Written evidence submitted by Metropolitan Thames Valley Housing (MTVH) [ASC 051]

I am writing in response to the Housing, Communities & Local Government Select Committee Inquiry into the long term funding of adult social care.

Metropolitan Thames Valley Housing (MTVH) is one of the UK's leading providers of affordable housing and care and support services. We own, manage and administer more than 57,000 homes across the South East, East Midlands and London. Our specialist areas within the adult social care sector include services for older people, those with a mental health diagnosis, people with learning disabilities, and transitional services through which provide intensive support to marginalised or vulnerable people.

Housing associations that offer adult social care services play a key role in the UK’s social care sector, which is currently facing rising pressure. Working in partnership with commissioners, our services take pressure off other public services, save public funds and deliver independence and wellbeing for many people with long and short term care and support needs. We welcome the opportunity to share our insight into the critical role care and support services provided by housing associations have to play in meeting the growing demand for adult social care support caused by the Covid-19 pandemic, and why sustainable, long-term funding for services is essential.

As a social housing provider, with a significant care & support portfolio, we have housing assets and manage services that allow us to deliver better, integrated and more efficient health and care services.

The coronavirus pandemic has undoubtedly increased the level of unmet need for adult social care services. In August 2020, the National Housing Federation conducted a survey of housing associations on the impact of the coronavirus crisis on supported housing. The survey results demonstrated increased demand for housing-related support services in response to the crisis. In particular there was increased need for short-term services aimed at supporting groups such as domestic abuse survivors, people sleeping rough and those experiencing acute mental health crises. Respondents also highlighted that providers face greater financial pressures because of increased staffing costs, additional cleaning, purchasing personal protective equipment (PPE) and higher security costs, alongside lost income from vacant properties.

At MTVH, we have seen an increased demand for access to the care and support services we provide from people with relatively low to medium levels of need, and often from people with undiagnosed or “below threshold” mental health difficulties. The reasons behind this are complex and varied, but in our experience, are most commonly people who have found themselves hitting an immediate crisis when just one aspect of life becomes unstable. For example, weekly referrals to our Domestic Abuse refuge in Nottingham have quadrupled since the start of the pandemic.

This increase in demand for adult social care services is putting pressure on services that are already stretched. For most local authorities, budgetary challenges have led to a reduction in funding for social care services, especially non-statutory or early intervention services, which has weakned the response capacity of the sector to this increase in demand. We are concerned that the budget pressures facing local authorities are leading to service cuts and reduced funding rates that have created pressures that are putting vital services at risk and, in some cases, have led to their closure. In Nottingham, for example, two MTVH Independent Living Support Services (ILSS) were recently decommissioned. These services provided targeted support to enable Nottingham residents to live independently, supporting 400 people at any one time. With the service now decommissioned, these customers will now be looking for support from other services, including statutory services, that are already facing increased demand . The value of non-statutory services, such as the ILSS services recently decommissioned in Nottingham, is best evidenced by comments we have received from people who have accessed the services. These powerful comments demonstrate why services such as these play a critical role in people’s lives, particularly during the pandemic, and the potential impact further decommissioning could have for communities across the country:

“I would not be here today if my support worker had not come into my life.”

- Customer suffering from financial abuse within the home affecting their mental health.

“These services are a template that other agencies should adhere to. Extraordinarily professional, but tempered with a warm personal approach. Unusually good listening skills and real patience. My wife and I felt supported and cared for. You do whatever you can to be able to reach out to as many people as you can. This kind of mature support is rare in our experience and hugely needed!”

- Customer did not know what services were available and ILSS supported them with information on Finances, Benefits, Accessing services, and Assistive Technology.

Not only do these services enable better outcomes for individuals, they also serve to reduce the need for people to access more acute health and social care services, as well as helping to reduce the risk of eviction or homelessness; a scenario which will put pressure on social care further down the line. For example, between July 2019 and June 2020, this ILSS service in Nottingham supported 218 customers to increase their income; 145 to maintain their accommodation and avoid eviction; and 368 to access mental health and wellbeing support.

In this repect, the pandemic has exacerbated existing funding issues across the adult social care sector, putting increasing pressure on under-resourced services and highlighting the need for long-term funding reform. In our experience as a provider of adult social care services, this is less an issue of incentivising the social care market to compete on quality and instead about ensuring local authorities are adequately resourced to commission quality services. The significant cuts to local authority budgets in recent years has resulted in cuts to services which we are unable to accommodate. Handing back services to local authorities because we do not believe they can be run safely at the required cost, is not something we do lightly.

The pandemic has also changed the customer base of our care and support services. We are seeing an increased number of people using our support services for the first time, which is likely a direct result of the new challenges brought about as a result of the pandemic. For example. our Coronavirus Support Hub has shown us directly the increased need for mental health services from our residents in ‘general needs’ housing. The majority of these referrals have been from residents who are unfamiliar with the system and are in need of short-term intervention support. Since the start of the pandemic, our Coronavirus Support Hub has referred approximately 105 residents to mental health and wellbeing services. Other key referral areas include employment, fuel poverty and financial support. This highlights the unique offer that housing providers and holistic adult social care models can offer when it comes to identifying need and stabilising the market. Through short-term, low-level intervention this approach is able to support people to maintain independence, and reduce the strain on more accute adult social care services and the NHS.

Our Essex Mental Health Intensive Enablement Service (EMHIES) exemplifies the role holistic social care models can play in stabilising the market. This service provides supported housing to adults with complex and enduring mental health needs through sixty-one units distributed across Essex. The service is designed to provide intensive, short-term support as an alternative to residential care and as preparation for more independent living. An independent evaluation has proven the EMHIES service reduces pressure on the overall mental health pathway in Essex by speeding up both discharge from hospital and successful exit from the pathway altogether; providing significant cost savings to the NHS and high value for money to Essex County Council, who commission the service

To stabilise the adult social care market, there is a need for further and more effective integration of adult social care and health, along with the broader housing and community-led support sectors, as demonstrated by our Essex Mental Health Intensive Enablement Service. We therefore recommend that services are commissioned on the basis of long-term commitment and partnership with local authorities and would welcome greater flexibility from local authorities regarding the types of models commissioned.

In our often dual role as both housing and care provider, we can offer a joined-up approach and respond quickly to evolving demand for services. Also, through preventative and holistic models of care, delivered through shared living and supported housing, people can be supported to maintain independence and will therefore be less likely to need more intensive and costly care in more acute settings such as residential care.

Thank you for the opportunity to provide this submission to the Committee’s inquiry.

April 2021