Categories
Policy

What is “Supported Housing”? (Part 1)

Supported Housing: A Victim of its Own Misdescription

As an advocate for supported housing I think it is important to think about what we actually mean when we think of “supported housing”.

In my experience it is certainly the case that supported housing has been and remains a victim of its own misdescription. We have allowed people and institutions, some of whom see themselves as advocates for supported housing, to impose their own limiting beliefs and definitions. We have allowed our vision of supported housing (and other preventative, enabling services) to be blurred by other agendas such as “cost control” in the commissioning of supported housing and the administration of public money. The preoccupation with the cost of everything and the value of nothing has led us to limit our own beliefs about what’s possible with supported housing and has helped to restrict its significance as an essential part of our social response to additional need.

Supported Housing, Health & Social Care

Supported housing is routinely seen as a disconnected, less important component of the social network of services people need. It’s not seen as an integral part of the wider social care agenda, which is its rightful place. Social care services throughout the UK are under immense pressure; there is both an opportunity and a necessity to talk about supported housing in a way that gives it the status it deserves but seldom gets as part of the solution to the UK-wide crisis in social care. 

The Scottish Government has taken steps to integrate health and social care in both structural and funding terms, but supported housing seems to be a separate matter. The Welsh Government is also focusing on health and social care integration and makes the link with housing and education without being very specific. Northern Ireland has integrated Health & Social Care Trusts, which cover residential care but not supported housing. The UK Government, on behalf of the otherwise ungoverned English, has said it wants to solve the social care crisis, but we have yet to hear any specific proposals. In all 4 constituent nations of the UK it is important to identify supported housing as fundamental to any vision of the structure of health and social care.

The next few posts to the Supported Housing Blog will focus on how we should define, fund, review, “measure” and regulate supported housing. The intention is to offer a view of the nature, scope and purpose of supported housing and its place within the wider agenda of social care.

What is Supported Housing?

The most obvious, and least helpful, way to see supported housing is as buildings in multiple occupation, owned or managed by a social organisation that were designed and developed to temporarily accommodate people with additional housing and other needs. It’s certainly true that such supported housing does exist, and so it should, but not at the price of limiting our thinking and peoples’ choices.

I’ve always considered that it is less about the building and the landlord and more about the people and their needs. For me supported housing is somewhere that someone with an additional need lives. It is supported housing for the duration of that additional need (and the length of time that someone is supporting the person to live there). Sometimes it’s permanent supported housing, sometimes it’s temporary supported housing: it all depends on what its occupants’ needs are

It shouldn’t matter whether it’s “social” housing, rented, owned, multiply occupied or solely occupied; whether it was developed and built as “supported housing” or just an ordinary house or flat

Furthermore, we shouldn’t make the damaging mistake of limiting how people see the scope of supported housing through careless definitions of its purpose and of the people who live in it, for example, as describing it as for “…people who need a bit of support”. Supported housing is for such people, but it’s also for people who would otherwise be in hospital, registered residential care or prison.

Neither should we allow the tail to wag the dog by giving different “types” of supported housing definitions based on timescales (“long-term”, “short-term”). Such definitions are based on a discredited “cost control” approach to managing the administration of the funding upon which supported housing depends. When looking to commission or fund supported housing “lowest unit cost” should not be a reason to fund it, it should be a reason to scrutinise more closely its outcomes in the context of Value Generation, which is defined as follows:

  • Outcomes (for people)
  • Cost benefit (to the public purse)
  • Wider social benefit (community sustainment)

Then we can have a much more nuanced idea of whether it should be funded. A crude dependency on cost control and the preference for lowest unit cost over all else prioritises the management of a budget over the needs of people. And it’s an expensive way of doing things too: when we fail to invest in preventative services such as supported housing, we pay a much higher financial price to fund otherwise avoidable healthcare, criminal justice, homelessness and other interventions as a consequence. And that doesn’t include the calamitous human cost of a failure to invest in prevention.

The funding bias in favour of “social” providers is a reflection of the lack of any proper regulatory framework for supported housing. The lack of dedicated regulation forces us to take false comfort from the fact that “social” organisations are often regulated by some agency or other (although not as supported housing providers per se). To assume that supported housing run by a social landlord will necessarily be cheaper or better than any other form of supported housing is an assumption borne of a failure to imagine how supported housing regulation and funding should work.

To Summarise

So, the story so far is that we are having to work and live with a system the fundamentals of which are in error.

We haven’t thought deeply enough about supported housing to conceptualise what it is in order to describe it properly. In order to describe supported housing properly I’m going to devote my next few blog posts on how we should 

  • define it
  • fund it
  • regulate it 
  • measure the quality of what it does.

It is important to take the opportunity to think in depth beyond the restraints of the system that currently defines and funds supported housing from a cost control perspective, which fails to regulate and measure quality in any meaningful sense.

Watch this space for weekly Supported Housing Blog posts that develop a definition of supported housing as part of the wider health and social care agenda. Please do comment on this blog post and share it widely.

Michael Patterson

May 2020

4 replies on “What is “Supported Housing”? (Part 1)”

I could not agree more… However the definition of Supported housing is limitless and many organisations are bespoke in the manner they deliver their services. So to define Supported Accommodation will be a significant task in itself. Therefore, I think this is part of the reasoning to why historically to date, we have been categorised and pigeonholed in the fashion we have been.
In relation to funding, we as many organisations have to project, evidence and cost everything we do (rightly so) before any funding is agreed to. Then there is an issue whether or not the funding should come from the local authority or central government and what percentage come from where…
Regulating such a diverse service may not be beneficial to some providers as they may fall into a different category, depending on what services they deliver under the umbrella of supported accommodation. Some may even fall out of the category of supported accommodation and others may need to change their ethos and delivery of service. I could continue…..
This leads me onto, how do you measure the quality of a bespoke service if the people measuring have no real grasp of the importance of the service, not only to the recipients but to the wider community. The does the quality of service equates to the cost alone????
Just a few thoughts

Hi Tony

Many thanks for taking the time to comment.

Yes, definitions of supported housing are difficult but, as my next blog post will set out, I believe we should define it in terms of the needs that people have & “measure” it according to the value it generates (not just financially). Watch this space! I think we must avoid defining it on the basis of how long it might be funded for if we are to keep the meeting of additional need front & centre of what we do.

It’s true that funders want to know about the costs of supported housing, but they should be concerned about its value as part of that. Unfortunately, the system seems to have evolved into an expensive mechanism to deny funding except to those who can demonstrate “lowest unit cost”, whether or not they generate value.

Regulation has always been problematic as you observe. Unfortunately in some supported housing it’s nonexistent & this is risky in circumstances where some people don’t have a social commitment behind what they do as Thea Raisbeck’s “Exempt From Responsibility?” report shows. Regulation should be based on value generation principles, support the diversity of supported housing, be agenda neutral (aside from asking “do you generate value?”) and not be an industry in its own right. It should facilitate the generation of value, not restrict it, and it should be independent of people who commission services. Again, watch this space as it’s one of the issues I will be exploring in the coming days.

Once again, thanks for your comments. Please keep them coming!

Thanks for the response Mike, very much appreciated. I’m looking to send the remaining 4 of the series out over the next 4 weeks. I’ll be covering definitions of supported housing, its funding, its regulation & how we might “measure” its quality. Within each I’ll be promoting the idea of Value Generation as a fundamental principle, especially in the funding/quality area, but generally too.

Leave a Reply to Mike Wright Cancel reply

Your email address will not be published.