supported housing blog – The Supported Housing Blog

In my 1st blog post of the “What is Supported Housing?” series I said that supported housing is a victim of its own limiting misdescriptions. I also argued that this isn’t helped by the definitions of supported housing in the UK Government’s (now stalled) “Funding Supported Housing” policy agenda of 2018, which I’ll look at below.

Here is an opportunity then, to offer some definitions for supported housing based on peoples’ needs. Definitions that will support the integration of supported housing into the social care mainstream.

This blog post may be of interest to UK-wide readers, despite the policy focus being on England. Social care is a devolved matter but supported housing still isn’t, to the extent that it’s funded through enhanced Housing Benefit/Universal Credit. In addition, the revised definitions of supported housing I propose have universal applicability.

Formal Definitions

The Social Housing Rents (Exceptions and Miscellaneous Provisions) Regulations 2016 give definitions of supported housing in its widest sense (for England) as follows:

“specialised supported housing” means supported housing—
(a) which is designed, structurally altered, refurbished or designated for occupation by, and made available to, residents who require specialised services or support in order to enable them to live, or to adjust to living, independently within the community,
(b) which offers a high level of support, which approximates to the services or support which would be provided in a care home, for residents for whom the only acceptable alternative would be a care home,
(c) which is provided by a private registered provider under an agreement or arrangement with—
(i) a local authority, or
(ii) the health service within the meaning of the National Health Service Act 2006(d),
(d) in respect of which the rent charged or to be charged complies with the agreement or arrangement mentioned in paragraph (c), and
(e) in respect of which either—
(i) there was no public assistance, or
(ii) if there was public assistance, it was by means of a loan secured by means of a charge or a mortgage against a property;

“supported housing” means low cost rental accommodation provided by a registered provider which—
(a) is made available only in conjunction with the supply of support,
(b) is made available exclusively to residents who have been identified as needing support, and
(c) falls into one or both of the following categories—
(i) accommodation that has been designed, structurally altered or refurbished in order to enable residents to live independently,
(ii) accommodation that has been designated as being available only to individuals within an identified group with specific support needs;
“support” includes—
(a) sheltered accommodation,
(b) extra care housing,
(c) domestic violence refuges,
(d) hostels for the homeless,
(e) support for people with drug or alcohol problems,
(f) support for people with mental health problems,
(g) support for people with learning disabilities,
(h) support for people with disabilities,
(i) support for offenders and people at risk of offending,
(j) support for young people leaving care,
(k) support for teenage parents
(l) support for refugees;

So Specialised Supported Housing is for people who might otherwise be in a registered care home and is funded through the use of private capital. It’s also exempt from the Rent Standard.

Other “Conventional” Supported Housing defined above is subject to the Rent Standard and reflects a “typical” definition of mainstream supported housing.

Both definitions in the Social Housing Rents (Exceptions and Miscellaneous Provisions) Regulations 2016 specify the landlord as a Registered Provider. However, there are many supported housing services run by nonprofit agencies that have no registered provider involvement, and still other supported housing services provided by the private sector. Are these not supported housing?

The legal identity of a tenant’s landlord does make a difference to that tenant’s entitlement to enhanced Housing Benefit where additional needs are an issue (only social/nonprofit housing tenants/licensees are eligible). This is perverse in circumstances where additional need isn’t restricted to social housing. The regulation of all supported housing is more important than the legal status of a supported housing landlord.

Definitions Proposed in “Funding Supported Housing”

In addition to these two broad definitions above, the UK Government’s “Funding Supported Housing” policy consultation originally had the following definitions of supported housing:

Short-term supported housing: The UK Government has defined “Short-Term Supported Housing” as being supported housing that is accessed by people in crisis and with a maximum duration of two years or until a transition to “long term stable accommodation” is possible, whichever occurs first.
Long-term supported housing: Long-Term Supported Housing includes people with learning disabilities mental health needs and other groups whose additional needs are permanent.
Sheltered & Extracare Housing: the UK Government hasn’t defined this type of supported housing in its “Future Funding” policy agenda, apart from identifying its existence. It did accept the need not to be too prescriptive in how sheltered and extracare are defined.

I don’t believe that timescale or client group should define Supported Housing; it should be defined by the nature of the needs it meets. As I mention in previous blog posts, definitions of supported housing based on a timeframe are about the restrictive management of a pot of public money, not about meeting peoples’ needs.

The proposed definitions of Short-Term, Long-Term and Sheltered & Extra Care Housing do not reflect the diversity of supported housing services. For example, where do Shared Lives/Adult Placements, Respite Care, Housing First and Intermediate Housing fit in? No consideration is given to the sometimes high degree of overlap between Sheltered & Extra Care, Long-Term Supported Housing and Specialised Supported Housing.

Proper consideration will be given to funding supported housing in my next blog post, but for the sake of clarity all forms of supported housing should be funded, in part at least, through the welfare system as the UK Government has accepted.

Revised Definitions

So-called “short-term supported housing” should be redesignated as “Immediate Access Accommodation“. Within that definition refuges and other forms of emergency accommodation for which Universal Credit is not immediately appropriate should be funded by a ringfenced local authority fund for up to 6 weeks, after which Universal Credit including an enhanced housing component should fund it.

“Intermediate Supported Housing“: which, by definition, applies to people who don’t need Immediate Access Accommodation, although they may have come from it, and don’t need Intensive Supported Housing, although they may have come from it. The duration of someone’s stay in Intermediate Supported Housing would depend on the duration and extent of their need within a system geared towards the maximisation of managed interdependence. If appropriate, Intermediate Supported Housing may be provided in the same building as Immediate Access Accommodation, for example a refuge. Funded through Universal Credit.

In the same way I challenged the appropriateness of the term “Short-Term Supported Housing” I believe the term “Long-Term Supported Housing” is inappropriate and should be replaced with the term “Intensive Supported Housing“. Within “Intensive Supported Housing” peoples’ needs can be of any duration but the point is that they’re intensive. This might be as a consequence of an addiction or as a consequence of a severe learning disability to give just two very different examples of many.

Specialised Supported Housing and Intensive Supported Housing are not dissimilar. If the requirement for Specialised Supported Housing to be privately funded by definition were removed, they would be practically identical.

Sheltered and Extra Care Housing is defined by the UK Government’s 2^nd set of “Funding Supported Housing” consultation proposals. I agree that definitions of the people who live in sheltered/extracare shouldn’t be too prescriptive.

Wherever we are in the UK it is important that supported housing is an integrated part of the network of social and healthcare services that people need. Social care reform is on the agenda universally and it’s important that we inform the nature of change by putting supported housing front and centre.

Providing revised definitions of supported housing that focus on peoples’ needs is important in a context where such definitions are habitually geared to the management of a budget (“long-term”, “short-term” etc). I understand that money is important but it’s much better looked at as part of a Value Generation approach:

Outcomes for people
Cost benefit to the public purse
Wider social/community benefit

Cost alone is a very crude measure of the value that supported housing generates. Value Generation contextualises it better within a wider framework of measurement.

My next blog post in this “What is Supported Housing?” series will focus on funding supported housing.

Michael Patterson 18th May 2020

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