Table Of Content1
Report Number 193/11-16
Committee for Health, Social Services & Public Safety
Review of supported living for older people in the
context of Transforming Your Care
Committee powers and membership
Powers
The Committee for Health, Social Services and Public Safety is a Statutory
Departmental Committee established in accordance with paragraphs 8 and 9
of the Belfast Agreement, section 29 of the Northern Ireland Act 1998 and
under Standing Order 46. The Committee has power to:
Consider and advise on Departmental budgets and annual plans in the
context of the overall budget allocation;
Consider relevant secondary legislation and take the Committee stage
of primary legislation;
Call for persons and papers;
Initiate inquiries and make reports; and
Consider and advise on any matters brought to the Committee by the
Minister for Health, Social Services and Public Safety.
Membership
The Committee has 11 members including a Chairperson and Deputy
Chairperson and a quorum of 5. The current membership of the Committee is
as follows:
Ms Maeve McLaughlin (Chairperson)
Mr Jim Wells MLA (Deputy Chairperson)
Mr Roy Beggs MLA
Mr Mickey Brady MLA
Ms Pam Cameron MLA
Mrs Joanne Dobson MLA
Mr Gordon Dunne MLA
Mr Kieran McCarthy MLA
Ms David McIlveen MLA
Mr Fearghal McKinney MLA
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Table of Contents
Background to the Review Page 3
Terms of Reference Page 4
Committee Consideration Page 4
List of Recommendations Page 6
Discussion of Key Issues Page 9
Appendix 1: Page 42
Minutes of Evidence
Appendix 2: Page 153
Presentations from witnesses and additional information provided by
witnesses
Appendix 3: Page 246
Departmental briefing papers and correspondence
Appendix 4: Page 303
Research papers
Appendix 5: Page 342
Letters to HSC Trusts and responses regarding promotion on websites
Appendix 6: Page 362
Information on the Pavillions development in Lisburn and Cedar Court in
Downpatrick
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Background to the Review
1. In October 2013, the Committee for Health, Social Services and Public Safety
agreed that scrutiny of the implementation of Transforming Your Care (TYC)
would be one of its strategic priorities for the 2013/2014 Assembly session. It
began this work by focusing on one particular programme of care – learning
disability – and produced a report in January 2014. The Committee then
selected older people as the next programme of care within Transforming Your
Care on which to focus its attention.
2. The TYC Strategic Implementation Plan states that for older people,
one of the significant changes and benefits of TYC which will be
realised over the next 3 to 5 years is:
“Community-based alternatives to residential care are increasing all the
time, and there is a need to ensure that the availability and functioning
of these is more widely known so that people can see the different
styles of independent living that it is now possible to offer to older
people, where the traditional response would have been to offer a
residential placements. Due to improved availability of these types of
community-based alternatives, it is expected that the demand for
statutory residential homes will decline further” (Section 4.3.2 of the
TYC Strategic Implementation Plan).
3. The Committee observed that the “shift left” outlined in TYC, whereby more
services will be provided in people’s own homes or in community settings
rather than in institutional settings, is also envisioned in terms of living options
for older people. However, the Committee also noted that within the TYC
Strategic Implementation Plan itself, there was an acknowledgement that
alternative models to residential care, where the emphasis is on more
independent living, are not widely known about by the public. Given this
context, the Committee believed it would be useful to carry out a review into
supported living options for older people. Furthermore, the Committee noted
that the TYC Strategic Implementation Plan links greater availability of
“community based alternatives”, such as supported living, to a reduced
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demand for statutory residential home places. Given that the future of
statutory residential homes is a live issue and subject to ongoing public
consultation, the Committee believed that supported living was a timely and
relevant important subject to explore.
Terms of Reference
4. The Committee agreed the following terms of reference:
Consider the structure and availability of supported living options for
older people in Northern Ireland;
Assess the capacity of supported living options to meet the policy
objective of Transforming Your Care in terms of reducing the need for
residential home places; and
Identify examples of best practice in relation to supported living options
in other countries/regions which could be applied in Northern Ireland.
Committee Consideration
5. The Committee held seven evidence sessions from February 2014 to
June 2014. The Committee heard from:
The Department of Health, Social Services and Public Safety
(DHSSPS)
The Department of Social Development (DSD)
The Northern Ireland Housing Executive
The Health and Social Care (HSC) Board
Five Health and Social Care (HSC) Trusts
The Commissioner for Older People in Northern Ireland
Age NI
The Northern Ireland Federation of Housing Associations
(NIFHA)
Professor Anthea Tinker, King’s College London.
6. The minutes of evidence of these sessions are at Appendix 1, and the
presentations and notes provided by witnesses are at Appendix 2.
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7. The Committee also wrote to DHSSPS and DSD throughout the course
of the review to seek additional information when required. The written
correspondence from both Departments is at Appendix 3.
8. The Committee considered two papers from Assembly Research and
Information Service entitled “Caring for an ageing population: TYC
proposals” and “Specialised grouped housing for older people:
introductory briefing”. These can be found at Appendix 4.
9. The Committee visited Cedar Court in Downpatrick on 7 May 2014,
which is a supported living facility in the South Eastern Trust area. On
4 June 2014, the Committee visited the Pavillions in Lisburn where it
viewed a proposed model of housing combined with care for older
people. Details of both these facilities can be found at Appendix 6.
10. All references in the report to “the Department” refer to the Department
of Health, Social Services and Public Safety, unless otherwise
specified.
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List of Recommendations
11. In relation to establishing a new definition for supported living, the
Committee recommends that the Department consults with older
people’s representatives, including but not limited to, the Older People’s
Commissioner for Northern Ireland. The Department should also consult
with NIFHA and other relevant stakeholders. The Committee
recommends that the Department should not re-label supported living
facilities as “frail elderly” schemes, given that the purpose of facilities is
to promote older people’s independence and support them with what
they can do, rather than focusing on that which they cannot.
12. The Committee recommends that the HSC Board requires each of
the five HSC Trusts to produce an action plan setting out their
proposals for raising awareness of the concept of supported
living for older people as a model of care, as well as proposals for
better promoting the facilities within their area.
13. The Committee recommends that the Department does not
proceed with its proposal to create a supported living champion,
given the costs involved. The Committee believes promotion
should be carried out by government departments and/or their
relevant arms-length bodies, as part of their existing
responsibilities in relation to supported living for older people.
14. The Committee recommends that the potential of the Trusts to take on an
element of risk sharing with the housing associations should be further
explored. Risk sharing may in fact act as an added incentive for the
Trusts to better promote their supported living facilities. The Committee
also recommends that there is more joint planning between the Trusts
and housing associations before decisions are made to commission new
facilities.
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15. The Committee recommends that the Departments should not
commission researchers or consultants to evaluate and review
Gnangara and Hemsworth Court, but rather this piece of work should be
carried out by officials from the Departments and/or their arms-length
bodies as part of their existing roles.
16. The Committee recommend that the HSC Board reviews the criteria
which the Trusts are using in terms of suggesting supported living as an
option for an older person in the context of their needs assessment.
17. The Committee recommends that the Department should begin
forecasting the need and demand for supported living places over a 10
year period. These indicative forecasts should be kept under review, and
reassessed when decisions are being taken to build new facilities.
18. The Committee recommends that the Department should begin
collecting data on the number of older people supported in their own
home through domiciliary care who would be suitable for supported
living, in order to provide a fuller understanding of need and demand.
19. The Committee recommends that the Department reviews the current
indicator of performance for older people living in supported living
facilities for the Indicators of Performance Direction for 2015. The
Committee recommends that a revised indicator should be produced
with an associated target, which provides as assessment of the Trusts’
performances in terms of their approach to supported living.
20. The Committee recommends that the Department clarifies its strategic
position on the links between the availability of supported living places
for older people and the availability of places within statutory residential
homes.
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21. The Committee recommends that in terms of implementing Transforming
Your Care, DHSSPS and DSD work closely in terms of developing
housing options for older people which will have the best health
outcomes for older people, based on the evidence available.
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Discussion of Key Issues
Definition of supported living
What is supported living?
22. The Committee has ascertained that there is a significant level of confusion
around what is meant by the term “supported living” and other terminology
used in relation to housing options for older people.
23. This issue first came to the Committee’s attention through an Assembly
research paper which pointed out that the terminology has changed with the
various iterations of Transforming Your Care (Appendix 4). In the initial
publication of 2011, Transforming Your Care stated that it wanted to help older
people to live independently “at home or in supported accommodation.”
However, in the Transforming Your Care Strategic Implementation Plan
(October 2013) the wording had changed somewhat, to older living
independently “at home or in assisted housing”. The Commissioner for Older
People in Northern Ireland had also picked up on this issue and advised the
Committee:
“Small differences between the editions of Transforming Your Care
cause some confusion over the nature of the objectives for supported
living. The initial publication set out an aim for people to be supported
to live independently at home or in supported accommodation, and the
implementation document talked about people living at home or in
assisted housing, so the confusion about exactly what the definitions
are goes back as far as that” (Appendix 1).
24. The Department initially advised the Committee at an evidence session on 26
February 2014 that there were 414 supported living facilities for older people,
comprising around 9,000 tenancies. Departmental officials advised:
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“The paper we provided sets out the number of supported living facilities and
tenancies for older people: 414 facilities covering some 9,081 tenancies.
Those represent just over 14% of the overall Supporting People budget and
just under 60% of supported living units. Obviously, other groups that utilise
supported living include those with learning disabilities, people with mental
health needs and those with physical disabilities” (Appendix 1).
25. However, when the five HSC Trusts attended Committee on 12 March 2014,
they stated that there were currently 18 supported living facilities across the
five Trust areas. The Belfast Trust advised the Committee:
“The trusts are here today to speak specifically about supported
housing, which is a partnership model between health and social care
trusts, particularly the social care dimensions to trusts, and housing
associations, whereby they pool their expertise in housing and care to
provide a model of support that allows people to have their individual
home and front door while receiving, as an option, 24-hour support,
instead of, for example, domiciliary care, residential care or even
nursing care” (Appendix 1).
26. The Committee queried the Trusts on their figure of 18 supported living
facilities, as opposed to the figure of 414 referred to by the Department. The
Belfast Trust offered this explanation:
“I think that the distinction is between supported housing and sheltered
dwellings. We do not see sheltered dwellings as supported housing.
Sheltered dwellings are a housing option for people with low or no
needs who choose to go into that” (Appendix 1).
27. The Committee also took evidence from the Northern Ireland Federation of
Housing Associations (NIFHA) regarding the definition of supported living. Like
the Trusts, they made a distinction between supported living and sheltered
housing, and were very clear that these are two different models. NIFHA
stated:
“Sheltered housing is the lowest level. Most people in sheltered
housing will not have a care aspect to their accommodation. They may
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