CELG(4) HA 04
Response from : Neath Port
Talbot County Borough Council
This note is provided in response to the open letter by the chair, Communities, Equality & Local Government Committee Letter dated 11th November 2012, seeking views on an inquiry they are to undertake into home adaptations. The responses related directly to each of the 5 points identified as “terms of reference” for the inquiry.
Point 1
1.1 “Why there are still significant variations in the time it takes to deliver aids and adaptations funded by Disabled Facilities Grants across Wales;”
1.2 The 2009 Equality of Opportunities Committee report, which considered the same question, broadly describes a position which has not changed today. The report states “Systems and arrangements for the delivery and performance management of services vary across housing tenures as well as across Wales. Adaptations, for example, can be delivered through a variety of mechanisms including Disabled Facilities Grants, Rapid Response Adaptations Programmes, Physical Adaptation Grants, Home Improvement Grants and Relocation Grants” The 2009 report also recognised that “Despite the review in 2005, the picture does not appear to have significantly improved. Many of the issues that emerged during that review - for example long delays, inconsistency across local authority areas and housing tenures, poor access to information and poor performance management - have arisen again during the course of this inquiry.”
1.3 The DFG process continues to be delivered in fundamentally different ways by each local Authority driven by different demographics, different geographical conditions, different financial pressures, different historical processes for delivery of adaptations, different local relationships e.g. with Care and Repair and different functioning directorates.
Point 2
2.1 “Whether sufficient progress has been made on implementing recommendations from the Equality of Opportunity Committee’s 2009 report on home adaptations1;”
2.2 The 2009 report made 15 recommendations none of which address the fundamental differences in delivery pressures or processes described above. Most critically it could not address a fundamental problem i.e. that DFGs is one of many priority functions which compete for access to limited, unhypothecated capital funding.
2.3 A clear example of the difficulties that exists in changing all-Wales thinking and establishing a collective approach to DFGs is illustrated in the context of the Neath Port Talbot Systems Thinking review of DFGs carried out in 2009/10. In 2009 NPTCBC chose to apply a different approach using Systems Thinking methodology to review all of its services. DFGs were at the forefront of this new approach. The 2009/10 systems thinking review of DFGs produced significant outcomes in terms of a single customer focussed method of approach which dramatically changed the Council DFG system and has delivered many customer focussed improvements. Understanding that this would take some time to see success, the Council chose to entirely redesign and restructure its Housing Renewal Service and its funding priorities. It recognised that the greatest level of housing grant demand was for DFGs. Consequently 98% of all general funding for housing renewal funding is now focused on delivering DFGs. The review was widely recognised and publicised by UK public service organisations as a good practise model. Most Authorities in Wales and many in England gained experience of the new system, examined its evidence and positively saw its benefits. Information has been shared across Wales. In 2009 the process and outcomes were presented to the WLGA and Equality of Opportunity Committee. In 2010 Welsh Audit Office commissioned and published a report on systems thinking approaches which positively recommended the NPTCBC approach to DFG delivery. In 2011 a change management book was published which recommended the DFG systems review carried out by the Council as the way forward for DFGs.
2.4 Whilst NPTCBC are continuing to see the new system delivering continuous improvements and while the council have been party to many organisational raids on this subject, there still does not seem to have been any significant move by other authorities to use the learning within their own DFG processes.
Point 3
3.1 “What impact reduced resources for housing are likely to have on the provision of home adaptations”
3.2 National strategies for care are now driven by the need to maximise the number of older people living independently for longer in their own homes. Reducing resources for housing is a failure to recognise that success in this area is depended on home design and condition being suitable. The alternative is unsuitable and inappropriate accommodation leading to early admittance to residential/nursing care and increased high cost formal care packages.
3.3 This will lead to longer DFG waiting times, negating the positive impact of adaptations provided in a timely manner. As a consequence higher costs will be incurred by other agencies, Social Services, the Health Service, GP Practices etc. where this failure demand will present itself.
3.4 The focus will be budget driven, not driven by providing the “right help”. The impact of a reduced budget will drive the wrong behaviour, and will result in a waste of resources where the “right help is not delivered first time”.
Point 4
4.1 “Is the Welsh Government effectively monitoring the provision of adaptation services.”
4.2 No. There are a number of factors that make the process ineffective:
i) The data collection is not indicative of local authority demand Eg KPI (point 4) only provides the total number of DFG’s delivered in that financial year and does not identify the number of grants being processed over that period and held unprocessed on waiting lists, which does reflect demand. This reflects money spent which will be a simple measure of the constraint due to budget setting rather than demand for the service.
ii) As indicated above the data collected is not recorded consistently. The Welsh Government needs to be clear on what they wish the measure to indicate and what does it tell the deliverers.
iii) Whilst ‘end to end time’ if it is split into its constituent parts is a good measure, consideration should be made to include the number of times the ‘right help’ was provided as this is crucial to the success of the DFG. Evidence of repeated interventions or additional care support needed after a DFG is not collected.
iv) By replacing a KPI target with data measures of “What Matters” from the customer’s viewpoint, measures of the systems should be undertaken to enable the use of objective criteria for distinguishing background variation from events of significance, based on statistical techniques. (i.e. Control charts help you ‘see’ when the system varies away from the normal process). By collecting data from a process, variations that may affect the quality of the end product or service can be detected and corrected, thus reducing waste as well as the likelihood that problems will be passed on to a client. Control charts have an emphasis on early detection and prevention. In addition to reducing waste, this can lead to a reduction in the end to end time required.
v) The definition in the primary DFG indicator needs clarification, particularly with the wide and varied delivery methods of the Local Authorities in Wales. This is impacting on how each Local Authority provides different schemes which may fall within or out of the indicator.
Point 5
5.1 “What more needs to be done to improve the Home Adaptation Service in Wales.”
5.2 The Welsh Government should develop a single framework for delivery of DFGs based on what matters to the customer. Identify the purpose of a DFG from the customer perspective and delivering only the “value steps” necessary to achieve its “purpose” , which will minimise cost and reduce delivery time. It will also have the benefit of removal of all those steps that do not add “value” to the customer or have them undertaken away from the front line where they do not impact the customer. Understanding these processes will require authorities to apply different thought processes similar to the ‘systems thinking’ approach used by this Authority.
5.3 If we can ensure that all providers are working to, and using the same methods in achieving the “purpose” and use measures to see improvement, or not, then these measures can be used to improve the service and be communicated in a way to ensure this.
5.4 The systems approach encourages a culture of continuous improvement. Operating Principles such are listed below are simple, consistent and can be clearly evidenced:
· Place experts to the front
· Get it right first time
· Only deliver value steps (Purpose)
· Have a system with no hand off’s
· Minimise Waste & Preventable Demand, only do the work that adds value to the process in customer terms, and do not build waste back into the system.
· Achieve the customers nominal value, the customer sets the nominal value
· ‘Pull’ an expert when required
· Continuously measure and improve the process
· Base decisions on Data
· Define who is the customer
· Purpose is defined as what matters to the customers
· System must deliver the purpose
· Check and act upon the system
· Those working in the system should design the system
· Decisions must be based on data and evidence
· Managers facilitate process of change and redesign to meet purpose
· Managers should create a supportive environment to encourage individual decision making to deliver the purpose
· System should provide help to the customer going through the process
· IT Should support the whole system end to end
· Use measures to tell us how we are achieving the purpose