Written evidence submitted by Campbell Tickell Ltd [EXA 044]
Introduction
Campbell Tickell is a multidisciplinary management consultancy, operating across the UK, Ireland and beyond. Our primary areas of specialism are housing, care and support, health, and sports. We work particularly with regulators and other government agencies and departments, local authorities, care providers, health bodies, and charities. We welcome this inquiry by the Select Committee, which is timely, and we are pleased to respond to the questions posed in the call for evidence.
While we are not in a position to provide information on the quality of specific exempt housing provision, our own research and work in this area would highlight that the quality of accommodation is variable. This tends especially to be the case where units are leased from private sector landlords, which are commonly Houses in Multiple Occupation (HMO) or have been converted under ‘Permitted Development’ rules.
While the majority of HMOs will be subject to the Housing Health and Safety Rating System (HHSRS), there is little monitoring or enforcement of these standards in exempt accommodation. There is no framework for actively monitoring the standard of exempt accommodation.
The governments report Supported housing: national statement of expectations – GOV.UK (www.gov.uk) set out an appendix with suggested building and safety standards in Annex A. We would suggest that these (or something similar) should be adopted and placed on a statutory footing.
The research further found that there is significant variation in costs between authorities. The costs of providing a bedspace in exempt accommodation vary widely across the country, from £1,100 to £13,900 per annum. The average cost is £6,973 p.a. This does not represent good value for money, given that the level of support provided is low in comparison with other supported housing. For example, the report The cost effectiveness of Housing First in England March 2019_0.pdf (homeless.org.uk) compared the annual costs of different types of supported housing and identified that under Housing First, an intensive housing support service for those with the most complex and multiple needs would cost between £12,000 and £14,000 a year. This would be based on a ratio of staff to tenants of around 1:6. Such a service would be far more intensive than any provided through exempt accommodation where the support is by requirement the minimal required to sustain the tenancy.
Research carried out by Mencap and Housing LIN on specialised supported housing Making the funding system of supported housing work for all people with a learning disability: Specialised Supported Housing - Resource Library - Resources - Housing LIN set out the costs of such exempt accommodation. Specialised Supported Housing is a type of exempt accommodation used extensively to meet the housing needs of people with learning disabilities, which is defined by the Government’s Policy Statement on rents for social housing (2020) Direction on the rent standard from 1 April 2020 - GOV.UK (www.gov.uk)as housing which is:
- designed, structurally altered, refurbished or designated for occupation by, and made available to, residents who require specialised services or support in order to enable them to live, or to adjust to living, independently within the community;
- offers a high level of support, which approximates to the services or support which would be provided in a care home, for residents for whom the only acceptable alternative would be a care home;
- provided by a private registered provider under an agreement or arrangement with a local authority or a health service;
- for which the rent charged, or to be charged, complies with the agreement or arrangement above, and for which at least one of the following conditions is satisfied:
Housing LIN and Mencap found that the overall cost for an individual requiring care and housing in specialised supported housing is state funding of £1,569 per person per week for care and housing costs, in comparison to £1,760 per week for average residential care placement costs, and £3,500 per week for an inpatient placement. There remains an argument that this model – the specialised supported housing model, whilst higher cost than other forms of accommodation, has a role to play in terms of increasing the independence and freedom of people with complex learning disabilities and/or autism
We would therefore strongly emphasise that any proposals for the regulation or control of exempt accommodation must avoid the unintended consequence of negatively impacting on the provision of specialised supported housing.
We are not able to comment on this, although we are aware of the particular issues related to the high level of exempt accommodation provision in Birmingham. We do know however, from our work elsewhere, that commissioners are receiving repeated approaches from exempt providers, often on a weekly basis.
We are not able to provide figures for this. We would however wish to point out that commissioned providers also often provide non-commissioned or exempt accommodation. There are several reasons for this. If a commissioned provider loses a contract for support and they wish to retain the provision and continue to provide the service, they will often remodel their staffing and cost base, and change the provision to exempt accommodation funded through HB. Some providers may also specifically provide non-commissioned exempt accommodation units as part of a pathway of housing support. For example, a domestic violence support provider may run a refuge which is commissioned and may also run a number of non-commissioned ‘step-down’ units that are overseen by the commissioned staff team, but are specifically designed to provide lower support accommodation for people who are ready to take on an independent tenancy after a stay in non-commissioned exempt accommodation.
The proportion of the different accommodation provided is also impacted by the fact that where the provider is a registered provider, the local authority receives 100% subsidy for the rent from central government, whereas if the provider is not registered, the authority will receive around 60% of the subsidy and will need to fund the remaining 40% from its own resources. This is clearly an incentive for local authorities to encourage registered social housing providers to develop rather than non-registered providers.
We do know however that there are a number of good quality providers that are not registered and provide good quality services.
One area for consideration we would suggest is that of licensing exempt accommodation providers in a similar manner to the licensing of private rented providers. We would also suggest that this licensing should be the responsibility of local authorities and be governed by a set of parameters, quality of service standards, building standards and the requisite enforcement powers. Local authorities should be given the additional resources needed to take on the licensing role and to carry out the enforcement of the standards.
Sometimes commissioned providers also provide non-commissioned exempt accommodation – see the points made above regarding step-down accommodation.
We have also worked with the London Borough of Lewisham to develop a quality assurance framework for their non-commissioned providers of mental health housing and support services. The example is cited in Supported housing: national statement of expectations - GOV.UK (www.gov.uk). The LB Lewisham model has a majority of the mental health pathway, which is jointly overseen by the health trust and the council, being provided by non-commissioned providers. The council has however worked closely with the providers, involving them in pathway meetings, and in working with them on the quality standards. An extract from the case study cited the following.
Lewisham Council took a strategic decision to work closely with a select group of non-commissioned providers to ensure that their services are used efficiently, are of decent quality and deliver positive outcomes for people.
The partnership work with these providers is based on certain criteria, including the standard of accommodation. The commissioning team advises the Revenues and Benefits team on the approach to these providers, who then become part of the council’s pathway with their voids allocated by a central panel. The Council collect data on outcomes for both commissioned and non-commissioned providers, to track the performance of their services and consistency of standards.
We would assert that the quality of provision is impacted by the motivation of the provider, not their registered or non-registered status. For example, a number of registered housing providers have been issued with regulatory notices by the Regulator of Social Housing, while a number of non-registered providers are well established charities providing excellent services, including some housing services.
We do not believe that registration as a social housing provider is an indication of quality of service or provision. We do not believe that charities providing housing funded through exempt or specialised supported housing routes should have to register with the Regulator of Social Housing to continue providing their housing services. Services are often provided alongside care and other related support, and housing is simply one element of their overall service provision.
The key Issue is that a commissioned provider can be held to a contract for service, whereas a non-commissioned provider has no framework that they are required to adhere to or to be held accountable for, except the wider legal frameworks around HMOs, Building safety etc that are in practice variably enforced.
Exempt accommodation should be provided within an established framework that local authorities are equipped to oversee and hold providers to account for. Housing Benefit is paid by the local authority. We also know from our work on housing needs assessments that each local authority area has a different set of needs in relation to supported housing and is best placed to manage its local market. The model used for example by adult social care is the development of market position statements. These set out needs and the type of services and housing that a local authority and its health partners require for different client groups. Local authorities are best placed to understand their local needs and the local market for supported housing and to understand where they need to bring in new providers, or develop the quality of existing providers.
We would suggest therefore that a framework of for example licensing exempt accommodation should be put in place with criteria around building safety, maintenance and housing standards as well as minimum levels of staff support and service quality parameters. Payment of HB should be dependent on being appropriately licenced and compliant with the licensing standards. There should be a requirement to renew the licence at least every two or three years. Local authorities should be funded and empowered to check that licensing standards are met and to take enforcement action when providers are found in breach.
Through a quality and value for money framework and a system of audit and accountability that is the responsibility of local authorities.
See above for details of how we believe such a system could work in practice.
There is at the same time a case for a national common framework of standards, which highlights any areas where there should be discretion to vary these at individual local authority level. This framework we suggest could be developed by the Local Government Association, which should be funded to do so. This Framework could be aligned to the Consumer Standards currently being defined and refined by the Regulator of Social Housing, to ensure a level playing field across registered and non-registered providers and to minimise gaps or overlaps between standards. The National Housing Federation should also be involved in the development of these standards.
One set of standards that could be drawn on to develop this would the previous Supporting People Quality Assurance Framework (Lite) standards, or the standards adopted by Birmingham City Council Charter-Of-Rights-Provider-Guidance.pdf (springhousing.org.uk). Campbell Tickell has developed a set of assurance standards based on these two frameworks and has already used them with one exempt accommodation provider. Our process involved the provider submitting evidence against the standards and quality indicators that our team evaluated. An improvement report was provided to ensure that the provider met the framework standards. We believe our framework could form the basis of an industry standard.
The regulations should be set around:
A number of reports have been published about this sub-sector of supported housing. However, there is no framework for systematically gathering information on the size and scope of the sector and no systematic framework for determining the quality of accommodation or of service provision. The Prospect Housing report, on which Campbell Tickell collaborated, Prospect housing report: A shared vision for better homes (campbelltickell.com) published in 2021, was informed by Freedom of Information (FOI) requests relating to the use of exempt accommodation. These were issued to 123 local authorities, of which 97 responded and 85 provided at least some data. This data showed that:
January 2022