CELG(4) HA 22
Communities, Equality and Local Government Committee
Inquiry into Home Adaptations
Response from : WLGA
Introduction
1. The Welsh Local Government Association (WLGA) represents the 22 local authorities in Wales. The three national park authorities and three fire and rescue authorities are associate members. It seeks to provide representation for local authorities within an emerging policy framework that satisfies the key priorities of our members and delivers a broad range of services that add value to Welsh Local Government and the communities they serve.
2. The need for appropriately adapted homes is increasing steadily as people live longer and the number of children and young people surviving longer with disabilities rises. Forecasts suggest that in the next forty years the number of people aged 65 or over will increase by 50%. This will clearly have significant implications for housing, health and social care services including home adaptations
3. Home adaptations play a vital part in enabling vulnerable people to remain living independently in the community. There is considerable evidence that adaptations significantly improve the quality of life of people with disabilities and reduce the need for more costly services such as residential care, nursing homes and hospitals. The WLGA therefore welcomes the inquiry and the focus on improving adaptation services in Wales. We hope that the committee will take the opportunity to look beyond Disabled facilities Grants (DFG’s) which fund a relatively small number of large scale adaptations, and consider the wide range of mechanisms for providing home adaptations and assistance.
4. The current pattern of home adaptation services is complex and therefore putting in place a coherent, efficient, equitable and effective provision across Wales is considerable. Navigating the range of provision also inevitably presents a real challenge for people who need adapted housing.
5. Home adaptations are currently funded through a range of grants which differ depending on tenure and the scale of work. Provision includes disabled facilities grants (DFG), physical adaptation grants (PAG), minor adaptations grants, independent living grants (ILG) and the rapid response adaptation programme (RRAP) as well as schemes which match need to appropriately adapted homes. This complexity of provision and eligibility criteria has inevitably also led to inequitable access to services.
6. The effectiveness of home adaptation services has been the focus of a number of reports as well as a committee inquiry over the past 8 years. The focus of attention has been on the delivery of Disabled Facilities Grants (DFG’s) which are just one form of assistance and which provide a relatively small number of large scale adaptations. In 2010/11 a total of 4743 home adaptations were carried out using statutory DFG’s. In contrast there has been little consideration of the full range of grants and assistance which provide adapted homes for many more people. A comprehensive review of the whole range of provision would provide a fuller understanding of the degree to which services are addressing needs effectively.
6.Unfortunately the variety of funding mechanisms for adaptations has resulted in some inequities, particularly in relation to tenure. In 2010/11 owner occupiers and private tenants in Wales, who make up 82% of households had access to just over £35m for Disabled Facilities Grants through Local Authorities. However housing association tenants who make up 10% of households also had access to £8.5m of funding for large scale adaptations via the Welsh Government Physical Adaptation grant (PAGs) scheme. This contrasts Local Authorities and Stock transfer associations who are expected to fund adaptations. It is increasingly the case that stock transfer housing associations not meeting their tenant’s need for large scale adaptations and consequently tenants are applying to their Local Authority for DFG funding.
Why are there still significant variations in the time it takes to deliver aids and adaptations funded by DFG’s across Wales.
7. The delivery time for a DFG has been a National strategic Indicator since 2009/10 and an indicator within the Wales Programme for Improvement (WPI) for much longer. The performance data shows a steady improvement in the delivery time for DFGs with the average time being reduced from 545 days in 2005/06 to 326 days in 2011/12, an improvement of 40% over 6 years. Consistency in performance across Authorities has also significantly improved as is demonstrated in the graph below included in the Local Government Data Unit Performance Bulletin 2011-12.
8. The data demonstrates the positive direction of travel however there is recognition that Authorities are interpreting some aspects of the PI definition differently, in particular the definition of “the first recorded contact with the Authority, relating specifically to an adaptation”. This makes it difficult to fully understand the level of inconsistency across Authorities.
9. Some degree of inconsistency in services across Wales is inevitable given the differences in demography, geography, labour markets, organisational structures, policies, processes and financial pressures. Authorities are also working with a number of partners such as RSL’s, Care and Repair agencies, Local Health Boards which each have varying policies and practices.
10. Local Authorities understand the importance of maximising consistency and continue to work together on a regional and national level to improve services and increase consistency. The Gwent Authorities for example meet on a regular basis to improve services and their work has evidenced considerable consistency in the policies and delivery of adaptation services.
Progress on implementing recommendations from the Equal Opportunity Committee Report on home adaptations 2009
11. Local Authorities are continuing to improve adaptations services in response to a number of factors including the increased demand for grants, the pressure on resources as well as the implementation of the 2009 Committee report recommendations. Examples of the improvements Authorities are making include:
· lean systems reviews leading to a significant reduction in processing times, an increase in the number of grants completed and reduction in costs (see case study Appendix 1)
· Improving access to grants through better information and promotional materials, one stop shops and a single point of access for disabled people
· Increasing the use of ‘trusted assessors’ in the place of an OT’s where this meets the guidelines
· Closer working between OT’s and housing staff including employing an occupational therapist (OT) to focus on DFG’s and joint protocols with OT’s in social care
· Joint visits between OT’s and grant officers to identify the most appropriate solution at the start of the process
· in house improvement agencies to streamline the process including use of a schedule of rates, contractor frameworks and contractor lists
· Regional procurement of contractors and equipment eg stair lifts, grab rails, showers etc to bring down costs
· Home visits to assist with the application including the means test and contractor selection
· Adapted housing registers to ensure the most effective allocation of social housing
· Better use of the ‘reasonable and practicable test’ when deciding on of the most effective and efficient solution
· re location grants to help someone move to an adapted or more appropriate accommodation as an alternative to grant work
· fast track procedures and prioritising applications according to need
· Close relationships with Care and Repair including co location
· self assessment for some minor adaptations
· Grants for landlords who agree to bring an empty properties back into use as an adapted property
· Increased use of IT systems for example electronic referral system and document management systems.
· designating individual planning and building control officers to speed up the processing of large scale DFG’s
· a corporate adaptations panel to bring together key professionals to review working arrangements, services and budgets
· embedding a register of accessible homes within the common housing register for social landlords
· recycling equipment eg stair lifts
· replacing expensive warranty schemes for equipment (eg stair lifts) with a local Authority sinking fund.
· increasing the cost ceiling for Minor Adaptation grant to increase the number of small scale adaptations that can be carried out more speedily
· regional benchmarking, sharing good practice and improvement action plans.
12. The WLGA in conjunction with the Housing Technical Panel (the Local Government officer network) continues to use every opportunity to share learning and support effective practice. This has included the publication of best practice advice by the Local Authority housing adaptations benchmarking club, officer learning events and discussions at the WLGA Cabinet Members Housing Network
What impact will reduced resources for housing have on the provision of home adaptations
13. The number of frail and very frail people in Wales is increasing steadily and the need for services is also therefore increasing. This presents a real challenge for Local Government particularly at a time when budgets are being squeezed and service pressures are increasing. Partner organisations including health Boards and the third sector are also facing similar budgetary pressures.
14. These pressures are increasing the challenge of meeting the rising need for adaptations, particularly large scale DFG’s. Authorities are increasingly focusing on how to make best use of resources and therefore it is very important that the means test for DFG’s is retained to ensure that assistance is focused on low income older people who are unable to fund the work themselves. It is also important that eligibility for the range of adaptation grants is coherent and does not allow DFG applicants who have failed the means test to access assistance via alternative funding streams.
15. There is extensive evidence that housing adaptations reduces pressures on primary health care services and the demand for nursing care and hospital admissions. There is therefore a very strong argument for health budgets to assist with the cost of adaptations in order to reduce the demand for high cost health services.
Is the Welsh Government effectively monitoring the provision of adaptation services?
16. National performance data currently focuses on the time taken to deliver a DFG’s and therefore provides a partial understanding of the extent to which people are being assisted to live independently at home through home adaptations. The focus on process also provides limited understanding of outcomes. The WLGA would not wish to see an increase in the burden of performance data collection, but we would welcome a more holistic picture of services which focuses on outcomes. We hope this inquiry will help to generate a broader understanding of the range of adaptation services delivered by Local Authorities and their partners and the variety of mechanisms that can be used to provide adaptations to enable people to live independently at home
What needs to be done to improve the home adaptation services in Wales
17. The current pattern of services for home adaptations is complex and in some respects inequitable. The inequity needs to be addressed, particularly in relation to tenure. We suggest that all social landlords should be expected to fund adaptations of their properties as part of their responsibilities as landlords and there should be equality of access to any additional Welsh Government funding, irrespective of tenure.
18. There has been some discussion about removing the means test in order to speed up the DFG process. We are concerned that this would result in the scarce resources being diverted to assist those who are able to fund their large scale adaptations and reduce assistance available for people on lower incomes. As an alternative there may be an opportunity to simplify the means test in order to reduce delays
19. The need for adaptations is rising steadily and this trend will continue as people live longer and increasing numbers of children survive significant disabilities. Authorities and other providers will need to continue to find ways in which needs can be met more efficiently. This will be achieved partly by streamlining processes but also by looking at using existing resources as efficiently as possible including making the best use of adapted properties and recycling equipment, helping people to move to more appropriate accommodation and considering recyclable loans as well as grants.
20. It is clear that expenditure on adapting properties and enabling people to live independently at home for longer saves Local Authority expenditure on residential care. Adaptations also deliver significant savings for Health Boards by reducing the need for hospitalisation and nursing care and assisting with hospital discharge. Home adaptations are an important preventative measure and serious consideration should be given to targeting some health funding on adaptations on a spend to save basis.
Appendix 1
The Lean Enterprise Research Centre undertook a lean review of DFG processes for Neath Port Talbot in 2010(1) which achieved the following improvements:
· 24% increase in the number of grants completed compared with the previous financial year
· 45% reduction in time between the applicants first contact and completion of the wok
· 54% reduction in construction time
· 22% reduction in costs
· Steps in process reduced from 291 to 34
(1) Zokaei K et al (2010) Lean Systems Thinking in the Public Sector in Wales
Lean Enterprise Research Centre