Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Draft 2
Adult Mental Health
Hertfordshire Accommodation
Strategy
2008 - 2012
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Contents
Section
Title
Page
1.
Definitions
Vision
3
5
2.
Introduction
5
3.
Key Aims and Objectives of the Strategy
7
4.
A Total Systems Approach
6
5.
The National and Local Context
9
6.
Recent Trends in Mental Health
10
7.
Housing Related Support in Hertfordshire
11
8.
9.
Historical Perspective to Specialist Mental Health 13
Accommodation
Supply and Demand
15
10.
Eligibility for Specialist Mental Health Accommodation 17
11.
13.
Matching Supply and Demand for Specialist 19
Accommodation
Finance and Unit Costs of Specialist Mental Health 20
Accommodation
Communication Strategy
23
14
Strategic Objectives and Action Plan
25
15
Review
25
12.
Appendices
Title
A
B
C
D
Data on Supply and Demand
Action Plan
Mapping of Services
Hospital Beds in the Community
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26
27
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Definitions
1. Specialist Adult Mental Health Accommodation
Eligibility for specialist mental health accommodation is dealt with in
section 10
1a. Supported Accommodation. Supported accommodation is defined
as accommodation at a specific address, where support and care are
offered to meet the day to day needs of the resident. The period of
residence is variable and can be long-term.
The property at which the care and support is offered is available only to a
person that is eligible for care and support. The property will be managed
by a housing association and care support provided by Hertfordshire
Partnership NHS Trust (HPFT) or the housing association.
The average level of support will vary according to the setting:



Group Homes – 2 or 3 people share a house and receive up to 5
hours support per week from visiting care workers.
Independent low support flats - up to 5 hours support per week
from visiting care workers.
Independent high support flats – staff on site, available as
required and offering high levels of daily support
1b. Rehabilitation is defined as a hostel with a specific number of beds
and 24/7 staffing on site and delivering a structured rehabilitation
programme for a period of up to 2 years. Property will be managed by a
housing association and care provided by rehabilitation workers from
HPFT or the housing association.
1c. Long stay/residential is defined as accommodation in a specific
home with 24/7 staff on site and offering full daily care including the
provision of some, or all, meals. The period of residence is usually longterm. Many of the homes are registered care homes however some have
been de-registered and within these homes residents will have greater
responsibilities to do their own catering.
2. General Needs Accommodation.
2a. General Needs Housing is defined as rented accommodation that is
of a suitable size for the number of people who will be resident in the
house, flat or maisonette. Residents apply for general needs housing to
the local housing provider and are prioritised for nomination for a dwelling
according to local authority eligibility criteria
2b. Homeless accommodation is defined as temporary accommodation
that is made available in a local area. Homeless accommodation can be
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in bed and breakfast or in homeless hostels or in any other dwelling
defined as available for homeless people by the local authority.
2c. Privately owned accommodation is defined as owner occupied or
shared ownership
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Adult Mental Health
Hertfordshire Accommodation Strategy
1. Vision
1.1.
To recognise residents of Hertfordshire with mental ill-health are
first and foremost ordinary citizens who do not wish to be
marginalised or excluded in any aspect of everyday life
1.2.
To recognise the provision of affordable, decent quality, adequately
supported accommodation is a key factor in helping people with
mental ill health achieve the highest degree of independence and
social inclusion.
2. Introduction
2.1.
The objective of this strategy is to ensure people with mental illhealth are able to appropriately access general needs housing but
also have access to a range of specialist mental health
accommodation when this is required.
2.2.
The strategy concentrates on accommodation that required for
people with mental ill-health in permanent or medium to short-term
accommodation. The strategy does not encompass mental health
acute or crisis care.
2.3.
For any strategy to be successful there must be agreement and
commitment by all stakeholders. The strategy should be based on
evidence which should identify the major changes required
2.4.
The Adult Mental Health Accommodation Strategy is based on
evidence gathered and is written following discussions with
representatives of:








2.5.
Viewpoint
Carers in Hertfordshire
10 District/Borough Councils
Registered Social Landlords (RSL) Sub Regional Group
Other local RSLs
Hertfordshire Partnership NHS Foundation Trust
Supporting People
Adult Offenders Project Group
Evidence presented in a 1999 Sainsbury report identifies that the
largest percentage of people with mental ill-health prefer to live
independently within the community. There are, however, many
who live on their own, or are homeless, that are vulnerable and, due
to mental ill-health, require a period of time in a supported or
rehabilitation environment.
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2.6.
Living in a supported environment at a time of vulnerability due to
mental ill-health enables most people to achieve levels of
confidence and independence and as a result be able to make the
transition to independent living.
2.7.
For a minority of people with serious mental illness the transition to
independent living may not be possible due to the nature of the
illness. In such situations access to specialised accommodation in a
long stay/residential setting is essential
2.8.
This strategy identifies how access to a range of accommodation
can be achieved by 2012 to ensure residents of Hertfordshire with
mental ill-health can access appropriate accommodation to meet
their needs.
2.9.
The strategy is agreed following the consultation and agreement of:




Strategic Commissioning Group (SCG)
Joint Commissioning Partnership Board (JCPB)
Supporting People Commissioning Group
Stakeholders as identified in S2.4 above
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3. Key Aims and Objectives of the Strategy
3.1.
To work closely with all stakeholders, including service users, local
councils, Supporting People, Hertfordshire Partnership NHS Trust,
Adult Offenders Accommodation Project and Registered Social
Landlords (RSLs) ensuring they are adequately represented on the
Joint Commissioning Team Mental Health Accommodation Steering
Group. The Steering Group will agree and deliver on an Action Plan
arising out of this strategy. Section 16
3.2.
To ensure the Mental Health Accommodation Strategy dovetails
with national priorities and other relevant local strategies such as
Supporting People and Adult Offenders Strategies Section 5 and 7
3.3.
To set priorities for action to ensure that by 2012 people with mental
ill health will have as greater a choice as possible over where and
how they live. Section 16
3.4.
To plan for the future in partnership with housing providers ensuring
the range of accommodation provision is based on what people
need now and will also cater for future needs. Sections 5, 6 and 8
3.5.
To ensure that the supply and demand for all types of specialist
accommodation and rehabilitation is monitored and that the data is
analysed, at regular intervals of no less than bi-annually. Sections 9
and 11
3.6.
To re-configure existing specialist accommodation according to
demand and taking into account current trends in demand. Sections
8 and 12
3.7.
To ensure that the accommodation needs of Mentally Disordered
Offenders and those leaving prison with mental ill-health are taken
into account within this strategy. Section 6
3.8.
To ensure a comprehensive communication strategy is in place and
that this strategy dovetails, and does not overlap, with other similar
working groups within Adult Care Services or housing providers.
Section 13
3.9.
To ensure the Action Plan agreed to deliver the strategy is reviewed
at bi-annual intervals taking into account data collected in regard of
supply and demand. Section 16
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4. A Total System Approach
4.1.
Planning for any change requires a whole system approach and this
is essential when considering accommodation issues.
All
stakeholders should have an interest in ensuring the strategy will be
able to deliver on set targets.
4.2.
Stakeholders however will also wish to ensure the strategy
complements their own organisations targets. Service users and
carers will have personal targets they wish to see delivered.
4.3.
This strategy therefore represents a model that is agreed by
stakeholders and is focussed upon social inclusion, the appropriate
evidenced based re-configuration of existing resources and the
development of new resources in order to achieve the vision
identified in section 1.
4.4.
Below is a model for a social inclusion approach. The key goal for
stakeholders is to enable service users to move to the greatest
independence provided by level 1 and 2.
Level 1
Level 2
Level 3
People living in their own home. Able to access
information, advice and support
People living in their own home who require minimum
intervention provided by floating support.
People who need specialist accommodation with
medium level support, short to medium-term
Level 4
People who need specialist high support
accommodation or rehabilitation. Medium-term
Level 5
People who need high support provided by residential
or long stay care. Medium to Long-term
4.5.
Essential partners in the delivery of the social inclusion model are:
 Service users and carers
 District and Borough Councils
 Hertfordshire County Council
 Registered Social Landlords
 Supporting People
 HPFT
Recommendation.
A Total System Approach model is formally accepted by stakeholders
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5. The National and Local Context
5.1.
The Adult Mental Health Accommodation Strategy dovetails with
national and local policies some of which are detailed below.
5.2.
National Policies, including the Promoting Mental Health Strategy
and the National Social Exclusion Programme, clearly identify the
importance of housing and appropriate support for people with
mental ill health.
5.3.
The Hertfordshire Supporting People Strategy recognises the
central role Supporting People plays in addressing homelessness
and enabling people to live as independently as possible. Thus
contributing to improving the health and well-being of local people,
reducing social exclusion and enabling people to contribute and
participate fully in their local communities.
5.4.
The Hertfordshire Adult Offenders Accommodation Project in
partnership with the Supporting People Programme have been
charged with leading the development of a detailed strategy for
meeting the housing related needs of adult offenders in
Hertfordshire.
5.5.
District and Borough Councils within Hertfordshire recognise the
needs of vulnerable and/or homeless people including those with
mental ill health. The councils are currently working together to
inform and shape the London Commuter Belt Sub-Region (LCBSR)
Housing Strategy which will be delivered in the autumn of 2008.
The LCBSR housing strategy will establish the key areas where
joint working across administrative boundaries can deliver
economic, effective solutions to commonly identified issues. A subregional approach has been adopted in tackling homelessness,
bringing empty homes back into use, developing more affordable
homes, identifying and promoting good practice and achieving
savings, by way of joint procurement, where the opportunities arise.
5.6.
Recommendation
Ensure the needs of people with mental ill-health are
adequately identified within the Sub-Regional Housing
Strategy
Ensure that within each District a specific allocation of a
number of units for people with mental ill-health are identified
when new developments of affordable housing occur
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6. Recent Trends in Mental Health
6.1.
Over a 15 year period improvements in the medical treatment for
mental ill-health have taken place. New anti-psychotic medication
has assisted stabilise many people with the most serious mental
illness.
6.2.
The importance of social care has been recognised and within
Hertfordshire the recovery approach of working adopted.
6.3.
The development of Assertive Outreach Teams and Crisis,
Assessment and Treatment Teams throughout county has led to
intensive home support and treatment. This development has
reduced the demand for in-patient beds and numbers of beds have
been reduced accordingly.
6.4.
There has been a shift away from institutional and paternalistic care
to a model encouraging recovery, social inclusion and
independence. The expectations of people with mental ill-health, in
relation to all aspects of their life including housing, is to be able to
have similar opportunities and choice as other members of the
community.
6.5.
Despite improved treatment some people with mental ill-health
continue to require intensive support or rehabilitation for times
varying from 12 months to long-term. This group will include those
with the most serious illness and some mentally disordered
offenders and ex-offenders.
6.6.
The trend, in relation to specialist accommodation, is for high need
intensive supported resources. This is evidenced in data collected.
See Appendix A. Within Hertfordshire a number of sites, currently
owned by the County Council, will be re-developed over the next
few years offering opportunities for specialist new mental health
development.
6.7.
Recommendation
Liaise with HCC Property Unit in order to prepare a business
case for the development of high needs and risk
accommodation.
This development should specifically
consider the needs of mentally ill offenders. Consider the Core
and Cluster model which will allow for move-on from the core
high dependence unit into the cluster low support flats.
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7. Housing Related Support in Hertfordshire
7.1.
Specialist single person accommodation. There is a pool of
accommodation specifically identified as available to people with
mental ill-health who are single, not living within a supportive family
setting and who therefore require a longer and more intense level of
support within specialised accommodation.
7.2.
The specialist accommodation pool has been developed over the
years by Hertfordshire County Council. Local District and Borough
Councils, Voluntary Agencies and Housing Associations.
7.3.
In general the properties are managed by a local Housing
Association who hold responsibility for ensuring they are allocated
in accordance with agreed eligibility and nomination procedures.
See Section 10.
7.4.
Over the last 2 years all specialist accommodation in Hertfordshire
to which the provider trust, Hertfordshire Partnership NHS
Foundation Trust (HPFT) has nomination rights has been mapped
and information has also been identified regarding placements in
the private sector. Information is as follows and Appendix C
identifies the areas in which the accommodation is situated.
Summary of Specialist Mental Health Accommodation







Group Homes
Independent low support flats
Independent high support flats
Rehabilitation/step-down
Low secure rehabilitation
Long stay (HPFT)
Residential/long stay private sector
Within Hertfordshire
Outside Hertfordshire
91 (37 houses)
98
61
49
7
30
107
88
7.5.
Hertfordshire Partnership NHS Foundation Trust hold responsibility
for ensuring a person needs are assessed, they are eligible for
health and social care services and that the need for supported or
residential/long stay accommodation or rehabilitation is identified in
the care plan.
7.6.
In the case of residential/long stay care 30 beds are designated as
Continuing Care and are managed and care provided by HPFT.
Other placements are purchased on the open market in a long
stay/residential home or registered hospital in the private sector.
Some long stay care is delivered in settings that are not registered
care homes or hospitals.
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7.7.
General needs accommodation. In addition to the specific
accommodation detailed in Section 7.4 above many more people
with mental ill-health will live in general needs accommodation in
either the public or private sector. These numbers cannot be
specified however the Promoting Mental Health Strategy 2003 –
2008 suggests that as many as 1 in 6 people, at any point in time,
suffer from a diagnosed psychiatric condition.
7.8.
People with mental ill-health living in general needs
accommodation, either independently or with their family, may also
require special support. Following an assessment of need carried
out by HPFT support will be offered through HPFT Support
Services or via a local Floating Support Schemes funded by
Supporting People.
7.9.
Recommendation
Continue to work in partnership with the Supporting People
Team to ensure appropriate support is available to people
living in general need and homeless accommodation in both
the public and private sector
In partnership with Supporting People and HPFT monitor
supply of general needs housing available to people with
mental ill-health particularly those requiring move-on from
specialist accommodation. Data should be reported to the
Steering Group quarterly
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8. Historical Perspective to Specialist Mental Health Accommodation
8.1.
In January 2001 agreement was reached with the Primary Care
Trust and Hertfordshire County Council (Adult Care Services) that
all secondary mental health services, including social care, would
be delivered by a countywide service, Hertfordshire Partnership
NHS Trust. The trust gained Foundation Trust status in 2007 and is
now known as Hertfordshire Partnership NH Foundation Trust
(HPFT).
8.2.
Prior to January 2001 mental health services were delivered by four
different trusts and this led to services developing in a somewhat
piecemeal fashion dependent on local need and available funding.
8.3.
Service development was particularly affected by the resettlement
programme of the 1990s when many long-stay patients in a number
of older, large hospitals in Hertfordshire were resettled in the
community. This programme had significant funding and resulted in
the development of specialist accommodation in the areas local to
the hospital closures.
8.4.
The areas of Hertfordshire benefiting from the resettlement
programme are St Albans, Dacorum and Watford in the west of the
county and North Herts in the north of the county.
8.5.
As a result of the resettlement programme supported
accommodation in Hertfordshire is skewed with the west of the
county holding 65% of all supported accommodation to which
people with mental ill-health can be nominated. See Appendix C.
8.6.
During the late 1990’s four developments of high support
independent flats (care staff based on site 24/7 or 8.0am – 8.0pm
with on-call overnight) took place. These flats offer a secure and
supportive environment for people with serious mental illness. At
the time successful applicants were offered secure tenancies and
there has been little move-on to less supported environments thus
blocking the resource to new applicants.
8.7.
A number of residents in the high support accommodation may no
longer require the level of support provided however as they hold a
secure tenancy and may choose not to move. It is possible
therefore that the current level of support offered could be reduced
in order to re-distribute resources.
8.8.
A further difficulty identified in the four developments of high
support independent accommodation is that when an occasional
vacancy occurs placing a new resident who has high needs and risk
may not be considered appropriate by other residents.
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8.9.
The lack of development of appropriate high support independent
accommodation in Hertfordshire has led, over a 20 year period, to
people requiring long stay accommodation being placed, both within
and outside Hertfordshire, in the private sector in residential/long
stay accommodation. Move-on to a less supported environment is
rare due to lack of resources for “step-down”.
8.10. During 2006/7 HPFT mapped all specialist accommodation to which
they hold nomination rights. The map identifies the spread of
accommodation throughout Hertfordshire and shows the inequitable
distribution of supported accommodation in county. See Appendix
C.
8.11. Recommendations
The East of Hertfordshire has the least amount of any type of
supported accommodation and should be considered first
when new developments are considered.
The programme of review of service users in residential/long
stay accommodation should specifically consider the need for
the development of step-down accommodation to facilitate
improved recovery and greater independence
A programme to review the level of support available in all high
support accommodation should occur in order to consider the
appropriate transfer of some resources. And/Or a targeted
programme to encourage move-on from high support
accommodation of those tenants no longer requiring the level
of support offered.
Vacancies occurring in high support accommodation should
only be offered to applicants with high needs and risk. A staff
training programme should be considered to ensure staff feel
they can appropriately manage the risk within the setting.
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9. Supply and Demand
9.1.
In order to maintain a healthy balance of supply and demand the
mental health accommodation system requires throughput. People
in the specialist accommodation (S7.1 – 7.6) need to move-on to
general needs accommodation, hence creating vacancies for those
moving from general needs (or having lost their homes) and
needing specialist help
9.2.
A UK audit (Lelliott, 1996) revealed an average point prevalence of
6.1 new long-stay people per 100,000 of the population. This
number may have decreased in the period since the audit due to
improved methods of treatment. Nevertheless within the population
of Hertfordshire each year there is a demand for residential/longstay accommodation that cannot be met within existing resources.
9.3.
Data on supply and demand for all specialist accommodation is
monitored by HPFT and these figures are supplied monthly to the
Joint Commissioning Team.
9.4.
Figures identify long stay/residential as a major requirement and
insufficient supply has led to the need to fund expensive
placements in the private sector.
9.5.
Figures identifying the demand for accommodation and the supply
of accommodation from January 2008 identify an over supply of
group home places.
9.6.
Data for the period January – April 2008 is shown in appendix A
9.7.
Move-on from specialist accommodation to general needs when
this move is appropriate is generally good with local councils giving
priority to nominate for general needs housing.
9.8.
There are however a number of factors, in particular local
availability of single accommodation and reluctance to re-house
someone with mental ill-health, that influence the time it takes to
arrange move-on. The introduction of Choice Based Letting may
also have a detrimental affect on the ability to move-on to general
needs.
9.9.
Recommendation
Set up a system to monitor local difficulties when move-on to
general needs is required.
Consideration may be required to conduct a further needs
analysis during the life of this strategy
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Work in partnership with housing providers to ensure an
adequate amount of affordable housing is available for people
with mental ill-health
Monitor the affect of Choice Based Letting and feedback to
local District Councils when difficulties occur.
Continue to monitor monthly the supply and demand for
specialist accommodation within Hertfordshire.
Plan a programme of closure of up to 60% of group homes
over a 3 year period.
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10. Eligibility for Specialist Mental Health Accommodation
10.1. People eligible for specialist mental health accommodation are
adults, over the age of 18 years, suffering from a functional mental
illness and being managed within the Care Programme Approach.
10.2. During the next 2 years Enhanced Primary Mental Health Teams
will be developed within Hertfordshire and it is envisaged referrals
for specialist low support accommodation may be generated from
this source if the person is eligible for social care services.
10.3. HPFT work within parameters of eligibility dependent upon the type
of specialist accommodation resource required. Details are as
follows.
10.4. Continuing Care 100% Health Funded Care
o Residents registered with a Hertfordshire GP.
o Adults over 18 years of age
o The criteria for qualification for fully funded NHS care is
explained in the National Framework for Continuing Care
introduced on 1 October 2007
10.5. Eligibility for Registered Care Home (or long stay in the private
sector)
o Adults over the age of 18 years and a resident of
Hertfordshire
o Eligibility for social care services is determined by
Department of Health guidance “Fair Access to Care
Services (FACS)” and is a national requirement.
o Currently social care services in Hertfordshire are provided
to people whose needs are identified as being within the
critical or substantial risk bands.
o Applications for a registered care home or a long stay home
should show evidence that all other options for care have
been explored and tried
o The service user should be managed on Enhanced Level
CPA or SAP (Single Assessment Process)
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10.6. Eligibility for Specialist Rehabilitation Placement

Within Hertfordshire rehabilitation is available in both health
and social care settings. Dependent upon setting of the
rehabilitation applicants for a health setting would be
required to meet the conditions set out in Section 10.2 and
for a social care setting Section 10.3 above
10.7. Eligibility for High Support Independent Accommodation
o The service user must be a resident of Hertfordshire over the
age of 18 years
o When the service user is eligible for social care services
(FACS) in the critical or substantial band
o When the service user is managed on Enhanced Level or
SAP
10.8. Eligibility for Group Homes and low support Independent Flats
o The service user must be a resident of Hertfordshire over the
age of 18 years
o When the service user is eligible for social care services
(FACS) in the critical or substantial band (See appendix G)
o When the service user is managed on the Care Programme
Approach
o Applications for all types of supported accommodation can
be made for people over the age of 18 years with functional
mental ill health
Recommendations
There
are
no recommendations
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11. Matching Supply and Demand for Specialist Accommodation
11.1. Over a two year period the provider trust, Hertfordshire Partnership
NHS Foundation Trust (HPFT) has developed a central Bed
Management and Placement Service (BMPS). This service is
responsible for receiving and ensuring eligibility of all referrals for
specialist accommodation, rehabilitation (including low secure
rehabilitation) and long stay/residential accommodation.
11.2. BMPS hold responsibility for nominating to the appropriate housing
provider a person who is eligible for the specialist vacancy. BPMS
is also responsible for agreeing funding if placement in the private
sector is the only option.
11.3. BPMS holds a vacancy register which is up-dated as and when
vacancies occur.
11.4. The advantage of the central system for matching supply and
demand is that it has allowed the provider trust, the Joint
Commissioning Team and all other stakeholders to identify
shortfalls in the current system that require to be addressed
strategically to ensure an improved correlation between supply and
demand.
11.5. Recommendations
BMPS should continue to supply monthly data on the demand
and supply of specialist mental health accommodation
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12. Finance and Unit Costs
12.1. Specialist accommodation requires the capital funding of property
and the revenue funding of the care support.
12.2. In order to develop new accommodation services to meet need
current expenditure and best value needs to be considered.
12.3. This section identifies costs associated with accommodation to
which HPFT hold nomination rights. When any placement is made
in the private sector the costs are set by the provider and driven by
market forces.
Property
12.4. The buildings and land used to supply the specialist
accommodation are owned or leased either by housing associations
or HPFT.
12.5. The properties owned by HPFT are used only for long stay care or
rehabilitation and to be eligible for a vacancy the Continuing Care
criteria must be met. These properties are all registered as hospital
beds in the community and were developed as part of the
resettlement programme during the 1990’s. Appendix D identifies
the locality of these beds.
12.6. The hospital beds in the community have a high occupancy rate
however in view of changing treatment methods and the
introduction of a recovery approach opportunities for the reconfiguration of these services exists.
12.7. The properties managed by housing associations are used for
medium to long-term social care and rehabilitation. In the main
these properties are leased, many from the Hertfordshire County
Council. A number of other houses owned by housing associations
were purchased in the 1990’s with resettlement monies. When this
is the case the housing association can only sell the homes on the
open market with agreement of the Primary Care Trust (PCT). The
PCT will then agree plans on how the money should be re-invested
within mental health services.
12.8. The current under-occupation of group homes has already led to
the PCT agreeing the sale of 7 houses in Hemel Hempstead. This
money is scheduled for re-investment and should be taken into
account in overall strategic planning
12.9. Vacancy monitoring indicates a further reduction in the number of
group homes is required thus creating further opportunities for the
re-configuration of specialist resources.
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Costs for the Provision of Care
12.10. In order to achieve best value it is essential to be able to consider
like for like unit costs. This work is currently underway within the
Joint Commissioning Team. The identification of unit costs is
complicated.
12.11. Funding is received from Supporting People for most group homes,
independent low and high support flats and the social care
rehabilitation units. The Supporting People monies are paid to the
provider of the care which could be a housing association or HPFT.
12.12. HPFT receive funding via the Joint Partnership Board block grant
for social care provision and this is delivered by support workers
some of whom will work mainly with service users occupying
specialist accommodation.
12.13. HPFT are funded for the hospital beds in the community as part of
the Foundation Trust Contract.
12.14. A small number of specialist high needs and rehabilitation units also
receive funding directly from the Joint Commissioning Team.
12.15. During 2008 the introduction of Individual Budgets will occur. An
individual budget allows the service user to choose who will supply
the care they require to meet their assessed need. The introduction
of individual Budgets may have significant impact on the providers
of care particularly to those delivering a service to low support
independent flats and group homes. The introduction of Individual
Budgets will be monitored following introduction of the scheme.
12.16. All new projects developed will be in line with Individual Budgets
and existing specialist accommodation will be transferred
incrementally to Individual Budgets
12.17. Recommendations
Review the use of hospital beds in the community with a view
to re-configuration to meet current needs for high support/high
risk provision
Agree formally with the PCT, HPFT and Aldwyck Housing
Association that the capital generated through the sale of the
Hemel Hempstead Group Homes is considered strategically
and agreed by the Accommodation Steering Group.
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Plan a programme of closure of up to 60% of group homes
over a 3 year period.
Ensure the on-going work to identify unit costs is completed
by September 2008 in order for the Accommodation Steering
Group to consider best value in relation to new projects
Best value should be considered in relation to current care
support supplied by HPFT or housing associations taking into
account unit costs on a “like for like” basis. Clear actions to
address best value issues must be agreed as a matter of
urgency.
Monitor the affect individual budgets has on the provision of
care by current providers.
Within any business case prepared for the development of new
mental health projects consider savings that may be made as a
result of any re-configuration or the introduction of Individual
Budgets
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
13. Communication Strategy
13.1. In order to deliver on the Strategic Objectives set out in Section 14
a comprehensive communication strategy is required with all
stakeholders including service users and carers.
13.2. During discussions with stakeholders it has been agreed that an
Accommodation Steering Group would be set up to steer the
actions required to deliver on the strategy objectives. Steering
Group members would hold responsibility for ensuring other
partners were briefed on the progress of the Steering Group.
13.3. Steering Group members currently agreed are:







Viewpoint (service users)
Carer’s in Hertfordshire
District and Borough Councils (1 representative to feedback
through Heads of Housing meeting)
Supporting People
HPFT (Head of Service and Finance Manager)
Joint Commissioning Team
HCC Property Unit
Other members would be co-opted in as and when necessary. In
particular financial advice may be required and the attendance the
Finance Manager JCT could be requested.
13.4. Communication with RSLs, via the Sub Regional Group or directly
with RSLs operating in Hertfordshire, must be a priority to ensure
they are involved in any discussions to changes in current provision
and new developments. The Steering Group should give early
consideration on how this communication can be achieved
effectively.
13.5. In order to reach the largest numbers of service users and carers
regular focus groups would be arranged no less than twice a year.
13.6. To consider how best information can be generated to the public by
way of leaflets or website
13.7. Recommendations
Inaugurate Accommodation Steering Group and agree Terms
of Reference
Agree communication strategy to RSLs
Agree date for first Focus Group for users and carers
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Consider within Steering Group how best information can be
delivered to the public
Ensure there is no overlap with other governance groups and
if this occurs re-consider the Terms of Reference
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
14. Strategic Objectives and Action Plan
14.1. In order to achieve the vision set out in Section 1 the strategic
objectives are:







To ensure service users and carers are fully involved in all parts
of strategy consultation and implementation
To improve geographical access to specialist accommodation
To re-configure (or reduce) the number of underused group
homes
To prepare a business case for the development of new high
needs/high risk accommodation
To investigate and evidence the case for a new development to
provide step-down rehabilitation for people able to move on from
residential care
To continue to monitor supply and demand
To ensure the communication strategy is in place
14.2. The Action Plan shown in Appendix B identifies actions required
arising out of the recommendations within this strategy.
14.3. A suggested timeframe is identified together with the organisation
most suitable to take each action forward.
14.4. Recommendation
Following consultation with all stakeholders that the Action
Plan is formally agreed by Steering Group Members on behalf
of their organisation
15. Review
15.1. This strategy will be reviewed annually and the Action Plan updated by the Accommodation Steering Group
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Appendix A
Data on Supply and Demand
Figures given below identify vacancies on the final day of the month
compared with the number of referrals received during the month.
2008
Jan
Vac
9
0
1
3
1
0
Group homes
Ind low support
Ind high support
Rehab
Step down
Long
stay/residential
Feb
Ref
1
0
0
6
0
7
Vac
8
1
2
3
0
0
Mar
Ref
0
0
1
2
0
3
Vac
8
1
1
3
0
3
April
Ref
0
0
3
2
0
5
Vac
15
0
2
4
0
2
Ref
1
0
1
10
0
2
Quarterly Referrals were received from the following Districts:
January – March
Dacorum
January - March
St
Albans
Wat
Htsmere
3
Rivers
E
Herts
Stvenage
N
Herts
Wel/Hat
Broxb
Total
0
0
2
3
1
0
1
0
0
0
0
0
4
8
11
0
0
0
3
Low Secure
Rehab
Residential
Independent
low support
Independent
high support
Group
Home
0
1
3
0
3
4
0
0
1
0
0
0
0
0
0
0
3
1
0
0
2
0
0
1
0
3
0
0
0
0
0
0
0
0
3
0
1
0
0
0
0
0
0
0
0
1
Total
4
11
3
0
0
5
2
4
1
0
30
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Appendix B
Action Plan
Appendix
Adult Mental Health Accommodation Strategy
Action Plan
Action
By Whom
By When
1.
Inaugurate Accommodation Steering Group and agree Terms of Reference
JCT to lead
2.
Following consultation with all stakeholders the Action Plan should be formally agreed by Steering Group
Members on behalf of their organisation
Steering Group
3.
Ensure the needs of people with mental ill-health are adequately identified within the Sub-Regional
Housing Strategy
Steering Group
September
2008
4.
Ensure that within each District a specific allocation of a number of units for people with mental ill-health
are identified when new developments of affordable housing occur
Steering Group
On-going
5.
Liaise with HCC Property Unit in order to prepare a business case for the development of high needs and
risk accommodation. This development should specifically consider the needs of mentally ill offenders.
Consider the Core and Cluster model which will allow for move-on from the core high dependence unit
into the cluster low support flats.
JCT to lead
December
2008
6.
Continue to work in partnership with the Supporting People Team to ensure appropriate support is
available to people living in general need and homeless accommodation in both the public and private
sector
JCT to lead
On-going
7.
In partnership with Supporting People and HPFT monitor supply of general needs housing available to
people with mental ill-health particularly those requiring move-on from specialist accommodation. Data
should be reported to the Steering Group quarterly
HPFT to lead
On-going
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2008
October
2008
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
8.
The East of Hertfordshire has the least amount of any type of supported accommodation and should be
considered first when new developments are considered.
Steering Group
On-going
The programme of review of service users in residential/long stay accommodation should specifically
consider the need for the development of step-down accommodation to facilitate improved recovery and
greater independence
10. A programme to review the level of support available in all high support accommodation should occur in
order to consider the appropriate transfer of some resources. And/Or a targeted programme to
encourage move-on from high support accommodation of those tenants no longer requiring the level of
support offered.
11. Vacancies occurring in high support accommodation should only be offered to applicants with high needs
and risk. A staff training programme should be considered to ensure staff feel they can appropriately
manage the risk within the setting.
SP/HPFT/JCT
December
2008
SP/HPFT/JCT
Complete
by March
2009
HPFT/HA
On-going
12. A programme to review the level of support available in all high support accommodation should occur in
order to consider the appropriate transfer of some resources
HPFT/JCT/SP
December
2008
13. Set up a system to monitor local difficulties when move-on to general needs is required.
HPFT
On-going
14. Consideration may be required to conduct a further needs analysis during the life of this strategy
Steering Group
On-going
15. Continue to monitor monthly the supply and demand for specialist accommodation
HPFT
On-going
16. Work in partnership with housing providers to ensure an adequate amount of affordable housing is
available for people with mental ill-health
Steering Group
On-going
17. Monitor the affect of Choice Based Letting and feedback to local District Councils when difficulties occur.
HPFT/HAs
On-going
18. Plan a programme of closure of up to 60% of group homes over a 3 year period.
HPFT/Has/JCT
19. BMPS should continue to supply monthly data on the demand and supply of specialist mental health
accommodation
HPFT
First
closures by
March
2009
On-going
9.
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20. Review the use of hospital beds in the community with a view to re-configuration to meet current needs
for high support/high risk
HPFT/JCT
December
2008
21. Agree formally with PCT, HPFT and Aldwyck Housing Association that the capital generated through the
sale of the Hemel Hempstead Group Homes is considered strategically and agreed by the
Accommodation Steering Group.
PCT/JCT/HPFT
/Aldwyck
Oct 2008
22. Ensure the on-going work to identify unit costs is completed by September 2008 in order for the
Accommodation Steering Group to consider best value in relation to new projects
JCT/HPFT/HAs
Sept 2008
23. Best value should be considered in relation to current care support supplied by HPFT or housing
associations taking into account unit costs on a “like for like” basis. Agree timetable for action to address
any best value issues.
Steering Group
On-going
24. Monitor the affect individual budgets has on the provision of care by current providers.
JCT/HPFT
On-gping
25. Within any business case prepared for the development of new mental health projects consider savings
that may be made as a result of any re-configuration or the introduction of Individual Budgets
JCT/HPFT
On-going
26. Agree communication strategy with RSLs
Steering Group
27. Agree date for first Focus Group for users and carers
Steering Group
28. Consider within Steering Group how best information can be delivered to the public
Steering Group
October
2008
November
2008
Dec 2008
29. Ensure there is no overlap with other governance groups and if this occurs re-consider the Terms of
Reference
Steering Group
On-going
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Appendix C
Mapping of Resources
Group Homes
Care
Provider
Property
owners
Address
Town
Number
of
placements
Hightown
Hightown
312 Hatfield Rd
St Albans
3
Cherry Trees
Cherry Trees HA
19 Upper Latimore Rd
St Albans
5
Cherry Trees
Cherry Trees HA
4 Upton Ave
St Albans
5
HPFT
HCC house
55 Whitehedge Dr
St.Albans
2
HPFT
Aldwyck (legal charge)
27 Roland Street
St.Albans
2
HPFT
Aldwyck (legal charge)
24 Valerie Close
St.Albans
2
HPFT
Aldwyck (legal charge)
20 Maynard Drive
St.Albans
2
HPFT
Aldwyck (legal charge)
1 Windamere
St.Albans
3
Aldwyck (legal charge).
41 Thrilmere
St.Albans
2
HPFT
Aldwyck (legal charge)
344 Camp Road
St.Albans
2
HPFT
Aldwyck (legal charge)
9 Rye Croft Court
St.Albans
2
HPFT
Aldwyck (legal charge)
25 Spooners Drive
St.Albans
2
HPFT
Aldwyck (legal charge)
Folly Drive
St.Albans
3
HPFT
Aldwyck (legal charge)
Drakes Drive
St.Albans
2
HPFT
Aldwyck (legal charge)
90 Hill End Lane
St.Albans
2
Cherry Trees
Cherry Trees HA
79 Manor Rd
London ColneySt A
2
HPFT
HCC house
34 Granville Rd
Watford
5
HPFT
HCC house
107 Horseshoe Lane
Watford
2
HPFT
HCC house
171 Horseshoe Lane
Watford
2
HCC lease Three Rivers
4 Robin Place
Watford
3
Total
units
in town
HPFT
HPFT
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
HCC lease Three Rivers
7 Robin Place
Watford
3
HPFT
HCC house
74 Sandringham Rd
Watford
3
HPFT
HCC house
68 Woodhurst Ave
Watford
3
Cherry Trees
Cherry Trees HA
421 North Western
Watford
2
HPFT
HCC house
101 Rant Meadow
Hemel
2
HPFT
HCC house
103 Rant Meadow
Hemel
2
Hightwn
Hightown
Martian Avenue
Hemel
3
Hightwn
Hightown
Long Chaulden
Hemel
3
10
HPFT
HCC house
31 St Albans East
Hatfield
3
3
HPFT
HCC house
First House
Welwyn Garden City
3
3
Springboard
Springboard
90 Brickendon Lane
Hertford
3
Springboard
Springboard
92 Brickendon Lane
Hertford
3
Granta
Granta
65 Willian Way
Letchworth
3
Granta
Granta
Blackmore
Letchworth
2
HPFT
23
6
5
91
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Independent flats low support
Address
Town
Number
of
placements
Hightown property
Woolmerdene
(Greatham Road)
Bushey
6
Springboard
Springboard
Brampton Court
Cheshunt
4
Springboard
Springboard
Wellers Grove
Cheshunt
4
Aldwyck
Aldwyck - Hill End Resettlement
22 Aldwyck Court
Hemel
1
Aldwyck
Aldwyck - Hill End Resettlement
16 Clarendon Close
Hemel
1
Aldwyck - Hill End Resettlement
109 Livingstone Walk
Hemel
1
Aldwyck - Hill End Resettlement
511 Barnacres Road
Hemel
1
HST
Aldwyck - Hill End Resettlement
422 Galley Hill
Hemel
1
HST
Aldwyck - Hill End Resettlement
19 The Rowans
Hemel
1
HST
Aldwyck - Hill End Resettlement
97 Briery Way
Hemel
1
HST
Aldwyck - Hill End Resettlement
6 Aldwyck Court
Hemel
1
HST
Aldwyck - Hill End Resettlement
6 Rutland Gardens
Hemel
1
Hightown
Hightown
Wilkinson Way
Hemel
5
Hightown
Satinwood Court
Hemel
5
HCC house
St.Albans
2
St.Albans
8
Care
Provider
Property
owners
Hightown
Aldwyck
Hightown
Aldwyck
Aldwyck
17 and 17a Ladies
Grove
2-14 Hickling Way
Aldwyck
Aldwyck
Artisan Crescent
St.Albans
6
Cherry Trees
Cherry Trees
4 Upton Av
St Albans
4
HPFT
Cherry Trees
Cherry Trees
Graham court
Grange St
Cherry Trees
Hightown
Cherry Trees
Hightown
4 Grimsdyke Lodge
Hatfield Rd
5 Guildford Close
Hightown
Hightown
Hightown
Hightown
Total units
in town
6
8
19
St Albans
5
26
St Albans
Stevenage
1
1
29 Guildford Close
Stevenage
1
28 Guildford Close
Stevenage
1
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Hightown
Hightown
6 Guildford Close
Stevenage
1
Springboard
Springboard
Blackwood Court
Turnford
2
Springboard
Springboard
198 Eleanor Cross
Waltham Cross
3
HPFT
Aldwyck Hill End Resettlement
Chester Road
Watford
6
St Pancras
St Pancras HA
Canterbury Road
Watford
6
St Pancras
St Pancras HA
Derby Road
Watford
3
15
Warden HA - Hill End Resettlement
Cherryhills
South Oxhey
8
8
Riversmead
Peartree Project
Welwyn Garden City
6
6
HPFT
HPFT
4
6
98
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Independent flats high support
Care
Provider
Property
owners
Address
Town
Number
of
placements
HPT (HST
Watford)
Aldwyck
Housing
Assoc.
Woodside Court
Watford
12
HPT (CST)
Riversmead
HA
1-13 Neal Court
Hertford
13
Hightown
Praetorian
Hightown
Praetorian
2 Higgins Walk
Stevenage
8
Hightown
Praetorian
Hightown
Praetorian
Oxley Road
Stevevnage
20
Hightown
Praetorian
Aldwyck
Housing
Assoc.
Cypress Avenue
Welwyn Garden
City
8
Total
units
in town
12
13
28
8
61
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Residential/Long Stay Care
Type of Property
Address
Town
Number of
placements
in Herts
Residential Care
10-20 Cardinal Avenue, Borehamwood, Hertfordshire, WD6 1EP
Borehamwood
1
Residential Care
Residential Care
41 Hillfield Road, Hemel Hempstead, Herts, HP2 4AB
2/4 Leys Road
Hemel
Hemel
1
6
Residential Care
1 Christchurch Road
Hemel
6
13
Hospital Beds in the
Community
Gainsford House
Hitchin
12
12
5
5
Hoddesdon, Herts
8-10 Springshott
Hoddesdon
Letchworth
Rowan House, Avenue One, Letchworth Garden City, Herts, SG6
2WW
Letchworth
Hospital Beds in the
Community
75 Hill End Lane
St Albans
6
Residential Care
31-33 Hill End Lane
St.Albans
6
Residential Care
Lye Lane, Bricket Wood, St Albans, Herts, AL2 3TN
St Albans
3
ditto
55 Harvey Road, London Colney, St Albans, Herts
St Albans
2
ditto
13 Springfield Road, St Albans, Herts, AL1 5LX
St Albans
8
ditto
46 Coombes Road, London Colney, Herts, AL2 1ND
St Albans
3
ditto
193 Watford Road, Chiswell Green, St Albans, Herts, AL2 3HH
St Albans
2
ditto
323 High Street, London Colney, S
St Albans
2
ditto
30 White Horse Lane, London Colney, St Albans, Herts, AL2 1JR
St Albans
1
ditto
38-40 Church Crescent, St Albans, Herts, AL3 5JE
St Albans
5
ditto
65 Sandridge Road, St Albans, Herts
St Albans
2
111 Hertford Road, Braybury End, Stevenage, Herts, SG2 8SU
Stevenage
3
3
Great Munden, Nr Ware, Herts, SG11 1JD
Ware
11
11
de-registered home
Registered Care Home
Residential Care
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Total
units
in town
1
6
1
7
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Hospital Beds in the
Community
696 St.Albans Road
Watford
6
Hospital Beds in the
Community
151 Rickmansworth Road
Watford
6
Residential Care
14-16 Westland Road, Watford, Herts, WD17 1QS
Watford
7
de-registered home
22-24 Alexandra Road, Watford, Herts, WD17 4QY
Watford
9
de-registered home
43 Grosvenor Road, Watford, Herts, WD17 2QS
Watford
2
ditto
79A Queens Road, Watford, Herts, WD17 2QN
Watford
2
ditto
54 Bushey Grove Road, Bushey, Watford, Herts, WD2 2JJ
Watford
1
ditto
18 Octavia Court, St Pauls Way, Watford, Herts, WD24 4UW
Watford
1
de-registered home
77A Queens Road, Watford, Herts, WD17 2QN
Watford
5
ditto
12 Rosslyn Road, Watford, Herts, WD 18 0JY
Watford
1
ditto
88 Woodhurst Avenue, Garston, Herts, WD25 9RW
Watford
5
ditto
180-182 York Way, Watford, Herts, WD2 4RX
Watford
11
Residential Care
76 Bushey Hall Road, Bushey, Herts, WD23 2EQ
Watford
3
SP
78 Bushey Hall Road, Bushey, Herts, WD23 2EQ
Watford
1
47
139
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Rehabilitation and Step-down
Number
of
placements
Total
units
in town
Address
Town
Care
provided by
230 Churchgate
Cheshunt
HPFT
5
5
Hampden House
Hitchin
HPFT
12
12
53 Hill End Lane
St Albans
HPFT
6
The Causeway
St.Albans
HPFT
14
Midpoint
Stevenage
Turning Point
12
20
12
49
Low Secure
Rehabilitation
Deacon Ward
St Albans
HPFT
6
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Joint Commissioning Team Mental Health Accommodation Strategy 2008 - 2011
Appendix D
Hospital Beds in the Community
Resource
Town
Beds
Current Use
Hampden House
Hitchin
12
Rehabilitation
Gainsford House
Hitchin
12
Long stay Continuing care
75 Hill End Lane
St Albans
6
Long stay Continuing care
696 St Albans Road
Watford
6
Long stay Continuing care
151 Rickmansworth Road
Watford
6
Long stay Continuing care
53 Hill End Lane
St Albans
6
Step-down from Secure Accommodation
Please note there are two other houses registered as hospital beds in the community at 801 St Albans Road Watford and
35-37 Hill End Lane St Albans. These units are not included in the above table as they are part of the acute bed provision.
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