CELG(4) HA 21
Response from : Conwy
County Borough Council
1) Why there are still significant variations in the time it takes to deliver aids and adaptations funded by Disabled Facilities Grants across Wales;
1.1 It is fair to say that the term Disabled Facilities Grant (DFG) is misunderstood by many. It is taken to mean all sorts of adaptations – not just those defined in the Housing Grants, Construction and Regeneration Act 1996. In Conwy we distinguish between mandatory (legislative) DFGs and discretionary Disabled Facilities Assistance – defined in our published Housing Renewal Policies. There are also minor adaptations that are processed by the Occupational Therapy Service or by the local Care and Repair agency. Aids are now identified as Assistive Technology due to the changing nature of electronic as well as physical assistance that is available.
1.2 The definition of the Performance Indicator (PI) for mandatory DFGs (PSR / 002) is ambiguous:
‘The number of calendar days taken to deliver a Disabled Facilities Grant should be counted from the date of the client’s first recorded contact with the local authority, relating specifically to an adaptation, for which Disabled Facilities Grant is subsequently offered, to the ‘certified date’. Alternatively, in the case of an existing client, the starting point should be the date on which the need for an adaptation for which Disabled Facilities Grant is subsequently offered is first raised, either by the client or the Authority.’
Authorities can choose whether to measure from the first recorded contact or (alternatively) the date on which the need for an adaptation is first raised. This will lead to variations in timescales depending on the choice made by authorities.
1.3 It has been suggested (if not implemented) that the denominator for the above PI should be pre-populated with data from the year ending 31 March 2012, provided previously by local authorities. It should be realised that the two figures (the denominator and the reported figure) are not the same – because a number of cases straddle financial years (for the PI). This could lead to an even greater level of misunderstanding unless the definition of the PI is changed.
1.4 Conwy has always prioritised the funding of adaptations (including DFGs) over other housing improvements although it is understood that other authorities have not. However all capital funded schemes have come under pressure in recent years.
1.5 Our experience is that relying on external agents to progress applications on behalf of applicants is fraught with difficulty – mainly due to the fact that they tend to have competing priorities. Timescales have improved since the Council have used our internal (arms length) agency to assist in delivering DFGs.
1.6 Obviously the level of available budget will have an affect on timescales and where the budget is not sufficient to meet demand Local Authorities may hold applications which cannot yet be funded outside the process. This may be by establishing a list of referrals waiting to be progressed when funding becomes available. Lists may be prioritised according to severity of need.
1.7 In Conwy efforts have been made to reduce the cost of all adaptations in recognition of the growing pressures on budgets. This has led to a situation where we are processing the same number of cases for a significantly reduced cost. However a small number of costly adaptations (normally extensions) can have a significant effect on both timescales and budget availability.
2) Whether sufficient progress has been made on implementing recommendations from the Equality of Opportunity Committee’s 2009 report on home adaptations
2.1 Whilst we have no direct knowledge of Welsh Government’s progress in implementing the recommendations in Conwy we have made the following improvements:
2.2 Aids and adaptations were made a corporate priority
2.3 When the major adaptations service was brought in-house a review of all processes were carried out and the teams structured to deliver an efficient service.
2.4 Close working with Occupational Therapists (OTs) has been maintained, including undertaking a joint visit involving the OT and the Technical Surveyor at the beginning of the process. Savings have been achieved by getting the scheduled work right first time. This is a result of the improved communication between the applicant, OT, Housing Renewals service and the contractor.
2.5 The use of an approved list of contractors - including pre-priced schedule of works and tight timescales for delivery.
2.6 Working with others to review and introduce good practice; Conwy Renewals staff facilitate cross-authority working in North Wales. OTs also participate in local and national networks.
2.7 A dedicated visiting officer to assist and support applicants to complete application forms etc., help them through the means-testing process and to act as a contact point for their enquiries. Previously there seemed to be a lack of case ownership and clients were handed over from one person to another. Relevant information is now gathered directly – leading to reduced timescales.
2.8 Regular progress reviews are carried out between the OT service and Renewals service to ensure that cases progress.
2.9 Improving ease of access to information about adaptations for our clients was one of our key priorities. Various leaflets and service standards were published in plain English (and translated into Welsh) and also distributed around hospitals, clinics and GP practises. The major adaptation service is publicised via various road shows and regular visits to local hospitals. This is supported by Conwy’s recently adopted Older Persons’ Housing Strategy, as one of the four strategic objectives, to ensure that ‘Older People in Conwy can access services that provide assistive technology and adaptations, enabling them to live independently’.
2.10 An Occupational Therapy Intake Team has been set up with the aim of addressing and reducing the waiting list for simple, non complex assessments, and in turn impact on the overall waiting list and time spent waiting for assessments.
2.11. Three OT assistants (OTA) carry out the assessments referred to in 2.10 and they are supervised by a Senior Practitioner OT. Maximum intervention time is limited to 3 months, by which time the immediate needs are addressed. If necessary, or if there is no resolution to the need, only then are these clients referred on to the locality team for longer term solutions. The evidence suggests that only a small percentage go on to reallocation, thus the knock on effect is that those who are identified from the outset as having substantial needs go direct to locality teams and do not have to wait so long for assessment as the waiting list is not clogged up with less complex referral issues.
2.12 A dedicated OTA for less complex adaptations was introduced as a follow on from introducing the Intake Team as a further initiative to speed up the adaptations process for less complex cases. In the main the adaptations identified by the Intake Team were typically bath out/shower in or simple access solutions. Rather than transfer to the main locality team an OTA with considerable experience was allocated to fast track those through the adaptations process. This has significantly improved timescales for those types of adaptations.
2.13 A very detailed customer feedback questionnaire has been introduced which has resulted in very good customer feedback (in excess of 90% positive responses). Satisfaction rates are analysed by management, by Occupational Therapists and by contractor so that any patterns can be identified. Any issues / concerns are then addressed accordingly in order to continually improve service delivery for our clients.
3) What impact reduced resources for housing are likely to have on the provision of home adaptations;
3.1 Major adaptations (including DFGs) are funded via the General Capital Fund. In Conwy the Housing Renewals service bids for its allocation on an annual basis as required by the business planning process. The allocation in 2011/12 proved to be inadequate and virements from other private sector housing allocations had to be obtained via the political process. The available budget has fallen considerably from a peak of £2 million (an annual allocation up to 2008/9), with 20011/12 onwards being just £1.million. In meeting the challenge the average costs of works has been reduced - partly due to re-cycling stair lifts, hoists etc. and looking at alternative products / materials as opposed to costly branded ones (but which meet the same specification e.g. CE/ kite mark). In part this reflects changes in demand and solutions identified, but it also reflects considerable work to reduce the cost through tighter specification and effective procurement.
3.2 By providing major adaptations at the appropriate time people can be sustained within their own accommodation, not only reducing residential care costs but arguably delivering considerable emotional and community benefits to service users. Nevertheless, the impact of a timely service could go beyond delaying admission into residential care, for example to alleviate costs in the home care service or to discharge existing clients from residential care. Evidence shows that the financial knock-on effect of not delivering service in reasonable lead times extended beyond the immediate costs to the adaptations service.
3.3 The relationship between demand and the level of financial resources required needs to be recognised as a key priority.
4) Is the Welsh Government effectively monitoring the provision of adaptation services; and what needs to be done to improve adaptation services in Wales:
4.1 We are not in a position to comment on monitoring arrangements other than the issue discussed in paragraph 1.3.
4.2 Fair and consistent access to DFGs, Physical Adaptation Grants (PAG) or other sources of funding (such as direct payment by stock transfer organisations) is imperative. Clients do not appear to be receiving equally easy or rapid help with adaptations for their disabilities. Where delays occur in meeting need, this can impact on service users' health and the cost of support required at a later stage. Occupational Therapists state that there are inequalities to the speed of delivery of adaptations especially between DFGs and PAG applications. Welsh Government may wish to consider funding RSL tenant applications via the award of DFGs as part of a tenure blind process.
4.3 Different funding routes can result in inconsistent arrangements, which are inequitable for Registered Social Landlord (RSL) tenants. Duplication and overlap of services between RSLs and Local Authorities can be confusing and poor value for money.
4.4 Conwy’s Housing Renewals Service carries out design works for a local RSL (following stock transfer) and this has been mutually beneficial to the service delivery and improving timescales and has resulted in consistency of standards across tenure. Working closely with RSL partners has resulted in improved and timely adaptations for affected tenants.
4.5 As part of our newly adopted Older Persons’ Housing Strategy, we have developed a sub-group to take the ‘Assistive Technology and Adaptations’ action plan forward. This group will include representatives from all the local RSLs who offer adaptations and will provide a platform for us to better co-ordinate the ways in which we utilise and monitor adaptations services. Although DFGs are also for people who are not over the age of 55, the work being done to implement this strategy gives us a valuable opportunity to further improve our services across the board, by getting the most appropriate people meeting, to discuss the following actions:
1. Ensure older people know who to contact if they have a problem and require an assessment for assistive technology or an adaptation
2. Promote Telecare development amongst staff so that they can pass on the knowledge to clients
3. Explore potential funding methods for a handyman and gardening service
4. Help older people to free up homes that have become impractical for them to live in by providing support and guidance
5. Develop Adapted Matching Property register that spans across all Registered Social Landlords, matching tenants to appropriately adapted properties
6. Develop training programme around Dignity and Respect for people going into tenants homes to fit assistive technology or adaptations
As part of action 6, we would also hope to develop a standard, cross-tenure customer feedback questionnaire so that we can begin to standardise the way in which we offer these services.