Public Accounts Committee Inquiry into Supported Housing: Call for Evidence

About the Challenging Behaviour Foundation

The Challenging Behaviour Foundation (CBF) is a national charity which supports children, young people and adults with a severe learning disability whose behaviour challenges and their families. The CBF exists to demonstrate that individuals with severe learning disabilities who are described as having challenging behaviour can enjoy ordinary life opportunities when their behaviour is properly understood and appropriately supported.

As part of the CBF’s work, we convene a Housing Group, which consists of people with expertise and experience in different areas relating to housing. This response is informed by the work of this group.

Further information about the Challenging Behaviour Foundation can be found on our website here: https://www.challengingbehaviour.org.uk/

Key points

• Supported housing is crucial in ensuring that people with a learning disability are able to live good lives in the community, but the current provision and funding flows for supported housing are not adequate and as a consequence, people with a learning disability are experiencing serious adverse effects
• Government actions, which have been promised and which have attached funding, are not being delivered
• There is insufficient data a) collected and b) available
• There is insufficient monitoring of targets and expenditure

Importance of supported housing to people with a (severe) learning disability, and impact of insufficient quantity/quality of supported housing

We support families of people with a severe learning disability who frequently share with us the significant challenges they face in ensuring there is appropriate housing available for their loved ones. Good quality supported housing for people with a severe learning disability ensures that they are able to live in their local communities, with or near the people they love, and to do the things that are important to them. The people that we support have behaviours that challenge, meaning that the right housing is crucial – housing needs to be robust, bespoke, and person-centred in order to meet their needs and ensure that they are safe.

People with a learning disability, as well as autistic people, are often admitted into inpatient assessment and treatment hospitals not because they have a condition that needs to be ‘treated’, but because there is not sufficient community support to meet their needs. Families we support have shared with us that their relatives with a learning disability have been admitted because they are unable to get the right housing where they can be supported. If the availability and quality of supported housing is not there, then people who do not need to be in hospital can be detained in an environment that frequently causes harm and trauma, as evidenced by multiple reviews and reports. Likewise, the main reason for delayed discharge of people with a learning disability and autistic people, as evidenced by NHS Digital’s Assuring Transformation dataset, is a lack of suitable housing in the community.[1]

We are deeply concerned that the lack of availability of good quality, suitable supported housing is directly contributing to the inappropriate detention of people with a learning disability, who do not otherwise need to be there, in hospitals, because there is nowhere in the community for them to go. It is crucial that there is both significant investment in the supported housing sector and strong oversight and regulation to ensure that there is an increase in both the quantity and quality of supported housing that meets the needs of people with a learning disability.

Lack of data collection, local needs assessments, and oversight of supported housing for people with a learning disability

In 2018, Mencap and Housing LIN released a report detailing the state of Specialised Supported Housing (SSH) within the UK. Their research estimated that there were between 22,000 and 30,000 SSH units in the UK, between two and three times as many as were previously estimated.[2] SSH, which is the most common form of supported housing for people with a learning disability due to the higher costs of housing for this group, is a form of exempt accommodation.

In conducting this research, Housing LIN found that the Homes and Communities Agency (now Homes England) did not require small registered providers of specialised supported housing (e.g., providers of less than 1000 units) to provide data; however, the majority of SSH providers provide less than 1000 units.[3] This means that they had to conduct their own research to collect meaningful quantitative data. Collecting data on the scope, make-up, geographical distribution, and costs of supported housing is crucial to ensure that there is evidence-based investment, and to provide local authorities, central government, and commissioners with the data they need to make decisions on spending and commissioning of services. The lack of data collected on these issues is therefore a concern.

This research also identified that there is insufficient local assessment of the a) current and b) future demand for supported housing for people with a learning disability. From our work with the Housing Group, we believe that, with a few exceptions, this remains the case. Without clear data on local populations and evidence-based assessments and projections of current and future need for supported housing, the sector will not receive the investment needed to provide the right support for either people with a learning disability or for the other groups that are eligible for supported housing. It is crucial that research into local area needs for supported housing, as well as regulation and oversight of the quality of the housing provided, is conducted on a regular basis by local authorities in line with their statutory duties.

Cost savings of supported housing compared to registered care homes and inpatient settings

The Mencap/Housing LIN research sets out how supported housing can work and the positive impacts that it can have for people with a learning disability, as well as the cost savings of supported housing compared to registered care homes and inpatient settings. The average weekly cost of a bed in an inpatient setting is over twice as high as the average weekly cost of specialised supported housing.[4] As discussed above, the lack of suitable housing, including supported housing, is a major factor for admission and the main factor for delayed discharge. By improving the quantity and quality of the supported housing sector within the UK, there could be significant cost savings, as well as a significant improvement in the quality of life for people with a learning disability.

Government’s current and promised actions to improve supported housing are not being met, and there is no accountability for the funding that has been set aside for these purposes

The government has committed to a number of actions related to supported housing for people with a learning disability, many of which were announced with earmarked funding. Our concern is that these actions have not been met and that funding set aside for these actions is not being used. This section details the actions promised, our concerns (including whether they have failed to be delivered within the timescale stated), and our proposals for how these can be improved.

Care and Support Specialised Housing Fund

The Care and Support Specialised Housing Fund (CASSH) was established in 2013 to provide funding to “support and accelerate the development of specialist affordable housing which meets the needs of older people and adults with disabilities or mental health problems”. The second phase of this funding ended in 2021. The 2021 white paper ‘People at the Heart of Care’ included a commitment to invest £213m in CASSH between 2022-2025 (£71m per year for three years), and this commitment was reiterated in both commitment 3b of the Building the Right Support Action Plan (July 2022) and in the government’s follow-up report to the UNCPRD (published December 2022). CASSH is a joint scheme between the DLUHC and the DHSC.

On the government’s website, the collection for CASSH was withdrawn in April 2022 “as this scheme is now closed” and the webpage redirects to the Affordable Homes Programme 2021-2026, which does not include any reference to CASSH. There is no reference to the scheme reopening or details of how providers might apply to the scheme for funding. Despite there being £71m of funding earmarked to be used for this scheme during 2022-2023, as of 7/6/23 there is no evidence that this funding can be applied for. This is a significant concern as it reduces the ability of providers to provide the specialised and person-centred supported housing that people with a learning disability, and in particular people with a severe learning disability whose behaviour challenges, require. Given both the shortage and expense of this specialised housing, the inability to make the earmarked funding available within the promised timescale is both concerning and disappointing.

Suggested questions re: the Care and Support Specialised Housing Fund

• Can the DLUHC/DHSC provide a date for the reopening of the Care and Support Specialised Housing Fund scheme?
• If the DLUHC/DHSC cannot provide a date for the reopening of the Care and Support Specialised Housing Fund scheme, can they provide details of where and how the funding allocated for this scheme is being used, and how much will be available to people with learning disabilities and autistic people within the BTRS programme?
• There is £71m of funding specifically allocated for the year 2022 to 2023 – is the scheme going to be reopened in time for this funding to be used, and if not, will this funding be redistributed to later years of this scheme or will it be used elsewhere? How much of this funding will be available to people with learning disabilities and autistic people within the BTRS programme, given that it is a commitment in the action plan?

Affordable Homes Programme

The BTRS Action Plan states that supported housing will be delivered as part of the Affordable Homes Programme (AHP) 2021-2026. This programme seeks to build ‘up to 180,000’ new homes, of which 10% will provide supported housing. This means that a maximum of 18,000 homes providing supported housing will be delivered under the AHP, although it could be less. The NAO report states that the internal DLUHC target figures for the total number of houses delivered were significantly lower than the public targets, with the number of supported living homes provided under the scheme by Homes England estimated at 12,200[5] – as of the publication of the report, Homes England still had approximately 3,700 supported homes yet to deliver.[6] Of the target 3,500 homes set to be delivered by the Greater London Authority, only 325 had been allocated funding.[7] These figures do not contain information on whether the supported housing is targeted at older people, people with a physical disability, people with a learning disability, autistic people, or other people eligible for supported housing.

We are seriously concerned that these actions are not enough to provide sufficient supported housing for people with a learning disability. Supported housing for people with a learning disability, and in particular for people with a severe learning disability whose behaviour challenges, can be very costly, as it often needs to be bespoke and with multiple adaptations in order to successfully meet needs. Without sufficient funding streams and targets to provide supported housing for this group, providers can be disincentivised to provide supported housing for people with a learning disability; meaning that there is insufficient supply to meet demand and needs. Of the maximum 18,000 supported living houses that could potentially be funded under the Affordable Homes Programme, there are no set targets for how many should supply housing for people with a learning disability; without setting out these targets, it is difficult to measure whether this action is meeting its aim of providing supported housing for this group.

In addition to this, housing associations have informed us that they have struggled to utilise the Affordable Homes Programme to provide accommodation for people with a learning disability, and in particular people with a learning disability who are covered by the Transforming Care and Building the Right Support programmes.

Suggested questions re: the Affordable Homes Programme

• How many houses providing supported living for people with a learning disability have a) been funded and b) been built under the Affordable Homes Programme since the programme began?

Community Discharge Grant

The Community Discharge Grant (CDG), which ran between 2020 and 2023, aimed to cover ‘double running’ costs to enable people with a learning disability and autistic people who were detained in hospital to be discharge into the community. In many cases, discharge from inpatient settings involves people with a learning disability and autistic people moving into supported housing.

The Community Discharge Grant has now ended. There has not been an evaluation of the effectiveness of the CDG, how the money has been spent, and whether this has enabled people with a learning disability and autistic people to successfully move from an inpatient hospital to the community. We are concerned about the lack of data on the effectiveness of the CDG programme, and that the evaluation was not planned and delivered during the programme’s duration. Without collecting data on how the grant has been used and what the outcomes of its use have been in enabling people with a learning disability and autistic people to move into the community, there is no evidence for a) whether the grant has been effective, and b) whether its funding should be renewed to enable people with a learning disability to move out of hospital.

Conclusion

We have significant concerns about the current state of supported housing in the UK. The lack of data collection, assessment of local need, and the availability and quality of supported housing have material negative consequences for people with a learning disability. The lack of progress on the actions that the government has committed to, and the lack of accountability regarding the funding that has been earmarked for these actions, are troubling. We hope that this inquiry will lead to improvements and action.