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12 September 2013
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Item 11
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19 September 2013
Scrutiny Review of the Aids and Adaptations Service
Scrutiny Group
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0845 505 5500 Ext. 1300
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Noting ☐
Discussion ☒
Approval ☒
Only complete the following Section if the report is a Board or Committee report:
Are any parts of the report not for publication i.e. (commercially
sensitive or confidential)
Yes ☐
Equality Impact Assessed
Yes ☐
Date Equality Impact Assessed
Please detail which Themes and Strategic
Objectives this report links to:
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☐Well Governed and Viable
☒Continuous Improvement
☐Effective People
☒Customer Focus
☒Efficient Assets
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No ☐
N/A ☒
Acknowledgements
The members of the Scrutiny Group who took part in the Review
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Emily Jones
Barbara Meakin
Joanne Jackson
David Roberts
Kevin O’Brien
Robert Corbett
Tony Cutmore
Dennis Bradley (Independent Chair)
Scrutiny Group would like to thank the staff who took part in interviews and provided
information during the course of the review. These include:
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DPA Team – Paul Proud, Andrew Plews, Emily Wilson
Business Intelligence – Kelly Mason
Complaints Team – Vicky Miller, Leah Kelly
Mears DPA Team – David Baxter,
Scrutiny Group would also like to thank those tenants who took part in interviews and
gave us their views about the service.
The Scrutiny Review was facilitated and supported by Sylvia Dodsworth and Jenna
Stephenson from livin and the Group would like to express their thanks for all their
valuable help.
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1.
Introduction
The Localism Act 2011 presented a new way of regulating the social housing sector.
Following the end of the Tenants Services Authority the Homes and Communities
Agency has overall responsibility for financial regulation, making sure housing
associations are viable and offer value for money while residents are expected to act as
consumer regulators checking the quality of what is provided by landlords.
Scrutiny Group was set up by livin in March 2013. Members were recruited through
external advertisement and interview process. The Group is made up of 6 tenants, 1
leaseholder and an Independent Chair and is representative of the demographic profile
across our communities. Four members of the group have not previously been involved
with livin before. Some members are in full time employment, others have caring or
voluntary commitments so we bring a wide mixture of skills and experiences to our work
on Scrutiny.
1.1
Since forming in March 2013 we have been learning as we go and working on our
pilot Scrutiny Review. Much of the training has been provided by Barry Smith
(Chartered Institute of Housing) and livin staff helping us to become familiar with
what livin do and how they work.
1.2
The main aims of Scrutiny are:
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to drive continuous improvement in performance and customer service
excellence through the process of resident led self-regulation
to ensure that tenants’ views, aspirations and priorities are central to and directly
influence livin’s strategic direction and that this can be clearly evidenced
to conduct regular scrutiny projects, examining livin’s services, which result in
making evidence based recommendations to Senior Management Team (SMT)
and the Board.
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2.
Our first Scrutiny Review
An internal review of the Aids and Adaptation Service is currently underway
and the newly formed Scrutiny Group was asked to carry out a pilot review to
run alongside this and report their findings and recommendations to Board in
September 2013.
Scrutiny Group has been mindful of livin’s mission and vision and has linked
each section of the report to its values by indicating in the margin the colour
of the value it relates to.
Fairness
___________
Openness ___________
Reliability ___________
Excellence ___________
Value
___________
Enterprise ___________
Respect
3.
___________
Why we chose this topic?
The Scrutiny Group in fulfilling its role will generally, although not exclusively,
carry out service reviews based on an annual programme. However, as this was
the first review to be undertaken Senior Management were approached and
asked to suggest topics which, whilst being meaningful, would not be too
complex or wide ranging given the limited experience of the Group.
The topic proposed, which was accepted by the Group, was a
review of the Aids and Adaptations Service. This Service exists to
assist those tenants who, as a result of a disability or other limiting
illness affecting them or a household member, find that their
properties are no longer suitable. As this service was due for a
review it was both timely and focussed. It was anticipated that the
Scrutiny Group report would complement the internal review of the
Service, it is therefore important that both are completed within
similar timescales to allow for sense checking.
The review process began in May 2013 and over a 12 week period Scrutiny
Group carried out a variety of activities which began by producing a Community
Map which portrayed the internal and external stakeholders involved in the aids
and adaptations process. Whilst this was to scope out the review, it also helped
the Group realise that the scale of the task was too great given the limited
resources available. This meant that there would need to be some prioritisation
to ensure the review was deliverable within the timescale. The decision on
priorities was made after an initial presentation by the aids and adaptations
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team. The Community Map was also used to allocate tasks to members of the
Group to provide direction and maximise effectiveness
4.
Methodology
A range of methods were employed during the research and investigative
phases of the review including:
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5.
Presentations by managers,
Requests for information from relevant managers,
Desk top review of the service looking at internal reports, standards,
complaints, correspondence.
Literature review, including good practice from other organisations,
Reading key documents,
Facilitated meetings and discussion groups,
Interviews with staff, customers, contractors and external partners,
Questionnaires and written questions,
Project planning.
Results and Findings
“Pleased with adaptation it has
made my life easier”
Members of the Group undertook interviews with a number of customers
selected randomly from a list nominated by the aids and adaptations team. The
interviews took place in early July, and involved 10 customers. Whilst most of
the comments were positive a number of issues were raised:
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There seems to be occasions when adaptations go ahead even if the
individual requiring the work is deceased.
There seems to be little consistency in follow up contacts with tenants
to check whether the adaptation is satisfactory.
The budget in 2012/13 was £550,000 with a total spend of £388,235, resulting in
an underspend of £161,765. Prior to 2011/12 the number of requests for aids
and adaptations each year exceeded budgetary provision and were carried over
to the following year, e.g. 2009/10 - 220 jobs carried over with a value of
£304,694 and in 2010/11- 273 jobs carried over with a value of £489,849.
Whilst this meant that the Service was always within budget such a policy was
unsustainable and in 2011 the Aids and Adaptations Service was re-structured.
Included within the re-structure was the direct employment of an occupational
therapist and by 31st March, 2012 the backlog had been cleared and this
continues to be the case. A key factor in this turnaround appears to be the
ability of the in-house occupational therapist to proactively challenge all new
referrals from Durham County Council’s Occupational Health Team and in so
doing reduce the growing demand on a fixed budget. However, the Group
considered that this could be misinterpreted as a cost cutting exercise leading to
accusations that the business is being supported to
the detriment of some of the most vulnerable
“Wet room is quick
tenants.
and easy for
disabled person and
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easier for the carer
to use and clean”
In 2012/13 the Service received fifteen complaints and in the first quarter of
2013/14 has received five. While the restructure only took place in 2011and it is
therefore too soon to see any trends, there was some anecdotal evidence that
the complaints procedure, in dealing with aids and adaptations issues, was not
working as well as it might and that accessibility and transparency may be
issues.
In the Aids and Adaptations policy it states that ‘…up-to-date and accurate
information …’ will be available and will include ‘…specific leaflets, information
in handbooks and newsletters…’ Some respondents suggested that information
is not freely available and that tenants are not always kept informed particularly
as to why an adaptation is not being installed. It was also suggested that
responses to queries were not always timely or indeed forthcoming.
Information also emerged that customers sometimes received visits from
different occupational therapists and were given conflicting advice regarding the
extent of aids and adaptations required. Durham County Council occupational
therapist makes first assessment followed by livin’s occupational therapist who
may alter the previous decision. Some tenants also felt that they did not receive
a satisfactory explanation as to why initial decisions are altered or amended.
We understand that when tenants are discharged from hospital and require the
provision of urgent aids delays are sometimes experienced. Whilst some delays
are inevitable it is important that due to the vulnerability of the customer these
cases need to be prioritised.
A questionnaire was sent to the contractor and further discussions were held
with a representative of the company. Inevitably information obtained related to
process and two areas were highlighted where improvements could be made. If
work tickets could contain all the information
required for a property, e.g. asbestos report
“It’s lovely to be able to
required, before being issued to the contractor the
go in the bath and
process could be speeded up. Regarding
sleep in my own bed”
replacement showers, the contractor’s
representative thought that the fitting of cladding
would dramatically increase customer satisfaction at a minimal increase in cost
to livin. Another possible improvement arises when a partial wet floor shower is
required; wall tiles are not replaced just matched.
Quick win - the Group suggested that carrying photographs to show
tenants what this is likely to look like may help to manage their
expectations.
Scrutiny Group notified that their suggestion has been adopted and will be used
on future partial wet area showers.
Another suggestion from the Group during the review was regarding metal
handrails which are unusable in winter, it was suggested that a coating of
some sort would insulate the rail and alleviate the problem. Our
understanding is that a solution is being sought,
possibly another quick win.
“You would not think
something so small
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could make such a
difference”
Concerns were expressed regarding the Service’s robustness given that there is
only one occupational therapist. The Head of Service reassured the Group that
contingency plans were in place to cover any short, medium or long term
absences. The Group also questioned whether there was a case for looking at
some professional direction and peer group support for the occupational
therapist given that she operates alone.
6.
Conclusions and Recommendations.
The Group concluded that the Aids and Adaptations Service worked well for the
majority of its clients; however, there are inevitably areas where further
improvements can be achieved. The following recommendations are made to
assist the service as it strives for continuous improvement.
1) We understand that there is no complete, historical record of all adaptations
carried out to date. We recommend that a comprehensive database be set
up and continuously updated, of all properties with adaptations. This should
assist in asset management and future housing allocations.
2) We recommend that the procedure for matching adapted properties with the
persons in most need be reviewed and if necessary amended to ensure
optimum decision making, fairness and transparency.
3) Whilst the Aids and Adaptations Policy states that ‘tenants have up-to-date
and accurate information available on the aids and adaptations service’, it
appears that some tenants and external partners find it difficult to obtain
such information. This has been borne out by the Group’s own research. We
recommend the materials are developed to explain the service and these
are communicated clearly and widely in a variety of formats which are
sensitive and accessible to all, without undue reliance on having access to
the internet.
4) External stakeholders and tenants have difficulty in contacting the service
on occasions; we recommend that points of contact are widely advertised
and promoted.
5) Anecdotal evidence obtained by the Group suggested that the partnership
with Durham County Council was not working as well as it might. It emerged
that there was duplication between the occupational therapists and we
recommend a review to ensure that it is truly collaborative and as efficient
and effective as possible.
6) We recommend that professional and peer group support be available to the
occupational therapist.
7) During discussions with service users it emerged that there would be benefit
in reviewing how applicants, requiring aids and adaptations, are engaged in
the process. This may best be illustrated using a ‘tell – ask’ continuum on
which the relationship between listening to the views of the tenants and
having input from the professionals can be considered. There is a decision
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to be made by livin as to how close they want to move towards the provision
of fully person centred services. Whilst the Group appreciate that this is a
grey area we consider that it may present a real opportunity for service
improvement. We therefore recommend that the interactions between
tenants and professionals are reviewed with particular emphasis on tenant
involvement, e.g.in the move house or adapt the current house debate,
customer focus and improved communications.
Business focused
Tell
Customer focused
livin
are
here
x
Ask
8) In discussions with Age UK there were some misgivings regarding the way
in which the complaints procedure currently operates. We are of the opinion
that this may be because there is no Appeals procedure in place within the
Aids and Adaptations policy. We recommend that consideration be given to
developing an appeals procedure to ensure fairness and transparency.
9) We recommend that consideration be given to the way the current system
for the provision of urgent aids and adaptations works, e.g. hospital
discharges, to ensure it is working as effectively as possible.
10) We recommend that tenants are contacted after all adaptations to ensure
that the adaptation is satisfactory and meets their needs.
11) We recommend that the fitting of cladding in replacement showers be
considered as a service improvement and an opportunity to increase
customer satisfaction.
12) We recommend that a solution be found to the problem of metal handrails
which cause difficulties during winter months.
13)
We recommend that there should be contact with the tenant to check that
the adaptation is still required and that all recipients of the Service receive a
follow up visit to check that the adaptation is satisfactory and meets their
needs. Scrutiny Group recommended an addition to the job card stating
who the adaptation is for so that Mears staff can check that the adaptation is
still required.
14) We recommend a review of maintenance instructions to ensure that all
relevant information is available before the target completion date is set.
We also recommend that there is a review of performance criteria for
starting work as concerns were expressed that there was no clear criteria
available.
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1. References.
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livin Aids and Adaptations Policy
EIA of Aids and Adaptation Service
Referral forms for Adaptation (under £500)
Letters
Referral process to DCC for Disabled Facilities Grant
Service Budget spend information
Satisfaction/Complaints information
Benchmarking/good practice information
Surveys: Mears DPA staff/Customers
DCLG Delivering Housing Adaptations for Disabled People: A good
practice guide (June 2006 edition)
Age UK information
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