This continuation of support ensures that the transition from intensive support to greater independence is continuous and does not allow individuals to fall into a gap in support provision.

Key Strategic Links

Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, Homelessness Strategy Children’s Services Plan 2002-2007,Children First Management Action Plan 1999-2004,Children and Young People’s Framework Partnership

Conclusion:

• Caerphilly county borough ranks in the top quartile of Welsh Authorities interms of number of single parent households

• There is a need to further strengthen the support for single parents and

vulnerable families to strengthen social cohesion, tackle poverty andchildren to develop in a stable environment – see bid for additional supportworkers

• Develop local multi-agency services to support families at times of crisis

• The requirement for family based/community based services targeted at

families in need

• The need for community based services rather than buildings .



2.1.13 Older people

Whilst older people do not appear as a separate vulnerable client group on the National Assembly’s guidance documentation, they do constitute the majority of users of Supporting People services. Both the national and local agendas focus on the promotion of independence, and supporting older people in their own homes for as long as is practicably possible. The joint agenda with health supports this, and also aims to reduce inappropriate hospital admissions, and facilitate early discharge. The Wanless programme, which has a LHB lead, targets this, and it is developing a commissioning strategy will reflect a more joined up approach. Options for reshaping some social care services were given to Members in December 2004 as part of the agreed programme for Project managing reshaping services. These included:

• Proposals for the remaining residential homes (3 have already increased

dementia capacity) • Changing the focus of the Authority’s Day Centres, providing a smooth

transition from day hospitals, and allowing less dependent older people to access community facilities.

• Working with housing to further develop extra care housing Older people (those aged 50 and above) have the support of a national ten-year strategy, introduced by the Wales Assembly Government in 2003, which emphasizes exclusivity, and the role of the older person as an active member of his/her community. This will form the background to any emerging strategies for the provision of health and social care to those who need such services. The Welsh assembly Government is currently consulting on a National Service Framework for Older People and supporting people has contributed to the consultation process within Caerphilly. The age profile of the county borough is understood to continue the trend of the Caerphilly county borough becoming an increasingly ageing population. Demographic information points to the age profile of the county borough as an increasingly ageing one. Forecasts are of an increase of over 20% during the next 15 years for those over pensionable age. People aged over 75 will rise from 10,600 in 1996 to 13,100 in 2011. This latter age group will increase from being 6.2% to 7.8% of the population in the same period. Younger age groups are due to decline in the same period (as a result of improved contraception after the “baby boom generation”), and out - migration of the economically active. This would be the generation of “informal carers”. Given the support needs of people, as they grow older a significant challenge exists to the providers of health, social care and housing services. “The demographic older person profile (19.4% of the population compared to 16.4% in Wales and 12.4% in Great Britain). Indicates a need to further develop services to older people to promote independence, and reduce dependence on residential and nursing home care. Evidence indicates that the Directorate of Social Services commissioned services for 33% of the over 85 population within the county borough.



This has been recognised in the submission for the Best Value Review of Alternative and Substitute Care, and the need to develop specialist services including increased Elderly Mentally Infirm provision and more respite/re-enablement services. The Strategy for Older People identifies the need to provide community services near or within peoples own homes and to move away from building based services. The Caerphilly county borough Supporting People team has worked closely with Age Concern to develop a floating support scheme that assists in helping older people who have been discharged from hospital and also offers a support service to older frail people in the eastern part of the borough (see section on disabled people). Through the work of these schemes a need has been identified for the establishment of a support service for older people and we will be seeking avenues to introduce such a service within Caerphilly. The other major areas funded by Supporting People relate to the sheltered housing and community alarm services.

Sheltered Housing

Sheltered housing allows tenants to live independently, perhaps in a smaller and easier-to-manage home, and people often like the idea of having someone to call on if there is an emergency. Sheltered housing differs from other types of housing because of the presence of a scheme manager (sometimes called a warden) who lives on the premises, or nearby. You can contact the scheme manager via an alarm system if you need to. Caerphilly county borough currently has 47 sheltered schemes comprising 1394 units of accommodation; the local authority manages forty of the schemes. A sheltered accommodation ‘task and finish group has been established by the authority to look into the complex issues surrounding the future of sheltered housing. A review of council sheltered schemes by Caerphilly county borough council identified a number of factors that are now characteristics of sheltered schemes.

• It is catering for a frailer, more dependant population than originally intended.

• Many providers now aim to offer a home for life. • It is staffed by an increasingly professional workforce. • Its potential to make an effective contribution to community care is being

increasingly recognized.

'The Council has 40 sheltered housing schemes providing a total of 1250 units of accommodation built between 1965 and the early 1960's. Some of these schemes may no longer be suitable for sheltered use and whilst the structure of the building has been well maintained, some of the early two storey schemes were built without a lift, with bedsit flats rather than separate bedrooms and with limited space standards.



Space standards within the individual units make it difficult for other agencies to meet the level of care required by some older people. The range of communal facilities also varies and some schemes are without guest bedrooms, laundry rooms or private car parking facilities within the curtilage of the scheme. More fundamentally, the lack of a lift may make them unsuitable for more dependent people and options such as refurbishment and upgrading or a change of use may now need to be examined. The opportunity exists to consider ways of meeting the needs of older people with low to medium dependency levels in ordinary sheltered housing schemes and the Council will therefore review the eligibility criteria and carry out a full appraisal of schemes to identify those with the potential for conversion to provide an environment where the care and support needs of tenants can be adequately met. The Council has also agreed the overall direction for the reshaping of Social Services in-house residential care services and a strategic shift away from residential care services towards Housing with Extra Care, Enhanced Care at Home and Day Opportunity Services, Respite Services and Rehabilitation and Re-ablement Services. It is recognized that the successful implementation of this strategic decision will need considerable support from the Council's Housing Service and a review of the current sheltered housing accommodation within the borough. If the strategic development of housing with extra care and ordinary sheltered housing, within the context of reshaping residential care options, is successfully implemented through joint working between Social Services and Housing, the Authority's approach to caring for older people will not only be responsive to the needs of individuals but will also meet the requirements of the Supporting People ongoing service reviews: • The proportion of older people in the community will increase over the next few

years. Many will be frail elderly and will require a form of accommodation, which provides extra care, without needing residential care. The Council has already commenced, and will continue to provide, extra care accommodation to meet this need and the need arising from reduced provision in residential care.

• A former sheltered housing scheme in Crosskeys has been refurbished, adapted

and extended to provide 25 units of extra care accommodation with 12 adjoining low dependency units. The scheme has been funded from BCA, SCA and HRA balances.

• An extra care scheme has been built by Charter in Highfields, Blackwood, which

will provide 42 units of which 28 units will have low to high support needs catered for.

• To establish the continuing strategic relevance of older persons schemes: and • To assess the quality and cost-effectiveness of support services, with a view to

disseminating good practice and negotiating service improvements.

With nearly fifty schemes within the Caerphilly area it is recognised that a strategic review of the services will be necessary, that look at issues such as under-occupation, differential charging for amenities and access criteria.



Supporting People as part of its remit to ensure high quality support services is working in partnership with providers of sheltered housing to work towards the center for sheltered housing studies ‘ code of practice’ or similar accreditation. Extra care/sheltered housing Sheltered housing, which offers a higher level of care, is also available. This type of accommodation is often known as extra sheltered housing or very sheltered housing. It is ideal for people who are less able to manage on their own, but who do not need the level of care available in a residential home. The services offered will vary between schemes, but meals and some personal care are often provided. There is widespread interest in it because it can replace some residential care and plays a useful role providing respite care and a base for good intermediate and rehabilitative care. Most importantly it has the flexibility to provide added health gains, and reduce pressures on acute services, such as tackling delayed discharges from hospital. It is also a popular choice amongst many older people. In response to the decline in the availability of residential home places and the projected increase in the elderly population, the authority has commissioned the establishment of an extra sheltered scheme at Crosskeys. The revenue funding for this scheme successfully comprised part of the Caerphilly pipeline programme for 2003/2004. A bid was contained within the last SPOP for the establishment of an extra care scheme in Blackwood by Charter, this scheme has now been built and at the time of writing this plan was due to open. A further extra sheltered scheme is planned by Glamorgan and Gwent and may also comprise part of the next Supporting People Plan presented by this Authority. Whilst it is accepted that extra sheltered housing is not a substitute for residential care, it is envisaged that many older people will in future be able to live in greater independence with only limited personnel care being delivered within their own home. Extra care housing has a role to play in helping to make sure that older people get the right care in the right place at the right time. It will not give us all the answers and it won't be right for everyone. It will be part of a range of services including good quality residential care, flexible home care services and community living options. Many older people want to stay in their own home, while others will want specialist forms of housing that offer complete security and an environment where care and support can be delivered effectively. Our challenge is to develop policies and services that allow older people to choose the housing that is right for them. The Assembly may look at the position in England where £87 million will be made available to be spent within the financial years 2004-6 (£29m in 2004-05 and £58m in 2005-06) where they are looking to issue allocations and project approvals for up to 1,500 new extra care places.



Community Alarm

Caerphilly’s ‘Careline’ Service provides a community alarm service to over 3,300 households covering Caerphilly county borough council and Registered Social Landlord sheltered stock, and homeowners. This service provides support to vulnerable people living at home and ensures there is a 24-hour emergency call out service for sheltered residents. It is considered to be a valuable service, which provides important links with other services such as health and social services. The alarm service plays a role in homelessness, domestic violence and all special needs groups including older people's services, mental health/learning disability, physical disability and other vulnerable clients. The Supporting People team has increased it’s funding of this service to cover owner occupiers who meet the fairer charging criteria and this is in line with the ethos of support being led by need rather than tenure. The Supporting People team will be working closely with the provider of the community alarm service to identify future areas of development e.g. tele-medicine which would benefit the more vulnerable within the community. The Social Care Pan has identified a number of development objectives in respect of older people and Supporting People will be undertaking it’s share in meeting these objectives. Telecare

In England ‘supporting people’ has been involved in developments in technology are taking place in the field of social care, especially in the area of alarms and the monitoring of daily living activities. The next step is an enhanced capability telephone with a client pendant alarm as the hub of the home system. The hub receives alarm signals via wireless transmission from a fall detector, flood detector, smoke detector, carbon monoxide detector, temperature monitor, and movement detector. These are all automatically relayed to the named carer or to a call centre and, in some cases, also triggering a shut-down of equipment. The introduction of such technology will involve in increased monitoring of equipment and subsequent increases in staff costs will follow and monitoring costs will inevitably increase.

the Management Board of the NHS Wales Department, Welsh Assembly Government, reviewed a detailed report on the current progress and status of the projects and activities which has constituted the All Wales Telemedicine & Telecare Programme for the last three years.

In the light of the closure of scheduled for March 2004 of many of the projects, the report also considered some of the key lessons and messages arising in the light of the involving Wanless modernisation agenda.

The Management Board universally agreed:



• That a need exists for an ongoing programme of Telehealth in Wales, which is supportive of, and fully integrated with other modernisation initiatives such as Wanless, Informing Healthcare and Informing Social care.

• That funding be made available to enable the continuation of the Telehealth support team.

Wanless funding within Caerphilly has identified £35,000 for the commencement of a telecare pilot (WISE Project) that links to the proposed extra sheltered scheme in Blackwood. In addition to the above it is noted that within the consultation for the Joint Working Grant 2006-2008, the following issues have been highlighted for its utilisation.

• Encourages the use of assistive technology, and other adaptations or innovative care arrangements that help people to be supported at home, and investment to control and reduce levels of dependency.

• Encourages support of the development of community equipment service

integration and/or the development of mainstream telecare service delivery in line with recently published guidance from the Welsh Assembly. Key Strategic Links

Health Improvement Programme (prepared by the Local Health Board), Housing Strategy and Operational Plan, Social Care Plan, Health and Well-being Strategy, Community Strategy, Corporate Plan, Strategy for Older People, homelessness Strategy, Older Person's Strategy for Wales; Fundamental's of Care; Communities Safety Strategy

Conclusion:

• Demographic information points to the age profile of the county borough as an increasingly ageing one

• Need to examine the strategic relevance of sheltered schemes within

Caerphilly – see application for Peripatetic warden service

• The development of extra care sheltered schemes should continue and be assessed

• Supporting People should where practical assist in the hospital discharge

process and further empower older people to remain independent

• Need to examine the impact of existing supporting people services for older people in terms of impact on Health and Social care.



PART THREE: SPRG - PROJECT DESCRIPTIONS

3.1 Grand total SPRG requirements

Priority Number – Supporting People Planning Group

Name of project

Type of project No of units

Client Group Annual Revenue costs

Comments

SPRG Caerphilly Substance misuse Rehabilitation project


6-10 Substance misuse

£75,00 - £125,000

£7 million of SHG available in Wales

SPRG Gwent Substance misuse Rehabilitation project


12 Substance misuse

£25,000 Monmouthshire lead authority

SPRG The Bon Marche Project

Floating support

9 Ex Offenders £90,000 Project out of county in Abertillery

SPRG Direct access hostel

Homelessness hostel

4-6 Homelessness £75,000 Identified in Homeless action plan

SPRG Women’s Aid outreach

Floating support

TBA Women fleeing domestic violence

£15,000 Extension to existing project

SPRG Floating support


TBA Young and vulnerable

TBA May involve remodelling existing schemes

SPRG Barnardo’s open door

Supported living

4 Young vulnerable people

30,000 Waiting list for this project – evidence from HAC and Leaving Care team

SPRG Vulnerable families support worker

Floating support

TBA Vulnerable parents

£40,000



PART FOUR: SPG – OLDER PERSON SERVICES 4.1 SPG Funding requirements for new provision

4.2 SPG funding requirements for Existing provision All schemes are new provision 4.3 Grand total SPG Older person requirements


Name of project



Comments Providers


Floating support

TBA Older people 20,000 Mobile warden who would respond to older people concerns who are connected to community alarm Local Authority

SPG Support for older people

Floating support

TBA Older People 40,000 Support workers who act for clients in older person supported accommodation to improve their independence

TBA

Total 80,000


Name of project



Comments Providers


Floating support

TBA Older people 20,000 Mobile warden who would respond to older people concerns who are connected to community alarm Local Authority

SPG Support for older people

Floating support

TBA Older People 40,000 Support workers who act for clients in older person supported accommodation to improve their independence

TBA

Total 80,000



PART FIVE: SPG - COMMUNITY CARE

. 5.1 SPG funding requirements for New provision

5.2 SPG funding requirements for Existing provision

5.3 Grand total SPG community Care requirements .


Name of project


Client Group

Annual Revenue costs

Comments Providers

SPG Supported lodgings


4-6 units

Care leavers

£13,000 New project being developed to assist care leavers in transition to independence

SPG High intensity floating support and Jubilee House

Floating support

TBA Mental health

141,974 Prevention of readmissions to Ty Sirhowy, 4th highest MH rate in Wales and only small funding by SP Gofal

SPG Substance misuse Support workers

Floating support

TBA Substance misuse

66,360 Workers to support clients with substance misuse problems

Two bids, one from LA and other from Drugaid for total of three workers


Floating support

TBA Learning Disability

20,000

Advocates who act for clients in supported accommodation to get their voice heard or exercise their rights as an individual Tender

SPG Home from Home


4 units

Mental health

83,146 Limited supported housing for mental health clients

Home From Home


Floating support


40,000

funding fro scheme to provide support to learning disability clients

Tender

SPG


Supported living


20,000 Local Authority

Total



PART SIX: REMODELLING EXISTING PROJECTS 6.1 Projects needing additional resources (Supporting People Revenue Grant and Supporting People Grant) A number of existing projects have been identified that require additional resources to complement existing provision of services, however, these schemes are all extensions of existing support services.

Funding type

Name of project Type of project No of units Client Group Revenue costs

Comments Providers

SPRG Women’s aid outreach

Floating Support 10 Women fleeing Domestic Violence

£35,000 Helps people who leave refuge and prevents people needing to utilise refuge

Rhymney Valley Women’s Aid

SPRG Floating Support – young ex offenders


4-5 Young Vulnerable

£40,000 May involve remodelling of existing schemes

Tai Trothwy / Llamau SPRG Barnardo’s Open

Door Supported living 4 Young people 30,000 Waiting list of

young people for this type of project– lots of evidence for this project from Housing advice center and leaving care team Barnardo’s



£20,000 Advocates who act for clients in supported accommodation to get their voice heard or exercise their rights as an individual

TBA – On going discussion with social services on funding of this project.

SPG Home from Home Supported accommodation

4 units Mental health £62,000 Limited supported housing for mental health clients

Home From Home SPRG Vulnerable families

support worker Floating support TBA Vulnerable

parents £40,000 May link into

funding for Star house when available TBA



£40,000 funding fro scheme to provide support to learning disability clients TBA

SPG


Supported living TBA Learning Disability

£20,000

Local Authority

Total

£287,000



PART SEVEN: APPENDICES

Appendix 1: Needs map and supply map (SPRG)

Agency Client Group Llamau Young Persons Barnardo’s Young Persons Tai Trothwy Various Foundation Housing Homelessness Rhymney Valley Women’s Aid Domestic Violence Gofal Mental Health Drugaid Substance abuse Victory Outreach Ex Offenders Homestarts Vulnerable parents Right from the Start Vulnerable parents

Project model/SPRG Tariff level Client Group Shared

Housing Floating support

Preventative & crisis intervention support

Direct Access

Shared temporary accommodation

Low level on going supp

Totals

no. refers to number of bed spaces

No % No % No % No % No % No % No % of total fig below

E1 Women seeking refuge from domestic violence

0 21 0 12 0 0 33 10.12

E2 People with learning difficulties

0 0 0 0 0 0 0 0


4 12 0 0 0 0 16 4.90

E4 People suffering from alcohol dependency

0 0 0 0 0 0 0 0


0 1 0 0 0 0 1 0.30

E6 Refugees 0 0 0 0 0 0 0 0 E7 People with physical disability who require support

0 0 0 0 0 0 0 0

n E8 single homeless people who require support and young people leaving care

3 13 0 0 19 0 35 10.74

E9 Ex-offenders 4 4 0 0 0 0 8 2.46

E10 – Homeless or potentially homeless people

0 139 0 0 8 0 139 42.64

E12 Vulnerable parents 0 94 0 0 0 0 94 28.8



Appendix 2: Needs map and supply map (SPG – older persons services) .

Scheme Type

Totals

No. refers to number of units

No. % of total fig below

Grouped older persons services (e.g. category 2) 953 32.63%

Dispersed older persons services (e.g. category 1) 1132 38.76%

Floating support 449 15.37%

Specialist Older persons services – add alarm private 386 13.21%

Total number of older persons services units 2920

Agency Service Caerphilly - Public Housing Sheltered and community alarm United Welsh Housing Trust Sheltered Wales and the West Sheltered Glamorgan and Gwent Sheltered Aelwyd Sheltered Charter Sheltered Abbeyfield Sheltered Age Concern Hospital discharge and befriending Greenbanks Domestic home-care Q Care Domestic home Domicillary Care Domestic home Village Support Domestic home



Appendix 3: Needs map and supply map (SPG - community care)

Client Group Shared

housing Floating support

Other models Totals

no. refers to number of bed spaces

No. % No % No % No. % of total fig below

People with learning disabilities 111

92.5 28

22.6

23

100

162

60.7

People with mental ill health 9 7.5 38 30.65 0 0 47 17.6

Others 0 58 46.8 0 0 58 21.7

Total No.

267

Agency Services Caerphilly Social Services Learning disabilities Charter Learning disabilities Opportunities Housing Trust Learning disabilities Mencap Learning disabilities Home from Home Mental Health K Ramsey Learning disabilities E Jones Learning disabilities Ategi Learning disabilities Cartrefi Cymru Learning disabilities Newport City Council Learning disabilities



Appendix 4

Breakdown of Supporting People funding into client groups

Vulnerable Client Groups Supporting People

Grants E1 Women seeking refuge from

domestic violence

346,755

E2 People with learning difficulties

2,275,490


490,131

E4

People suffering from alcohol dependency


---------------

E6 Refugees

----------

E7 People with physical disability who require support and Older people

341,199 1,344,294

E8 Young single homeless people who require support and young people leaving care

545,901

E9 Ex-offenders

E10 Homeless or potentially homeless people who require support

28,496 745,162

E11 People with chronic illness including AIDS, AIDS related conditions or who are HIV positive

-----------------

E12 Vulnerable single parents/families who require support

172,702

Total 6,290,130



Appendix 5

Mental Health Accommodation Strategy Research Scoping Document

Background A mental health accommodation strategy will be developed for Caerphilly County Borough over and beyond the provision of general housing support. The strategy is not designed to replace the general housing strategy nor to set up a different system for people with mental health problems. The mental health accommodation strategy will include the following principles:

It will have clearly identified links to the Caerphilly County Borough Housing

Strategy;

It will be part of, and link into, the Social Services Accommodation Strategy

across all client groups. The mental health accommodation strategy is designed to supplement general housing support and will encompass the following range of housing provision and support needs: Housing advice Homelessness Crisis Housing Low intensity support Floating Support Supported accommodation Residential/ Nursing Home Care Continuing Care Accommodation needs research project The Mental Health Strategic Planning Group has acknowledged the development of an Accommodation Strategy as one of the key priorities for the County Borough. To complete an Accommodation Strategy, a thorough understanding is required of the accommodation and housing needs of people with a severe mental health problem in Caerphilly County Borough who can no longer reside within independent accommodation or



who need a period of rehabilitation to redevelop the skills necessary for independent accommodation. For their support needs to be fully met, it is envisaged some people with a severe mental health problem will need one or more of the following, recognising these categories describe a traditional model that is itself in need of validation and modernisation: Rehabilitation accommodation - ward based residential based Supported accommodation - unstaffed group homes staffed group homes supported housing adult/family placement schemes board & lodging schemes Residential/ Nursing Home Care - generic

- specialist placements catering for specific conditions

Continuing Care - hospital care Nursing Home care

Research proposal The research will need to be broken down into the following elements:

Mapping existing placements within and out of the County Borough Mapping unmet and perceived need within the County Borough Literature review, review of accommodation strategies throughout Wales and

an analysis of mental health accommodation schemes and projects Stage One The first stage will be setting up a multi agency reference group to oversee the mapping and assessment of need and current accommodation models Stage Two The second stage will map existing placements within County Borough and out of County Borough to obtain a profile of clients. This data will include: age; gender; diagnosis; length of placement; type of placement; level of support being required and provided, risk assessment and future options.



This stage would require someone to undertake those assessments. The mapping would need to include those who fall within the category of “continuing care”. It will also give a financial assessment of current costs and possible re-investment monies. Stage Three The third stage will involve a small multi agency project team to undertake an accurate needs mapping, incorporating unmet needs, in order to assess and effectively plan accommodation services. This will include:

• Collating demographic statistics to obtain an understanding of the characteristics and needs of the local population.

• A survey of CMHT care co-ordinators to obtain information on the

number of clients with a housing/accommodation need and the level of support required to meet that need

• Floating support clients • A questionnaire to housing providers

Stage Four Stage four will involve:

• A review, whether through a literature search or site visits, of each of the existing accommodation models currently in use throughout Wales and England together with a cost analysis of each model.

• Survey of Supporting People schemes throughout Wales (using the

Supporting People network)

• Survey of accommodation strategies in LHB/LA areas throughout Wales – literature review (Joint Review/Baseline Review) and questionnaire

• Independent survey of local service users/carers perceptions

• Analysis of existing accommodation schemes throughout the UK in

terms of effectiveness, cost analysis and relevance to Caerphilly County Borough

Stage Five Stage five will be an analysis of the information and data obtained by the project team and researcher. This information will be used by the reference group to make recommendations on the priorities needed within an accommodation strategy.



Stage Six The final stage will be the formulation of a costed accommodation strategy by the Independent Researcher to be presented to the Mental Health Strategic Planning Group.

Next Steps

• Setting up a reference group

• Setting up a multi agency project team

• Identifying and the employment of an independent researcher with

specialist knowledge of mental health and accommodation issues



Appendix 6

GWENT NEEDS MAPPING EXERCISE

1st April – 30th June 2005 Number of Gwent GNME’s completed LA No. Blaenau-Gwent 158Caerphilly 266Monmouthshire 97Newport 244Torfaen 189Total 954 Age/gender breakdown of completed GwentGNME’s Male Female Total Age No. % No. % No % 16/17 14 3.9 15 4.2 29 4.0 18-24 115 31.9 105 29.2 220 30.6 25-39 131 36.4 94 26.2 225 31.3 40-59 66 18.3 83 23.1 149 20.7 60+ 34 9.4 62 17.3 96 13.4 Total 360 100.0 359 100.0 719 100.0 Lead need on Gwent GNME’s Lead need No. % Domestic violence 69 9.8 Learning difficulties 15 2.1 Mental Health 113 16.0 Alcohol issues 13 1.8 Drug issues 12 1.7 Refugee 1 0.1 Physical disability 24 3.4 Young & vulnerable 19 2.7 Ex-offender/at risk of re-offending 13 1.8 Homeless/potentially homeless 352 49.9 Chronic illness 8 1.1



Vulnerable single parent 9 1.3 Vulnerable two parent family 6 0.8 Older person 23 3.3 Frail elderly 28 4.0 Sensory impairment 1 0.1 HIV and AIDS 0 0.0 Total 706 100.0 Gwent Housing related support needs by age

Age Type of HRS needed 16/17 18-24 25-39 40-59 60+ Total Rank

Help setting up/maintaining a home 15 59 40 22 5 141 1 Help developing domestic/practical living skills 8 24 15 9 3 59 Help developing social skills/confidence 7 15 27 17 7 73 Help establishing personal safety/security 4 14 15 13 17 63 Help managing behaviour/attitude 3 18 18 6 2 47 Advice/advocacy/liaison with other agencies 9 26 23 20 10 88 5 Help budgeting/managing finances 9 40 39 17 4 109 3 Help with benefit claims 12 31 19 21 9 92 4 Emotional support/counselling 3 25 23 24 4 79 Help gaining access to services 8 29 17 8 2 64 Help establishing social contacts 3 10 17 6 9 45 Monitoring of health/wellbeing 4 13 19 15 36 87 Peer support/befriending 2 6 4 6 8 26 Help finding other accommodation 5 44 47 20 9 125 2 Community alarm services 1 2 3 4 27 37 help arranging other services 3 10 18 10 7 48 Other 0 2 0 3 0 5



Appendix 7 Caerphilly GNME Analysis

GNME April – June 2006 Age and gender

1. Age by Gender for period April to June

Male Female Age No. % No. %

Male Female 16/17 6 50 6 5018-24 16 20.8 61 79.225-39 24 26.7 66 73.340-59 13 20 52 8060+ 5 50 5 50Total 64 190

Current accommodation

2. Current Accommodation (Where are you currently living?) April - July 05

Accommodation type No. % Sleeping rough 7 2.7B & B 2 0.8Staying with friends 10 3.9Sofa surfing 2 0.8Children's home/foster care Supported lodgings Prison Adult placement scheme Other specialist supported accom 1 0.4Living with parents/partner/other family 41 16.0Sheltered accommodation 2 0.8Residential care/nursing home Hospital - psychiatric 2 0.8Hospital - medical 1 0.4Hostel 17 6.6Refuge 8 3.1Group home Armed forces accommodation Ordinary accommodation 164 63.8Total 257



Lead need

3. Lead Need April - July 2005

Lead need No. % Domestic violence 148 56.5Learning difficulties 2 0.8Mental Health 23 8.8Alcohol issues 3 1.1Drug issues 3 1.1Refugee Physical disability 3 1.1Young & vulnerable 5 1.9Ex-offender/at risk of re-offending 2 0.8Homeless/potentially homeless 64 24.4Chronic illness 1 0.4Vulnerable single parent 2 0.8Vulnerable two parent family 1 0.4Older person 2 0.8Frail elderly 3 1.1Sensory impairment HIV and AIDS

Housing related support needs by age

4. Housing Related Support Needs by age (number only)

Age Type of HRS needed 16/17 18-24 25-39 40-59 60+ Help setting up/maintaining a home 8 43 34 27 1Help developing domestic/practical living skills 4 10 10 9 1Help developing social skills/confidence 2 8 11 12 1Help establishing personal safety/security 2 29 28 21 2Help managing behaviour/attitude 3 3 1 Advice/advocacy/liaison with other agencies 6 33 26 22 5Help budgeting/managing finances 6 11 16 12 2Help with benefit claims 8 37 34 24 1Emotional support/counselling 3 42 43 33 2Help gaining access to services 3 10 3 7



Help establishing social contacts 4 1 4 1Monitoring of health/wellbeing 1 6 4 7 2Peer support/befriending 1 1 1Help finding other accommodation 15 20 14 2Community alarm services 2 21 18 12 1help arranging other services 4 3 3 1Other 1 1

Current and future accommodation needs

7. Current and Future Accommodation Needs (number only) April to July 2005

Accommodation needs Now (no.) Longer-term (no.) Housing and support satisfactory 22 9Ordinary with support 42 86Ordinary without support 66 79Sheltered accom/extraCare 1 2Temp specialist accom 1 Detox facility 1 Hostel 2 Domestic abuse refuge 118 residential care/nursing home 1 1shared house 1 Self contained Need to return home 1 1Don't know 1 37Other 1

Current and Future Accommodation Needs by Length of Support (number only) April to June 2005

Length of support Accommodation needs (now) Up to 6 months 6 - 12 months 12 - 18 months over 18 months permanent don't knowHousing and support satisfactory 5 7 1 1Ordinary with support 1 6 1 3 2 24Ordinary without support 7 8 3 1 17Sheltered accom/extraCare 1 Temp specialist accom 1 Detox facility 1Hostel 2 Domestic abuse refuge 1 2 109



residential care/nursing home 1 shared house 1Self contained Need to return home Don't know 1Other

Length of support Accommodation needs (longer-term) Up to 6 months 6 - 12 months 12 - 18 months over 18 months permanent don't know

Housing and support satisfactory 1 1

Ordinary with support 1 3 2 79

Ordinary without support 6 7 1 1 1 34

Sheltered accom/extraCare 1 1

Temp specialist accom

Detox facility

Hostel

Domestic abuse refuge

residential care/nursing home 1

shared house

Self contained

Need to return home

Don't know 2 33

Other



Glossary of terms used in the Plan Advocacy services Advocacy is when an individual or more than one

person have their views put forward by someone else (acting as an advocate). Sometimes we cannot put our own views and wishes forward for a variety of reasons, we may lack confidence or may not know exactly how to go about making out voice heard.It may be that we know how to say what we want, but are not listened to.Advocacy is about protecting and enhancing peoples' rights and ensuring that they have a voice in the decisions that affect their lives

Ccbc Caerphilly county borough council Community Alarm This service provides support to vulnerable people

living at home and ensures there is a 24 hour emergency call out service for sheltered residents.

CPN's Community psychiatric nurses - The community psychiatric nurse (CPN) provides psychiatric therapy in the community to patients with mental health problems

Cross boundary issues This term is used to highlight the need for local authorities to discuss the provision of services that serve the needs of people who are homeless, potentially homeless, who have support needs and who may, for whatever reason, move between local authority areas

Cymorth Cymru Cymorth Cymru is the representative body for supported providers in Wales

Direct Access Emergency, crisis accommodation services which people can access 24 hours a day & which include 24 hour staffing- on-site waking or sleeping, or off-site but on call to admit new residents

Epidemiological research The science that uses statistical methods to investigate associations between risk factors and disease outcomes in human populations

Extra sheltered housing Sheltered housing which offers a higher level of care is often known as extra sheltered housing or very sheltered housing. It is ideal for people who are less able to manage on their own, but who do not need the level of care available in a residential home. The services offered will vary between schemes, but meals and some personal care are often provided.

Fairer charging The Government has asked all councils to introduce a new charging system for non-residential social services by April 2003. Some supporting people services charges will be assessed using this criteria

Floating Support Support provide to people in their own homes, it is usually of a temporary nature and has the person gains greater independence, then the support 'floats' to someone else with grater support needs

GAVO Gwent Association for voluntary organisations - GAVO is an independent voluntary organisation which aims to....



Provide support to the voluntary sector through training, advice, information, publications and the recruitment of volunteers Promote opportunities for the voluntary sector to work together in forums Encourage partnership between voluntary and statutory services Respond to the needs of the community by identifying un-met needs and developing new services Support town and community councils

GIS Geographic Information System - A system for storing, manipulating, analysing and displaying data which are shown on a map of the County

Homeless priority need The council has to look into your circumstances to decide whether you are in priority need for emergency accommodation. E.g. pregnant women and people who live with them people who are responsible for dependent children people who are homeless as a result of fire, flood or other disaster 16 and 17 year olds

Homelessness Forum Housing Strategy and Operational Plan - This annual document will set out interim activities and milestones that local authorities and their partners will be undertaking to achieve the strategic aims contained in the Local Housing Strategy

Inclusive forum These are suggested as a method of informing and consulting stakeholders in order to achieve a broad level of involvement in the development of the Supporting People Operational Plan. They may take place twice yearly to bring people together to exchange views about the Supporting People Operational Plan.

LHB Local Health Board - Established on 1st April 2003, Caerphilly Local Health Board is the largest LHB in Gwent and the fourth largest LHB in Wales, There are 34 GP partnerships and over 90 GPs providing services to the County Borough population that stretches from Rhymney in the north to Caerphilly in the south and Risca in the east. The aim of Caerphilly Local Health Board is to implement strategies which will improve the health and health services of people locally. Its key roles are as follows:



NME Needs Mapping Exercise - A data set of information on the presenting needs of individuals who require accommodation related support. This data set is to be completed by as wide a range of users and potential users as is practicable in order to allow Supporting People teams to assess needs for SPRG services

Pan Gwent Schemes that cover the authorities of Caerphilly, Blaenau Gwent, Newport, Torfaen and Monmouthshire

Pipeline bids Bids for additional funds to support schemes during the year 2003/2004. Caerphilly received pipeline funding of £195,628

QAF Quality Assessment Framework - Review process adopted by Caerphilly Supporting People team that allows self assessment against agreed standards with validation visits to ensure compliance

Re-modelling The need to alter an existing service to meet changing needs

RSL's Registered Social Landlords - housing rented from what are now termed Registered Social Landlords (RSLs) - a new name for Housing Associations who are independent of local authorities. The majority of RSLs are housing associations, non-profit making bodies who specialise in housing and plough any surplus back into the organisation to maintain existing homes and help finance new ones

Service provider An agency that provides services to people living in supported accommodation and Older persons services. This may include housing associations, local authorities, voluntary sector or private sector bodies

Sheltered housing Sheltered housing allows tenants to live independently, perhaps in a smaller and easier-to-manage home, and people often like the idea of having someone to call on if there is an emergency. Sheltered housing differs from other types of housing because of the presence of a scheme manager (sometimes called a warden) who lives on the premises, or nearby

SHG Social Housing Grant - While councils no longer build homes of their own, LocalAuthority Social Housing Grant allowed local authorities tocontribute their own capital towards the development of housing association schemes that meet local priorities.

SPG Supporting People Grant - The element of Supporting People revenue funding that will be transferred to local authorities in respect of services provided to people living in older persons services and community care funded provision.

SPIN Supporting People Information Network - Welsh forum for all supporting people officers that meet every two months



SPOP Supporting People Operational Plan - The SPOP will be produced on an annual basis and co-ordinated by the Supporting People Planning Group (SPPG). It will be the document, which prioritises the need for new expenditure relating to Supporting People Revenue Grant (SPRG) and Supporting People Grant (SPG).

SPPG Supporting People Planning Group - The local authority led group with responsibility for overseeing the needs assessment process and the establishment of the Supporting People Operational Plan

SPRG Supporting People Revenue Grant - The grant that will be distributed directly to agencies who have become accredited support providers. This funding may be transferred to local authorities in 2006

Supported living Supported living are the separation of housing and support services with increased tenancy and ownership rights, and an emphasis on designing individualised ‘natural’ community supports to meet the choices, aspirations and needs of a person acting as an active citizen rather than a passive recipient of services

THB Transitional Housing Benefit - A benefit payable to tenants to meet their support costs. THB ended in April 2003 and has been replaced by Supporting People Grants

WAG Welsh Assembly Government YOT Youth Offending Team - Joint Caerphilly/Blaenau

Gwent team that specifically deals with offenders under the age of 18

supporting people plan – caerphilly county borough council...

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