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Inter‐Departmental Review of Housing Adaptations Services ‐ Evidence Base Report

Contents Tables ..................................................................................................................... 2 Figures .................................................................................................................... 2 Acknowledgements ................................................................................................ 3 Glossary of terms.................................................................................................... 4 Acronyms................................................................................................................ 8 SUMMARY .............................................................................................................. 9 SECTION 1‐The underlying need for housing adaptations services in NI ................ 14 SECTION 2 ‐ The value of housing adaptations and assistive technology ............... 24 SECTION 3 ‐ Legislation and Policy ........................................................................ 40 SECTION 4 ‐ Resourcing adaptations and routine assistive technology.................. 87 SECTION 5 ‐ Design standards, costs and communication ................................... 109 SECTION 6 ‐ Usage and re‐cycling of existing resources ....................................... 118 SECTION 7A ‐ Governance ................................................................................... 132 SECTION 7B ‐ Case management ......................................................................... 138 Appendix 1 ‐ Index of governance criteria........................................................... 151 Appendix 2 ‐ Housing Adaptations: Standards of Service .................................... 152 Appendix 3 ‐ Treatment planning: Decision Tree................................................. 154 Appendix 4 – The housing support process ......................................................... 155 Appendix 5 ‐ Protocols for joint liaison/visits in the public sector (NIHE) ............ 156 Appendix 6 ‐ Protocols for joint liaison/visits in the private sector. .................... 158 Appendix 7 ‐ Other housing options for people in the private sector .................. 160 Appendix 8 ‐ Potential shared definitions of complex cases................................ 161 References.......................................................................................................... 162

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Tables Table 1: LE, DFLE and DLE at Age 65 by UK Region and Gender 2004 – 2006......... 17 Table 2: Social housing adaptation volumes.......................................................... 23 Table 3: NIHE Supporting People expenditure....................................................... 36 Table 4: Bamford Funding ..................................................................................... 37 Table 5: Weekly & annual care costs in Northern Ireland HSC Board..................... 38 Table 6: Adaptations expenditure by organisation and type (thousands).............. 93 Table 7: HSC Trust Adaptations and Assistive Technology expenditure................. 94 Table 8: NIHE stock by type................................................................................. 105 Table 9: Design Space Standards Matrix.............................................................. 113 Table 10: Potential cost savings .......................................................................... 114 Table 11: Social housing adaptation volumes...................................................... 118 Table 12: Frequency of adaptation usage............................................................ 119 Table 13: Age Profile of NIHE Tenants ................................................................. 119 Table 14: NIHE households with disability or long‐term illness ........................... 120 Table 15: Definitions ........................................................................................... 142

Figures Figure 1: Inter‐departmental review infrastructure & frequency of meetings ....... 13 Figure 2: Projected demographic change in Northern Ireland ............................... 15 Figure 3: Estimated number of people with dementia in NI 2010‐2051................. 16 Figure 4: Distribution of wheelchair users in Northern Ireland by ward ................ 20 Figure 5: Wheelchair service referral activity April 2006 – April 2011.................... 21 Figure 6: Referrals received by Occupational Therapists 2001 – 2009................... 22 Figure 7: Provision of adaptations by provider...................................................... 23 Figure 8: Reasons for the award of FDAstatus: Homelessness 2010 (All tenures) .. 32 Figure 9: HSC Trust expenditure on community care 2008/09............................... 35 Figure 10: Financial components of community care 2009/2010........................... 36 Figure 11: Better support at lower cost – Wales.................................................... 38 Figure 12: NIHE high level funding flow chart........................................................ 89 Figure 13: HSC Trusts Funding Flowchart............................................................... 91 Figure 14: Resolving bathing difficulties................................................................ 97 Figure 15: Resolving difficulties climbing stairs ................................................... 100 Figure 18: Routine Housing Adaptations Pathways ............................................. 139 Figure 19: Housing/Health Interfaces.................................................................. 143 Figure 20: Housing & health options appraisal process ....................................... 144 Figure 21: Community Occupational Therapists by Trust and speciality .............. 146

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Acknowledgements Department for Social Development

Northern Ireland Housing Executive

Department of Health, Social Services and Public Safety

HSC – Board

HSC Trusts

Belfast

Southern

Northern

Western

South‐East

Public Health Agency

Northern Ireland Federation of Housing Associations

Disability Action

Community Occupational Therapy Managers (Northern Ireland) Forum

The College of Occupational Therapists Specialist Section ‐ Housing

University of Ulster

University of Bristol

Welsh Assembly

Scottish Executive

Communities and Local Government

Ownership Options Scotland

Northern Ireland Housing Council

Irish Department of the Environment, Community and Local Government

The Core and Joint Housing Adaptations Steering Groups wish to pay a special tribute to Mrs Patricia Blackburn, Lead Allied Health Professions Officer and co‐chair of the Interdepartmental Review of Housing Adaptations Services, who sadly passed away during the completion of this work.

Her vision, leadership and inspiration were recognised by everyone she worked with in this interdepartmental review. She will be sadly missed by everyone who knew her within this work and beyond.

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Glossary of terms

Term Meaning

Accessible An accessible home allows a disabled occupant to approach and use all essential facilities.

Adaptable An adaptable home is designed to facilitate future adaptations at minimum costs. Lifetime Homes are examples of adaptable homes.

Assistive technology Any product or service designed to enable independence for disabled or older people.

Bespoke housing Housing that is built to the individualised needs of a disabled person and their family.

Canadian Occupational Performance Measure

An occupational therapy tool to measure improvements in daily living activity.

Capital expenditure Capital expenditure is incurred when a business spends money either to buy fixed assets or to add to the value of an existing fixed asset with a useful life that extends beyond the taxable year.

Community equipment

Equipment on loan from HSC Trusts to support community care at home.

COTSS‐Housing College of Occupational Therapy Specialist Section Housing.

Decent Homes’ Standards

A decent home is one which is wind and watertight, warm and has modern facilities and is a minimum standard that all social housing should have met through time.

Design Communications Toolkit

A suite of standardised design documentation to facilitate inter‐agency communication.

Design Space Standard Matrix (DSSM)

A comparative chart of space standards for specific adaptations matched against varying degrees of disability.

Design Standards Standards applied to housing including those which meet the varying needs of disabled people.

Direct Payments Packages

Cash payments given to people instead of services that would otherwise have been arranged by HSC Trusts so that they can arrange provision of their own services.

Disabled Facility Grant (DFG)

This is a grant to help improve the home of a person with a disability who lives in the private sector. Only work recommended by an Occupational Therapist can be considered for this type of grant.

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http://en.wikipedia.org/wiki/Fixed_assets


Term Meaning

Domiciliary care Provided in an individual’s home normally of a personal nature such as help with dressing, washing or toileting.

E.A.T. Electronic Assistive Technology.

Environmental design Design of housing and the surroundings in which people live.

Functionality points Points awarded to a housing applicant under the Housing Selection Scheme to reflect any difficulties they may experience either within/outside the home.

Full Duty Applicant (FDA) Status

A Full Duty Applicant (FDA) is a person to whom the Housing Executive owes a duty under the homelessness legislation, Article 10 (2) of the Housing (NI) Order, 1988 to “secure that accommodation becomes available for his occupation.”

Health Social Care Trust Estate Services

The HSC Trust Service which delivers minor adaptations, lifts, hoists.

Home Improvement Agencies (FOLD or Gable)

Independent agencies that offer additional assistance to process DFG applications for adaptations in privately owned or privately rented property.

Housing associations A Registered Housing Association (RHA) is a society, body of trustees or company, which is independent and does not trade for profit, established for the purpose of providing, constructing, improving and managing, social housing accommodation in Northern Ireland.

The Housing Association Guide

A DSD publication regulating the provision of housing association services.

Housing Health and Safety Rating System

Approach to the evaluation of the potential risks to health and safety from any deficiencies identified in dwellings.

Housing Selection Scheme

The Housing Selection Scheme represents a single gateway into social housing in Northern Ireland, let on a permanent basis, whether owned and managed by the Housing Executive or any of the housing associations operating in Northern Ireland.

Housing transfer A transfer takes place when a tenant is offered and accepts a move from one dwelling to another dwelling within a landlord’s own housing stock, or to a dwelling belonging to another landlord participating in the Housing Selection Scheme.

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Term Meaning

Incidence

Incidence is the frequency with which something, such as a disease, appears in a particular population or area. In disease epidemiology, the incidence is the number of newly diagnosed cases during a specific time period.

Incremental basis Increase in money or value.

Inter‐agency Involving or representing two or more agencies, especially government agencies.

Lifetime Homes Housing design standards which make a home more visitable and adaptable through a person’s life cycle. Not suitable for assisted wheelchair users.

Limiting long‐term illness

An assessment of whether a person has a limiting long‐term illness, health problem or disability which limits their daily activities or the work they can do, including problems that are due to old age (NISRA).

Major housing adaptations

Major adaptations usually require statutory approval such as building control or planning approval and the nature of the work will either involve significant internal structural alterations and/or an extension.

Minor housing adaptations

Generally a minor adaptation is lower cost, less complex work that does not usually require significant structural alteration.

Owner occupier Someone who owns their own home.

Prevalence Prevalence represents new and pre‐existing cases alive on a certain date, in contrast to incidence which reflects new cases of a condition diagnosed during a given period of time.

Private rented sector Housing provided by private landlords.

Private sector housing Privately owned or privately rented property.

Procurement Procurement is the process of the acquisition of goods, services, works and other supplies by the public sector, usually by means of a contractual agreement after public competition.

Public sector housing Social housing provided by NIHE or housing associations.

Revenue expenditure Relates to the day to day recurring costs of running a business, e.g. wages and salaries.

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Term Meaning

Select Adaptations List A range of minor adaptations which can be safely delivered by housing providers and which do not require a formal HSC Trust/OT assessment as agreed on an interagency basis.

Service users People who use services.

Stakeholder One who has a share or an interest in an enterprise.

Supported housing A term used to describe a range of both long and short term accommodation provided for people who need an additional level of housing related support to help them lead as independent a life as possible.

Supporting People Programme

The Supporting People Programme is designed to provide housing related support to prevent difficulties that can typically lead to hospitalisation, homelessness or institutional care and can aid a smooth transition to independent living for those leaving an institutionalised environment.

Visitable

A dwelling is ‘visitable’ if any visitor can reach the entrance and all the facilities that a visitor is normally allowed to use.

Wheelchair standard housing

Housing which is designed to enable wheelchair users to access and use the facilities in the home.

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Acronyms

Acronym Definition

COT College of Occupational Therapists

DFG Disabled Facilities Grants

DHSSPS Department of Health Social Services and Public Safety

DSD Department of Social Development

HPSS Health and Personal Social Services

HSCB Health& Social Care Board

HSC PFA targets Health& Social Care Priorities For Action

HSO Housing Support Officer

MSD Musculoskeletal disorders

ODPM Office of the Deputy Prime Minister

OFMDFM Office of the First Minister and Deputy First Minister

PHA Public Health Agency

POC Programme of Care

PPMS Programme Planning Management System

PSIS Private Sector Improvement Services

PSSRU Personal Social Services Research Unit

RDS Regional Disability Service

RQIA Regulation & Quality Inspection Authority


SUMMARY

Background & Rationale Housing adaptations are necessary to make the home of a person with a disability suitable for his/her needs and to promote independent living. The assessment for and provision of housing adaptations requires effective joint working at several organisational levels between housing, health and social care to improve standards and make best use of available resources.

In the financial year 2010/11 the Northern Ireland Housing Executive spent a total of £28.9m on disabled adaptations. The 2010/11 housing association spend on adaptations was approximately £2.4m. The Health and Social Care Trusts (HSC Trusts) also incurred annual expenditure of £11.7m in 2009/10 (the most recent year available) on minor works, community equipment and lifts.

Demographic trends indicate growing demand for these services as the population ages.

The Government has an obligation to ensure, through collaborative working, that resources are being used effectively and are helping as many people as possible. Given the significant levels of public funding involved in delivering this essential service in a period of economic uncertainty and diminishing public funding, the Department for Social Development (DSD) and Department of Health, Social Services and Public Safety (DHSS&PS) agreed to undertake an inter‐departmental review of housing adaptations services.

The review was launched in February 2010. The purpose was to review the current system of approval, resources and delivery of housing adaptations in Northern Ireland on a cross tenure basis, to maximise resources, ensure best value and equality of provision across HSC Trusts and housing providers.

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SUMMARY

Scope of Review With a central focus on processes that directly affect the lives of service users, the review examines:

Current and likely future demand for the housing adaptations service.

The impact of housing adaptations investment on the health and well being of service users and on cost savings elsewhere.

The key legislative and policy influences on housing adaptations services considering interdepartmental/interagency interfaces.

Joint interdepartmental resources available, including HSC Trust community equipment, to meet the housing and independent living needs of older and disabled people in Northern Ireland.

Funding models utilised in other parts of the UK.

The use of existing housing adaptations and the use of recyclable resources.

Governance arrangements and current performance in the assessment and delivery of housing adaptations services.

Interagency co‐ordination of complex case work and the range of options/solutions which can be utilised to meet assessed needs.

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Review Methodology and Communication The key findings and recommendations contained in this report arose from a robust and comprehensive review process.

Terms of reference were drafted and agreed between the Department for Social Development (DSD) and the Department of Health, Social Services and Public Safety (DHSSPS) in January 2010.

The scope, content and review methodology were agreed by all stakeholders at an interagency seminar in February 2010.

A comprehensive literature search was undertaken of the evidence base relating to the agreed review topics. This was supported by the Northern Ireland Housing Executive’s Research Department.

A Core Group (Project Board) was established to oversee the review, which is jointly chaired by DSD and DHSS&PS.

Other group members include representatives from NIHE, Health & Social Care Board, Public Health Agency and Housing Adaptations Liaison Manager. The role of the Core Group was to provide strategic direction and guidance on policy/governance issues and the overall content of the review report.

The Joint Housing Adaptations Steering Group (JHASG) was initially established to support the Joint Fundamental Review of the Housing Adaptations Service in 2002 and comprises representatives from housing, health and social care, community and voluntary sector and service users. The group is currently co‐chaired by the Department of Health & NIHE. The role of this group is to quality assure the key findings/recommendations and overall content of the review report and ensure full stakeholder representation. The organisational structure is illustrated in Figure 1.

The Housing Adaptations Liaison Manager was the project co‐ordinator who linked the varying strands of the review, provided focus and direction for the task groups and involved statutory and voluntary agencies and service users.

Service user involvement was ensured through:

1. Representation on the JHASG.

2. Integration of Disability Action research findings and recommendations in relation to:

User involvement in the Housing Community Network (HCN).

The experiences of disabled people when seeking housing solutions to their needs.

Case studies on the benefits of housing adaptations for disabled people and carers.

User involvement in the evaluation and selection of housing products.

User trials of benchmark housing design standards.

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SUMMARY

Three interagency focus groups were established to address issues of concern such as lift provision, design standards, design communication & design costs and case management. Comprehensive cross sector representation including service users’ involvement was achieved in the groups.

These task groups were co‐chaired by both housing and HSC Trust representatives and reported to the Housing Adaptations Liaison Manager.

The task groups met regularly between March and August 2010.

As the review progressed the Health and Social Care Sector (DHSSPS, HSC Board, Public Health Agency, HSC Trusts and the Community Occupational Therapy Managers Forum) established three short‐duration task groups on resource identification, governance and legislation/ policy to ensure the co‐ordination of appropriate organisational representation, skills and data collection/validation.

Drafting and administrative support were provided by the NIHE Housing Centre.

Legislative and policy scrutiny was provided by respective Departmental Officials at the DSD and DHSSPS.

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Figure 1: Inter‐departmental review infrastructure & frequency of meetings

JHASG (meets bimonthly)

Housing Adaptations Liaison Manager

Task Groups x 3 Managing complex needs Lifts Space standards, costs & communications

Service user representation Regional service user facilitator

NIFHA

NIHE cross‐divisional meetings H&R Grants PDG Pre‐JHASG

NIHE Managers groups Area Grants Technical (meet monthly)

PHA HSC Board PMSI BSO Health Estates Pre JHASG

(meet monthly)

OT Community Managers OT Performance Managers

NIHE PHA HSC TRUST DHSSPS DSD Policy & Governance CORE GROUP (meets monthly)

SECTION 1‐The underlying need for housing adaptations services in Northern Ireland


Context Finding the exact numbers of people who have a disability is problematic, not least because in Northern Ireland there is no comprehensive register of disabled people. Reports and reviews of the prevalence of disability in Northern Ireland present significant difficulties surrounding the definition or definitions of disabilities, including the conflict between the medical and the social models (Sweeney & Furphy, 2008). Most surveys (including the Census of Populations) request the respondent to provide a self assessment of whether or not they have a limiting long‐term illness, health problem or disability which limits their daily activities or the work they can do, including problems that are due to old age (Census, 2001). Some respondents will be more willing than others to disclose that they do in fact have a disability. Nevertheless, quantifiable data is needed to ensure that facilities and services meet the needs of current and future populations.

Aim The aim of this chapter is to provide a statistical summary of the current and projected numbers of people with a disability in Northern Ireland and to illustrate the way in which demographic changes may impact on the underlying need for housing adaptations in the future. Comparisons with the rest of the UK have been made where data was available.

General Demographic Trends Data shows that over the past 20 years the Northern Ireland population has grown more rapidly than other countries within the UK (McWhirter, 2002). It is projected that the population will increase from 1,775,000 in 2008 to 2,075,000 in 2051 (NISRA, 2008). This predicted increase also shows that Northern Ireland is becoming an older society. By 2051 almost one quarter (469,000) of the population will be of pensionable age. Almost one in six (16%) will be aged 75 or older or 68% of those of pensionable age, while 30% of those at pensionable age will be the very elderly, i.e. those aged 85 or more. Figure 2 shows a significant percentage increase in those aged 85 or more between 2010 and 2051 (NISRA, 2012).

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Figure 2: Projected demographic change in Northern Ireland by age group – Percentage change from 2010 to 2051

-50

0

50

100

150

200

250

2010 2028 2036 2046 2051

Year

% i

nc

rea

se

fro

m 2

01

0

0-14 15-44 45-64 65-74 75-84 85+

Age and Disability

rate and severity of disability increases with age. As

n HPSS resources

r people want to remain in their own home, for as

Dementia

e of the main causes of disability in later life. The World Health tia a

d

all

The evidence shows that theage increases, so too does the rate of disability, so that amongst the most elderly inthe population the rate is at its highest. Amongst those aged 85 or more, the overallrate of disability is 920 per thousand (McCoy and Smith, 1992).

As McWhirter shows, the very elderly place a greater demand othan any other population group, consequently this will have a significant impact onthe demand for services (2002).

Literature would suggest that oldelong as possible. To enable them to do so adaptations, home technology, care and repair services and sufficient heating are often essential prerequisites.

Dementia is onOrganization’s Global Burden of Disease report, accorded disability from demenhigher weight than almost any other condition, with the exception of spinal cord injury and terminal cancer (Dementia UK, 2007: p.6). According to the 2003 WorlHealth Report, Global Burden of Disease estimates, incidences of dementia are projected to rise by 60% from 2005 to 2030. Dementia also contributed 11.2% ofyears lived with disability among people aged 60 and over; more than stroke (10%), musculoskeletal disorders (9%), cardiovascular disease (5%) and all forms of cancer

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(2%), (WHO, 2004). In the United Kingdom it is estimated that 683,597 (1% of the entire UK population) have some form of dementia and this is forecast to increase 940,110 by 2021 and 1,735,087 by 2051. The female population have twice the rate of late onset dementia compared to males. It is estimated that in the UK the majority(424,378 or 63.5%) of individuals with late onset dementia live in private households (the community) and 37% (244,185) live in care homes (Dementia UK, 2007: p.5).

The number of people in Northern Ireland diagnosed with dementia is currently

to

010‐

estimated to be 19,000, rising to more than 23,000 by 2017 and to approximately60,000 by 2051 (Figure 3) (Dementia Services Development Centre, 2010).

Figure 3: Estimated number of people with dementia in Northern Ireland 22051

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

2010 2017 2051

The projected figures were not available for the period 2017 to 2051.

Life Expectancy

ulation is due in no small measure to increased years in Life

1925

The rising trend in popExpectancy (LE). With new medical treatments and technologies the present population in Northern Ireland is living longer than its predecessors. Betweenand 1927 males and females in Northern Ireland could expect to live for 55 and 56 years respectively. This has risen to 76 years for males and 81 years for females (CARDI, 2010).

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Other significant drivers influencing disability Evidence suggests that although life expectancy is increasing, healthy life expectancy is not increasing at the same rate. People are spending a longer time living with conditions which seriously reduce their quality of life, such as arthritis, the effects of stroke, or dementia. Current trends in obesity and other lifestyle related diseases will also increase the need for care (Humphries et al, 2010). The Wanless (2006) report concluded that although people are living longer, they will experience more years of ill health, so the number of people needing help with one or more of their daily activities – such as washing or going to the toilet ‐ is likely to double by 2025 (The Kings Fund, 2010).

The Office of National Statistics (ONS) produces two measures of health expectancy; healthy life expectancy (HLE), defined as expected years of life in good or fairly good health; and disability‐free life expectancy (DFLE), defined as expected years of life free from limiting long‐standing illness or disability (ONS, 2010). Disabled Life Expectancy (DLE) which is years living with a disability is calculated by subtracting DFLE from Life Expectancy (LE).

Males and females in Northern Ireland will experience less disability free years and more (years) Disabled Life Expectancy than their counterparts in either, England, Scotland or Wales (ONS, 2010), (Table 1).

Table 1: LE, DFLE and DLE at Age 65 by UK Region and Gender 2004 – 2006 (Office of National Statistics)

MALES

2004‐06

FEMALES

2004‐06

LE DFLE DLE LE DFLE DLE

England 17.1 10.2 6.9 19.9 10.7 9.2

Scotland 15.8 9.8 6.0 18.6 10.7 7.9

Wales 16.7 9.5 7.2 19.5 9.8 9.7

Northern Ireland

16.6 9.1 7.5 19.5 9.0 10.5

Congenital conditions

Historically Northern Ireland rates for congenital malformations at birth have been significantly higher than the rates for England and Wales; however, statistics would suggest that trends for babies born with anencephaly, spina bifida and Down’s syndrome are on the decrease. Conversely incidences of hydrocephalus have trebled over the period 1996 – 2000 (McWhirter, 2002). These children may continue to need long term services.

A recent study by (Dabib, et al 2009) has re‐examined the prevalence of neural tube deficits (NTD) in Northern Ireland between 2000 ‐2004.This study shows that

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Northern Ireland does not have the highest prevalence of NTD (In Europe) as noted in the past and the prevalence rate is reduced to 1 in 1000 births. This prevalence rate is in keeping with the trends noted in other UK and Irish centres during the same period.

Multiple sclerosis

Multiple sclerosis is the most common cause of chronic neurological disability in young adults. Northern Ireland has one of the highest prevalence rates of multiple sclerosis in the world (MacLurg et al, 2005).

The legacy of the conflict in Northern Ireland

The conflict in Northern Ireland has resulted in significant long term disability and a requirement for housing adaptations services for many people. Some 47,000 people sustained injuries in 16,200 bombings and 37,000 shooting incidents (Eames, Bradley, 2009). Injuries sustained in the troubles include: blindness, loss of hearing, disfigurement and single or multiple amputation. A much higher proportion of people living in areas of high intensity violence (13%) reported having poor health compared with those living in areas of low violence (4%) (Eames, Bradley, 2009: Para 3.23).

Carers and caring

The provision of housing adaptations not only promotes independent living for disabled people but also plays a major role in promoting the health, safety and well being of carers in Northern Ireland.

It is clear that employers (in the case of formal paid carers), have an obligation to ensure the health and well being of carers in their employment. By the same token landlords (whose tenants may provide informal care), should ensure that carers who make such an important contribution to society, can provide care and support in a safe environment within their own homes or the homes of friends and relatives.

In the Northern Ireland Census 2001, 184,434 people identified themselves as carers (11% of the population).

By 2037 the number of carers could increase to 400,000 (Carers Northern Ireland, 2010).

The value of informal care in Northern Ireland cannot be underestimated. For example, Carers UK (2004) state that informal care saves the Northern Ireland economy over £3.12 billion ‐ the equivalent of the Health and Social Care spending in Northern Ireland.

A second study estimated this value at £2.17 billion, if one considers replacing informal care with statutory care at £9.95 per hour (Community Relations Council, 2006).

Current costs (2010) in one of our HSC trusts is £11.32 per hour i.e. £4,031 p.a.

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The care gap

The impact of the rise in the older population and falling birth rates on the availability of carers has been the subject of a number of studies.

Findings from the Personal Social Services Research Unit (Pickard, 2008) concluded that the supply of intense informal care to disabled older people by their adult children in England is unlikely to keep pace with demand in future years. Demand for informal care by disabled older people is projected to exceed supply by 2017, with the ‘care gap’ widening over the ensuing years. Around 90% of people who provide care to their older parents are themselves under retirement age and it is well known that ‘old age dependency ratios’ are due to rise sharply in the next thirty years (Pensions Commission 2004).

Effective environmental design and assistive technology will play an increasing role as part of a strategy to address this ‘care gap’ (DSD & DHSSPS, 2009: Heywood and Turner, 2007: Preiser, 2001, Audit Commission, 2004).

Prevalence rates of disability In 1992 disability prevalence rates for Northern Ireland adults stood at 174 per 1,000 (or 17%) which is higher than any other region of the UK and higher than the Great Britain rate of 142 per thousand or 14% (McCoy and Smith, 1992). By comparison results from the NISRA survey found that, in 2006/07, 18% of all people living in private households in Northern Ireland have some degree of disability. The prevalence rate for adults is 21% and 6% for children.

At household level almost two out of every five (37%) Northern Ireland households include at least one person with a disability. Around one‐fifth of these households contain more than one person with a disability (NISRA, 2007: p.16)

Apart from an ageing population, there are a number of medical conditions that influence the prevalence rate of disability among younger people in Northern Ireland; some of these conditions have been shown to be more prevalent in Northern Ireland than in other UK regions.

Geographical distribution of disability in Northern Ireland

There are variations in the prevalence of disability across geographical areas from just under 18% in outer Belfast to 23% in the north of Northern Ireland ‐ this area includes the local government districts of Coleraine, Derry, Limavady, Moyle and Strabane. Comparisons across these geographical areas will be further affected by differing age profiles (NISRA, 2007). Geographical Information Systems’ (GIS) mapping study of wheelchair usage in Northern Ireland has identified a lower prevalence rate in the commuter belt around Belfast and higher concentrations in areas of our inner cities and rural communities. The ability to determine the location of need is critical to the strategic planning of housing services for disabled people.

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Figure 4: Distribution of wheelchair users in Northern Ireland by ward

Review of the Northern Ireland Wheelchair Service

A major review of the wheelchair service was published by the DHSSPS in August 2008. A number of findings from this review are relevant to the planning of housing services for wheelchair users. Wheelchair users and particularly assisted wheelchair users need some of the most complex housing services.

It is estimated that there are approximately 35,000 wheelchair users in Northern Ireland, including people who purchase their wheelchair privately (DHSSPS, 2008) and people who require occasional use outdoors. Of these, 25,627 are known to the Regional Disablement Service at Musgrave Park Hospital (March 2011). Children under 18 account for 9% of service users and adults and older people account for 91%.

The demand for wheelchair services is continuing to grow. As Figure 5 shows there are significant increases in the demand for wheelchairs, with many requests requiring an urgent response. This has implications for planning housing supply to address demand.

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Figure 5: Wheelchair service referral activity April 2006 – April 2011

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

2006-7 2007-8 2008-9 2009-10 2010-11

New Wheelchair Users Existing Users Total Activity

Every new service user who requires a wheelchair on a daily basis will require an OT assessment of the home environment and a housing response either through adaptations, housing transfer to existing wheelchair standard housing, new build wheelchair standard options or various types of communal care settings.

There is also evidence of a growth in demand from younger service users as children’s (paediatric) services develop.

Improvement in the care of people with spinal cord injury means that life expectancy is now approaching that of the general public (DHSSPS, 2008).

An NIHE GIS mapping survey of the location of wheelchair users using RQIA and RDS data (2009) indicates that 93% of wheelchair users are resident outside nursing or residential homes and 7% are living at residential and nursing home post codes.

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Community occupational therapy assessment

DHSSPS figures for referrals to community occupational therapy services indicate a high level of demand for services over the last decade. As Figure 6 shows, the service received 50,673 referrals from all sources in 2007 and 47,363 in 2009 (new data definitions to measure demand for allied health professions were introduced by the DHSSPS in September 2007 which explain a slight reduction since then).

Figure 6: Referrals received by Occupational Therapists 30th September 2001 – 30th September 2009

42,000

43,000

44,000

45,000

46,000

47,000

48,000

49,000

50,000

51,000

52,000

2001 2002 2003 2004 2005 2006 2007 2009

Recommendations for housing adaptations

Need is also reflected in the level of housing adaptations provision.

The DHSSPS Price Waterhouse Cooper audit of the Occupational Therapy Service in 2008 considered the volume of housing adaptations by provider (Figure 7).

The number of recommendations for housing adaptations must be considered in relation to the size of the sector. Many of the high volume adaptations delivered by HSC Trusts are relatively low cost, with the exception of lifts.

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23

Figure 7: Provision of adaptations by provider

10,777 (50%)

1,181 (6%)

3,437 (16%)

5,883 (28%)

NIHE property NIHE Grants Housing associations HSC Trusts

More than one adaptation type might be provided in the same household e.g. the

HSC Trust may provide a lift in combination with a DFG grant for a shower and ramp.

Table 2: Social housing adaptation volumes

Tenure Extensions Showers Heating Lifts Total

NIHE 892 3,958 1,290 583 6,723

Housing associations 28 2,055 16 51 2,150

Total 920 6,013 1,306 634 8,873

(Source: NIHE/DSD report on paid housing association claims 2007‐09)

The table above illustrates the scale of investment in social housing by type over a three year period.

Conclusions The numerous studies examined as part of this review highlight a range of demographic, social and medical factors which will significantly increase future demand on health, social care and housing services in Northern Ireland.

The current lack of a consistent approach in defining and measuring disability across all parts of the UK constrains planners and providers from targeting areas of greatest need and channelling resources to meet demand.

SECTION 2 ‐ The value of housing adaptations and assistive technology


Introduction “There is a wealth of detailed evidence that housing adaptations are beneficial to individuals, families and the state. The evidence presented here will indicate why it is appropriate to treat them as an investment that will deliver dividends in terms of both social benefits and financial savings” (Office of the Deputy Prime Minister, 2005, p.16)

“If a drug was discovered with a similar cost‐profile, it would be hailed as the wonder drug of the age” (Audit Commission, 2000)

In recent years a systematic approach to the co‐ordination of housing, health and social care research evidence is emerging, demonstrating the benefits of housing adaptations and assistive technology in promoting the health and well being of our population and cost savings for public services of such investment (Awang, 2004, Heywood, 2001&2006, Office of the Deputy Prime Minister (ODPM), 2005 and Office for Disability Issues, 2007).

Many key findings in this area were identified by the Office for Disability Issues and University of Bristol who undertook a major literature review of published evidence in this area in 2006.

Using a similar framework this review presents evidence from actual case studies in Northern Ireland. It is complemented by strategic Northern Ireland and UK wide statistical data and includes specific benefits for housing providers. Data from the recent Northern Health & Social Care Trust audit on the effectiveness of minor adaptation provision in private sector housing is also included.

The case studies included are summaries. Full details of these and other UK wide case studies and a breakdown of costs and benefits are available at www.cot.org.uk

Reducing or removing the cost of hospital/residential/nursing home care “The cost of residential (nursing) home care for a wheelchair user with significant disability is estimated to be £700‐800 per week – the equivalent of £400,000 (or more) in ten years. The provision of housing adaptations and equipment can allow a person to move back to family from a hospital or nursing home setting or defer entry into a nursing or residential home. Delaying admission to a residential setting will save £26,000 per person, less the cost of the adaptation.” (Heywood, 2007 p.2)

Case Study 1

Mr A is a middle‐aged gentleman who lives with his wife and teenage children. His elderly disabled mother‐in‐law also lives with them in a ground floor granny flat.

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As a result of brain surgery he was paralysed on his right side, with loss of sight and speech. He was admitted to hospital following a serious fall at home where he needed the assistance of two carers for personal care.

He is now a full time wheelchair user. He could not return to his home as the safety of carers would be compromised due to lack of circulation space and wheelchair access.

A private nursing home placement for a two year period was therefore required at a cost of £48,464 until adaptations to his home were carried out.

The Community Occupational Therapist (OT) explored options with the family such as various lifts, moving home, a permanent nursing home placement and adapting the existing home. His wife wanted to stay in her house if at all possible, mainly because the accommodation suited the needs of her disabled mother, family and carers.

Following liaison with the NIHE Grants Department the ground floor adaptation was completed within two years of receipt of Community OT recommendations at a cost of £29,527.

This meant the existing outlay of nursing home costs was no longer needed. The benefits to Mr A could not be calculated in monetary terms as his wife advised he had been unsettled in the nursing home and anxious to return home. His wife stated he was happy and contented to be at home with a better quality of life. For Mrs A the stress and strain of visiting her husband several times a day has been reduced. This housing adaptation reunited the family.

If this housing solution had not been found, the client would have had to remain in the private nursing home at a recurring cost of £24,497.00 p.a. Over a 20 year life span this would cost at least £489,940.00.

Reducing the cost of home care “Appropriate adaptations and assistive technology can facilitate independence both by substituting for traditional formal care and by supplementing these services in a cost‐effective way” (ODPM, 2005 p19).

“An hour’s home care per day costs £5,000 per year. At national level, because of the large numbers and burden of revenue payments, the potential for savings is again in millions” (Heywood, 2007 p11).

Case Study 2

Mr. A is an 83 year old gentleman who lives in a privately owned bungalow with his wife. He has a very supportive and attentive family who live nearby.

Mr. A has limited standing balance and stamina which results in fluctuating mobility and difficulties with everyday activities. His wife is his main carer who is in relatively good health. She assists him with bathing and personal care and manages all domestic activities of daily living.

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Mr. A had a heart attack a few years ago, and since this he has been finding bathing an increasing problem. He also has osteoarthritis affecting, shoulder, hip and knees.

Mr. A’s bathroom facilities include a toilet, wash hand basin and bath. There is no shower in situ. Mr. A has been unable to get out of the bath and his wife is very concerned about coping.

Following assessment a bath lift was provided at a cost of £285 and has promoted Mr. A’s independence in bathing, reduced the need of his wife’s help and support and avoided the commissioning of a package of personal care twice weekly for 30 minutes each session, which would have cost the trust £588.64 on a yearly basis. This one off payment of £285 for a bath lift was a cost effective solution. It also meant that the client did not need to apply for a Disabled Facilities Grant for a level access shower at £2,900. Mr. A is very satisfied with the solution to his bathing problem.

Northern Health and Social Care Trust Audit findings

87% indicated that their independence was improved with 78% able to complete certain functional tasks without assistance. Of these 51% required assistance prior to the fitting of the adaptation.

75% reported that the adaptation assisted the carer with their management. Reducing the demands on carers helps to demonstrate the value of such work in enabling the client to be cared for in the home environment.

Prevention of health care costs for carers

It makes moral, legal and economic sense to ensure the health and safety of carers, both formal (statutory/community and voluntary sector) and informal (tenants, family and friends), when providing essential personal assistance for disabled people, through evidence based environmental design and equipment provision.

Musculoskeletal disorders (MSDs) are the most common occupational illness in Great Britain, affecting 1million people a year. They include problems such as low back pain, joint injuries and repetitive strain injuries of various sorts.

More than a third of all over‐three‐day injuries reported each year to the Health and Safety Executive (HSE 2001/2002) and local authorities are caused by manual handling. An estimated 12.3 million lost working days were caused by these work related MSDs. On average each sufferer took about 20 days off in a 12 month period.

The most up to date figures show that MSDs cost society £5.7 billion p.a.

In 1998 the health care costs due to back pain alone were £1,632m, of which £565m was the cost of non‐NHS health care costs (Maniadakis & Gray, A., 2000).

Not surprisingly prevention and control of MSDs, such as manual handling injuries, has been identified as a priority by the Health and Safety Commission.

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Preventing accidents It is estimated that the cost of a seriously injured home accident casualty is £45,600 and a slightly injured casualty that attends hospital is around £8,300. These costs exclude ongoing GP and long term care costs. The estimated overall UK cost of home accident casualties is £94,600 million per annum (Transport Research Laboratory, 2010).

Home accidents in Northern Ireland

The DHSSPS Home Accident Prevention Strategy and Action Plan has identified that 41% of all accidents occur in the home. Of these 66% occurred inside the home and 34% occurred directly outside the home.

In 2000‐2001 there were 9,042 hospital admissions resulting from home accidents.

In 2000‐2001, 75 deaths were attributable to home accidents of which 27 were due to falls.

The cost of home accidents to the DHSSPS is estimated to be £78m and to the economy in total is £80m p.a. respectively (DHSSPS, 2005).

Housing adaptations can help to avoid/address many types of home hazards identified under the Housing Health and Safety Rating System, particularly those associated with falls, burns, carbon monoxide/fuel combustion products and excess heat/cold (Roys et al, 2010).

Falls ‐ A growing problem

The treatment of hip fractures places a heavy burden on Health & Social Services and recurrent falls in older people are one of the leading causes of hospital admission.

As the UK population ages, the cost of falls is expected to escalate.

Elderly people are most at risk of hurting themselves on stairs and more than 100,000 are treated for stair injuries every year. Of these, more than half end up in hospital with serious injuries. Over 1,000 older people die each year as a result of falls on stairs in England (BBC, 2000, Department of Trade and Industry (DTI), 1999). In fact every five hours one older person is killed by an accidental fall in the home (DTI, 1999).

The average cost of a hip fracture in the United Kingdom is between £12,000 (hospital care only) and £28,665 (including one year’s residential care). Intermediate care is more cost effective at (£21,014). If a year’s residential care was required after a fracture this would be 4.7 times the cost of a routine housing adaptation (£6,000) and more than 100 times the cost of fitting a grab rail to prevent a fall. In Northern Ireland the estimated total cost of in‐patient episodes with a diagnosis of hip fractures in 2008/09 was £19.9m.

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The institutionalisation rate for older people following a fall has been estimated to be 13% of those previously dwelling in the community in the year following the fracture (PSSRU, 2007).

Visual impairment leads directly to 90,000 falls per year in England and Wales at a cost of £130m ‐ Swedish research indicates large savings have been made through housing improvements and equipment for people with visual impairment (Office of Disability Issues, 2005).

The UK cost estimates for falls to the NHS and Personal Social Services vary from £726m (Parrott, 1997) to £909m (Scuffham and Chapman, 2002). 63% of these costs are incurred from falls in those aged 75 years and over. Measures to reduce the incidence of falls will generate significant savings to the NHS and society as a whole (Parrott, 2000).

Responding to falls

The National Institute for Clinical Excellence (NICE) states that the causes of falls are multi‐factorial including balance impairment, muscle weakness, polypharmacy and environmental hazards. NICE recommend a combined package of intervention programmes, including environmental modification following home hazard assessment (NICE, 2004).

Housing allocation of single level accommodation and housing adaptations provision, including the provision of low cost grab and handrails through to lifts and extensions where people cannot safely manage stairs play a significant role in targeted accident prevention. Housing adaptations form an integral part of regional and national policy and guidelines on accident prevention.

Case Study 3

Mrs C is a lady in her mid 60s who lives with her husband in a two storey privately owned property. Owing to age related medical conditions her mobility was greatly reduced and she relied heavily on her husband for support and supervision on steps and stairs and other areas of personal care and daily living.

The OT provided advice and education to improve transfers, and safety on steps and stairs which helped reduce Mrs C’s anxiety levels, as managing stairs was her “biggest dread”.

A level access shower at a cost of £3,000 was recommended through the Disabled Facility Grant process, a stair rail and modification of steps at the back door were provided by the HSC Trust following assessment at a minimal cost of £437.

The risk of Mrs C having a fall was high and the projected costs of hospital treatment with 8 weeks rehabilitation at home and a personal care package would have been approximately £21,014.

This study highlights the benefits of pro‐active falls prevention for a nominal cost. The benefits for Mrs C were significant, giving her increased confidence and independence and most importantly reducing her anxiety and fear of falling. For her husband it was “peace of mind”.

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Northern Health and Social Care Trust Audit findings

Of those surveyed 88% reported that provision of the adaptation improved their safety within the home.

These benefits are supported by comments such as "had falls previously but none since" and "the rails have reduced my fear of falling".

Prevention of other health costs

Home heating and health

The relationship between inadequate indoor heating and excess winter death has been extensively researched (Eurowinter Group 1997, Wilkinson et al, 2001). Wilkinson concluded there an excess of 40,000 deaths each winter compared to the death rate in non‐winter months. In particular there is a 23% excess of deaths from heart attacks and strokes. Baker from the Centre for Sustainable Energy has produced evidence showing a particularly strong correlation between indoor cold and increased risk of strokes, heart attacks and respiratory illness.

Many older and disabled people cannot safely/independently manage certain types of older manual heating systems, thus placing them at increased risk.

Targeted heating adaptations can directly address this need and make savings on home help needed to light and maintain the fire.

Avoiding risks for formal carers

MSDs represent the most common kind of reported injury within the health and social work sector as a whole. In 2007/08, handling accounted for 41% of reported injuries to workers, and slips and trips accounted for 25%.

In the health services, manual handling injuries account for 40% of absence from work through sickness.

There are over 5,000 manual handling injuries reported each year which occur in the health service sector. Approximately half of these happen during handling of patients (Health and Safety Executive, 2010).

Avoiding risks for informal carers

Without appropriate adaptations and equipment, carers are at risk (and so is the disabled person) when carrying children upstairs, helping people in and out of the bath, on and off chairs/toilet and assisting a wheelchair user over thresholds and steps.

38% of carers assist someone in their own home and 61% of carers themselves have some type of health problem.

HSC Trust moving and handling equipment combined with jointly planned adaptations ensuring adequate space for safe moving and handling are critical to

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ensure the health and safety of informal carers (tenants, family, friends) and formal (paid statutory carers).

Reducing physical and emotional stress for carers

Case Study 4

This young man, (Mr E), lives in a privately owned 3 bedroom, 1 bathroom bungalow with his parents and a sibling. Mr E lives with severe autistic spectrum disorder with associated injurious behaviour and is incontinent of both bladder and bowel, requiring total personal care which is carried out by Mr E’s mother.

Like so many other informal carers the situation has taken its toll both on Mr E’s mother’s physical health and personal relationship with her husband.

In this instance the OT made recommendations for a large double bedroom with padded panels throughout, to reduce risk of self harm, a separate bathroom facility and a secure external area at a cost of £37,000 DFG grant aid.

The main benefit to Mr E is an overall improvement in his behaviour. He is now less agitated and there is a decrease in self injurious behaviour.

The benefits of having an improved living environment has reduced the stress on the family and his mother reports that for his younger brother it has created an opportunity for “normal” social interaction with his friends therefore improving overall family relationships. For his mother there is less physical strain and her long standing back problem has eased.

Should this housing solution not have been achieved, the family unit would have needed increased respite and ultimately care would have broken down. Therefore this adaptation has prevented the admission into nursing home care and it is projected that the existing frequency of respite care, at £620 per weekend, will reduce significantly.

Preventing waste Further case study evidence of the effectiveness of housing adaptations and assistive technology has been compiled by the College of Occupational Therapists and is available at: www.cot.co.uk/ot‐helps‐your‐client/reablement

“If for the same money a disabled person may have someone to come in every day to lift them on and off the commode and help them to wash, or may choose an automatic toilet and level access shower to use whenever they please they will normally choose the solution that offers more dignity and autonomy”(ODI 2006 p6).

Case Study 5

Miss F is an elderly lady who has lived alone in her own privately owned home all her life and whilst her GP recommended she consider moving to fold type accommodation; Miss F declined ‐ “it would have killed me to move house, I’ve lived here all my life”. Due to her medical condition and physical frailty Miss F was

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advised to bring her bed downstairs and to use a commode as she could no longer manage stairs until a stair lift could be installed. Although she already had a first floor shower she could not access it.

A package of personal care and equipment was provided as an interim measure to help her wash and empty the commode. If the HSC Trust had not provided a lift this package would have cost £16,482 p.a.

A re‐cycled stair lift was provided by the HSC Trust at a cost of £506 including a bi‐annual service. The client was delighted with her stair lift ‐ “the stair lift is powerful, it means life to me, I’m really glad of it” ‐ not only has it improved Miss F’s dignity, reduced her level of anxiety and improved her independence in safely gaining access to her bathroom and bedroom ‐ “it is a relief to know it’s there”.

This case clearly indicates the need for a rapid response to ensure client dignity, quality of life and safety, by preventing falls.

Should Miss F have sustained a fall at home the cost of hospitalisation, Intermediate Care Scheme intervention (rehabilitation) and package of care at home would have been £21,002.24 in total.

Benefits for housing providers The adaptation service forms a key element of the Housing Executive’s strategic commitment to sustaining independent living. The adaptation service contributes to a number of the Housing Executive’s Corporate Objectives:

Delivering the Decent Homes Standard

Promoting independent living

Building a stronger community

Delivering better public services

Disabled Facility Grants enable those people living in the private sector to adapt their homes. If this facility was not available people would be unable to function within their homes and would have to move to more suitable accommodation, this could increase demand for social housing.

The adaptation service and Supporting People Programme assist people to live independently. Support can take many forms; in some cases the supply of a simple device can assist an individual to live independently e.g. a ramp to the front door. For others advice or personal assistance may be the right solution or new or alternative accommodation may be required. The adaptation service plays a key role in supporting independent living. The Supporting People Programme relies on the fact that housing can be adapted when required to maximise the person’s independence. In the absence of this resource many people would need higher levels of support/care.

Adaptations ensure that disabled people are socially included by enabling them to live independently within their local community with family or carers. Building stronger communities improves the quality of life for tenants, promoting good

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relations and ensures that disabled people can live without fear of discrimination and intimidation. When carefully planned moving a person to an alternative housing solution can create a sense of community e.g. sheltered complex.

"Unable to get out of the house prior to ramp installation" (NHSCT, 2010)

Adaptations are critical to the health & safety of disabled people, failure to provide such a service would result in an increase in public liability insurance claims. The provision of an adaptation service is two‐fold in that it serves the needs of the disabled person and also promotes responsible litigation management.

We have statutory responsibility to work with disabled people and their representatives when evaluating, planning and delivering services for disabled people including the provision of adaptations. Future challenges will be to ensure that the strong collaborative working relationships that have been established continue. Collaborative working is at the heart of delivering better public services.

Reducing homelessness

Almost three quarters of all people meeting the criteria for functionality points do so because their dwelling is deemed to be unsuitable for their needs.

Figure 8: Reasons for the award of Full Duty Applicant status: Homelessness 2010 (All tenures)

4% 4%

2%

3%2%

2%7%

2%

74%

Relationship breakdown Breakdown of sharingDomestic violence Accommodation not reasonableNeighbourhood harrassment Mortgage arrearsOther Loss of private tenancyNo accommodation in NI

There may be instances where low or medium cost adaptations packages could address unmet need as a cost effective alternative to moving to social housing, with the associated costs that are involved for the client and housing providers. Many of

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these clients may progress to Full Duty Applicant (FDA) status under homelessness legislation depending on other measures of vulnerability.

Reducing the demand on social housing from other tenures

There is significant cross tenure demand for scarce social housing for a variety of reasons. One reason is that people may not be able to secure affordable and accessible new build or existing housing in other tenures to meet their needs.

There are significant numbers of people applying for social housing from the private rented sector (343) and owner occupier sectors (540) on grounds of unsuitable housing. These clients can request an assessment of need under homelessness legislation and may progress to become full duty applicants if their accommodation is deemed to be unsuitable on grounds of disability or other priority needs. It is important that adequately funded adaptations services are available in all tenures to prevent a rise in demand for social housing due to potential homelessness on the grounds that accommodation might not be otherwise reasonable to continue to occupy.

Any reduction in resources for housing adaptations services will have a detrimental effect on general housing waiting lists.

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The value of adaptations and assistive technology for our economy In a world where the population is ageing and with rising levels of disability, there is substantial economic value to Northern Ireland’s building, technology and commercial sectors arising from both the private purchase and statutory provision of housing adaptations and assistive technology. The British Healthcare Trades Association has over 400 assistive technology companies registered throughout the UK. Twenty nine Northern Ireland assistive technology companies are registered with Assist Ireland.

The NIHE estimates that there may be between 800 to 900 small to medium sized firms involved in the delivery of housing adaptations in Northern Ireland. While definitive overall figures are not available the NIHE estimates on the basis of adaptation activity that the number of firms undertaking grant work has increased in recent years as more firms have turned to Disabled Facilities Grant work as a result of the general economic downturn.

The investment in Home Improvement Agencies both helps to support people in working through the DFG process and helps to ensure that DFG resources are deployed to the construction sector.

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The contribution of housing adaptations to community “care” Housing adaptations services and assistive technology make a major contribution to community care in its broadest sense. The DHSSPS document “People First” defines community care as, “care outside hospital’’. Ideally this spectrum ranges from support offered to people at home, with access to respite and day care as necessary; through family placements, sheltered housing, group homes and hostels where increasing levels of care are available; to residential care and nursing homes for those for whom other forms of care are either inappropriate or no longer enough.

An essential characteristic of community care is that it helps people to live as independently as possible in their own homes or in homely settings in the community. One of the key objectives of People First is to ensure that ”people are helped to stay in their own homes for as long as possible, so that residential, nursing home and hospital care is reserved for those whose needs cannot be met in any other way” (DHSSPS, 1991 p11).

There are a number of interagency funding streams which contribute to community “care” as defined in People First.

Figure 9: HSC Trust expenditure on community care 2008/09

£22,293,346 (6%)

£63,035,742 (16%)

£153,939,686 (38%)

£7,241,975 (2%)

£151,521,518 (38%)

Nursing home care Residential home care Supporting PeopleDomicilliary care Direct payments

Source: HSC Board 2008/2009.

In addition to HSC funding above, there is significant investment by housing providers. Alongside housing adaptations, one of the most significant funding streams comes from Supporting People which is jointly funded in partnership with HSC Trusts.

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The founding principles and purpose of the Supporting People Programme is to promote independent living. The current funding and governance arrangements, incorporating a dual funding and oversight regime, promotes a healthy tension which ensures the housing support element is not subsumed and secondary to care provision. Rather it is complementary to personal care and is able to make a significant contribution to promoting independent living.

Table 3: NIHE Supporting People expenditure

capital revenue

2008/09 £13,867,382 £34,411,598

2009/10 £17,687,681 £34,480,351

Figure 10: Financial components of community care

£153,939,686

£151,521,518

£63,035,742

£41,007,068

£22,293,346

£21,629,000

£16,467,000

£8,296,000

£7,241,978

£3,166,000

£1,857,000

£292,572

£0

£20,000,000

£40,000,000

£60,000,000

£80,000,000

£100,000,000

£120,000,000

£140,000,000

£160,000,000

£180,000,000

Nursing Home Care Domicillary Care

Residential Home Care Supporting People NIHE

Supporting People HSC Trusts NIHE Grants

NIHE Public Sector HSC Community Loan Equipment

Direct Payments HSC Trust Adaptations

Housing Association Adaptations HSC Sensory Loss Equipment

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Footnote: please note that the HSC figures for supporting people, domiciliary care and direct payments are based on fully validated figures from 2008/2009 and are therefore used for illustrative purposes only. 2010/2011 figures for HSC residential care (£66,595,495) and nursing home care (£170,348,192) signify a substantial increase in expenditure. These figures also exclude certain financial benefits which can be used to provide personal care or promote independent living.

The Bamford Review will result in substantial inter‐agency investment over the current CSR period. A proportion of this funding may be delivered through the provision of housing adaptations.

Table 4: Bamford Funding

Bamford Funding ‐ Per DSD Budget

REVENUE FUNDING YEAR CAPITAL FUNDING

Annual increase Cumulative increase on baseline budget

2011/12 £27,300,000 £1,300,000 £1,300,000

2012/13 £30,000,000 £3,200,000 £4,500,000

2013/14 £25,000,000 £7,200,000 £11,700,000

2014/15 £11,630,000 £5,000,000 £16,700,000

£93,930,000 £16,700,000

The relationship between services

These services are often complimentary and interdependent (see Figure 11).

A primary objective in planning these services is the promotion of independent living, reduce unnecessary dependencies and offering choice and control. As higher levels of care incur greater costs, services which reduce the need for preventable personal care have particular value in the current economic climate.

In 2009 an estimated 235,559 contact hours of domiciliary care were provided by HSC Trusts in Northern Ireland, 6% (13,166) more than in 2008 (222,393).

There are inter‐dependencies between some of these funding areas as investment in one service can reduce expenditure in other areas. Investment in assistive technologies can reduce the need for certain adaptations services but where essential housing adaptations and assistive technology can in turn reduce the need for more costly domiciliary, residential, nursing home and hospital care.

These interdependencies also mean that a loss of resources from one funding stream could result in a requirement for a more costly response from another funding stream.

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Depending on the extent of care needs, housing adaptations and assistive technology combined with personal care/ support packages, will often present a more cost effective means of providing the type of care, independence and autonomy that people want in their own homes.

The important role that housing adaptations and assistive technology can play as preventative services as part of targeted interventions which make considerable savings in care costs has been formally recognised and is reflected in current policy for England (DH, 2010, DH 2011) and Wales (SSIA, 2011)

See Figure 11 which illustrates policy and service organisation in Wales.

Figure 11: Better support at lower cost – Wales

Universal Services Targeted Interventions

Care & Support Supply

Information & advice – including self‐funders

Equipment & aids to everyday living and Telecare products

Eligibility criteria applied

Commissioning the right range of services

Health Services Intermediate care and reablement

Assessment & care management

Macro and micro procurement

Wellbeing & community offer – social capacity

Supported housing Direct payments Contracts & spot purchasing

DFGs/Adaptations Advocacy & support

Direct payments & supply of personal assistants

Care & repair

Falls clinics

The table below illustrates comparative weekly and annual costs in Northern Ireland.

Table 5: Weekly & annual care costs in Northern Ireland HSC Board

Type of care No. of clients in Northern Ireland

Average weekly cost per person

Average annual cost per person

Hospital care £1,554 per week (1999)

£80,808

Nursing home care 7,432 £385 £20,080

Residential care 4,119 £255 £13,293

Supporting People 1,240 £397 £20,709

Domiciliary care 29,030 £100 £5,193

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Direct payments 1,145 £127 £6,597

Source HSC Board 2008/09

Footnote; the Supporting People figures represent the HSC component only. The NIHE also makes both capital and revenue contributions to this programme.

Although housing adaptations and community equipment, combined with domiciliary care or direct payments packages, are generally a much more cost effective means of delivering community care, there are some instances, where the cost of very intensive domiciliary care packages can exceed nursing home costs. Current estimates are that 3% of cases would fall into this category; however as housing adaptations and community equipment costs are not included in these regional calculations, the real costs of complex domiciliary community care options will be underestimated.

SECTION 3 ‐ Legislation and Policy


Introduction Legislation relating to housing adaptations and related community care services has been evolving since the 1970s in Northern Ireland and since the late 1980s legislation to strengthen the rights of disabled people and their carers in society has been enacted. One of the fundamental objectives of more recent legislation is to promote social inclusion and address the causes of social exclusion in society. As a result the social model of disability (Oliver, 2004) has been embraced as important influence on statutory policy development. (ODPM, 2005, DHSSPS, 2010)

Some of this legislation relates to one sector only, but other legislation is cross cutting. An outline description of the key legislative duties of the DHSSPS/HSC Board/Trusts and the DSD/NIHE/housing associations is outlined in chronological sequence with reference to relevant sections/articles where they relate to housing adaptations services. Some key legislation and policy documents from the Office of the First Minister/Deputy First Minister, Department of the Environment /Department for Regional Development and Department for Finance and Personnel which may influence housing adaptations are also referenced.

While there are a considerable number of policy documents which influence service delivery in this area, only selected relevant documents are considered in this paper.

The legislation in this area is constantly evolving, can have cross sector impacts, and is sometimes open to interpretation, therefore regular co‐ordinated reviews of departmental guidance to assist service delivery are required. This section will consider the policy issues arising in each sector and where appropriate, cross reference will be made to legislation in other parts of the UK to assist discussion of key policy issues arising in Northern Ireland.

Key issues in current legislation and policy This section will consider some of the current policy issues for each of the major stakeholders in the housing adaptations process.

Historical context

When the housing adaptations service was last reviewed in 2001‐ 2003, it was concluded that “existing legal and financial frameworks for adaptations are not financial impediments to improving the service” although further research into aspects of the Disabled Facilities Grant in relation to children with disabilities and more flexibility in the consultative process between occupational therapy services and the NIHE was recommended (NIHE/DHSSPS 2003 p.7)

A subsequent DSD review (DSD, 2003) of DFG means testing resulted in abolition of the means test for families with disabled children in Northern Ireland in 2004 which

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in turn triggered reviews and abolition of similar means testing in Wales and England.

The funding models for housing adaptations delivery in Northern Ireland based on the current interpretation of legislation are considered to be some of the more effective in the UK.

In the current environment of economic downturn there is renewed scrutiny and prioritisation of resources in relation to statutory duties in all sectors as there are increasingly scarce resources to address growing needs.

Service user involvement in the planning, delivery & evaluation of housing adaptations & related assistive technology services

It is clear that there is a robust legislative and policy framework for the formal inclusion of disabled people and their representatives in the planning, commissioning, delivery and evaluation of housing adaptations and related assistive technology services for disabled people.

Cross sector planning of user involvement initiatives

Currently this is being delivered through a variety of methods in the various sectors:

In housing, the emergent NIHE disability forum will advise the NIHE Housing Community Network

In the Health and Social Care Sector there are a number of initiatives to strengthen service user involvement, including initiatives for disabled people and their carers e.g. the involvement of disabled people in the planning, evaluation and delivery of wheelchair services

The Patient and Client Council (PCC) was established on the 1st April 2009, as a powerful, independent voice for people. They have a remit to ensure every patient and client has every opportunity to express their views in health and social care

The Public Health Agency will take a lead role in establishing a regional Personal and Public Involvement Forum

Further inter‐agency co‐ordination of initiatives around the needs of service users who require adaptations and related assistive technology services is required to reflect the cross sector nature of the service user’s journey, ensure the most efficient and effective use of public resources and to consider the capacity of the community and voluntary sector to deliver on multi agency consultation.

In considering the legislative and policy priorities above in relation to housing adaptations services, the need for stakeholders to develop disability action plans and specific priorities emerging from this Interdepartmental Review of Housing Adaptations, a number of priority areas for service user involvement have been identified (See recommendations within the Executive Summary)

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Issues regarding DHSSPS/HSC policy on housing adaptations services

The ultimate legal responsibility for ensuring that adaptations or other solutions are provided to meet the assessed needs of disabled people lies with the DHSSPS/HSC Board/HSC Trusts. There are statutory responsibilities both for the assessment of need and to ensure arrangements are made to provide housing adaptations where appropriate, either by direct provision or to secure that provision through other agencies. (Bull, 1998, Mandelstam, 2005, Wilson, 2010) Assessed need may be met either through housing adaptations or by other means. (Withnell, 2004) These duties are delegated from the DHSSPS to the HSC Board/HSC Trusts.

The requirement for HSC Trusts to assess needs (Section 1: Chronically Sick and Disabled Persons (NI) Act 1978) to determine if a person is disabled and what type of facilities are “necessary” for specific types of disabilities (Section 2) is generally understood by both agencies. Arrangements have also been jointly agreed between agencies for a range of minor adaptations which can be safely undertaken by housing authorities without the need for OT assessment, for example an additional stair rail. This is delivered through the use of “select lists” of such adaptations.

When it comes to provision in relation to Section 2: Chronically Sick and Disabled Persons (Northern Ireland) Act 1978 and Article 15 of the Health and Personal Social Services Order 1972 there is less clarity regarding the exact legal interpretation of “make such arrangements and provide or secure the provision of such facilities. The DHSSPS consider that arrangements for the provision of housing adaptations services have been addressed both in DHSSPS circulars and service agreements jointly agreed with the NIHE (see the Service Agreement between NIHE and HSC Trusts at the end of this section)

At an operational level there is also a requirement to clarify the interpretation of additional facilities referenced in section 2 e) “the provision of assistance for that person in arranging for the carrying out of any works of adaptation in his home or the provision of additional facilities designed to secure the greater safety, comfort or convenience. It is already clear that “additional facilities” can include the provision of assistive technology.

Can “additional facilities” include other non‐adaptations housing solutions which might meet assessed need, such as transfer to adapted stock or a new build housing scheme or financial incentive to move to a more suitable home?

Policy clarification in this area is a prerequisite to the further development of interagency case management and joint option appraisals.

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HSC provision of Community OT assessments and housing adaptations

Impact of the Review of Public Administration 2002 – Present

Since 2007 HSC organisations have been subject to continuous change at various organisational levels, starting with a major rationalisation of Northern Ireland’s HSC Trusts. These changes resulted in mergers between community and acute hospital Trusts. By 2011 the most significant changes had been implemented. Due to the scale of this change clarification of delegated statutory responsibilities for housing adaptations services within new HSC organisations is required, and co‐ordination of activity at numerous HSC organisational levels is required to plan, commission, deliver and evaluate these services.

HSC Trust delivery of housing adaptations services

In addition to Community Occupational Therapy assessment of need, HSC Trusts are responsible for the provision of lifts, minor works in private sector housing and ceiling track hoists in all tenures.

DHSSPS Priorities for Action targets

The DHSSPS have established Priorities for Action targets relating to Community Occupational Therapy waiting times and HSC Trust adaptations provision.

The Allied Health Professions, including Community Occupational Therapy waiting time targets have been improved over time and are subject to annual review.

Additional DHSSPS targets have subsequently been established for certain types of housing adaptations provided directly by HSC Trusts.

By March 2010, all lifts and ceiling track hoists were to be installed within 22 weeks of the OT assessment and options appraisal as appropriate, and all urgent minor housing adaptations were to be completed within 10 working days.

Significant progress regarding regional performance for OT assessment and HSC Trust adaptations delivery has been achieved, however it is likely that due to increasing financial pressures within HSC Trust’s, the ability to sustain and build on progress will be challenging. This area will require ongoing monitoring and proactive commissioning activity to maintain regional equity and prevailing standards of service. Further co‐ordination and integration of HSC activity is required to support DHSSPS policy in this area and there is scope for further procurement improvements to ensure value for money in service delivery.

HSC Trust minor works / Disabled Facilities Grants interface

The review has identified that due to varying HSC Trust financial thresholds for minor adaptations, the interface with the DFG system is not always consistent. HSC Trust

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adaptations provision is free at the point of delivery while the DFG system is means assessed. (except for disabled children)

HSC “Top Up” payments

Routine “top‐up” payments by Boards and Trusts to DFG grants ceased in December 1998 as a result of DHSSPS circular HSEE (DMHU) 6/98. This circular clarified that there were some very exceptional circumstances where Boards and Trusts could consider financial assistance. A number of considerations influenced policy at that time including:

The DHSSPS considered that it may be inappropriate for one government agency to provide “top up” payments where another government agency had undertaken a means test regarding the ability to make a personal contribution. Variances in opinion regarding the application of means testing to determine fair personal contributions remain an issue (CLG, 2011) both for housing policy makers and HSC Board/ Trusts.

At that time builders were routinely charging clients more than the estimated cost of the works/grant limit as building contractors were in high demand. There was concern that requests for HSC statutory resources to meet such funding shortfalls might enhance the builder’s profit margins.

At this time the NIHE was proposing to uplift the financial threshold for mandatory Disabled Facilities Grants in exceptional circumstances and this addressed many of the situations where financial shortfalls occurred. Historically these shortfalls were often caused by exceptional onsite works. Part III: Article 64 of the 2003 Housing Order permitted payment of further sums in excess of the mandatory grant, subject to limits. Additional payments of up to £25,000 were agreed as outlined in the NIHE DFG handbook in 2007, making a total of £50,000 payable on a mandatory DFG grant.

Current position

Social Services “top up” assistance remains an option in English, Welsh and Scottish local authorities in exceptional circumstances. A framework for financial assistance, in certain circumstances, also exists in DHSSPS legislation.

More recently there have been a small number of high cost private sector grant schemes which have exceeded the statutory limit of £50,000 and where the families have sought other sources of financial assistance. An absence of clear HSC operational policy on the circumstances in which HSC contributions can be made has delayed decision making in such cases.

Assistance with temporary alternative accommodation

In 2006 The Nelson Bailey Judicial Review also clarified that HSC Trusts could make exceptional payments towards the costs of temporary alternative accommodation

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although not necessarily in his case, where it was essential for a client to vacate his home during adaptation work. The DSD and DHSSPS formed a task group to develop an interagency strategy to assist disabled people and their families in such circumstances. Policy guidance is at an advanced stage however the issue of whether the HSC Board/Trust should apply means testing has yet to be resolved. Close interagency working is required to deliver working solutions in these circumstances guided by co‐ordinated inter‐departmental policy.

Summary of top up payments

In summary, there may be circumstances albeit rare, in which HSC Trusts might consider exceptional payments to compliment existing housing provision. Such circumstances might include:

Contributions to pay for temporary alternative accommodation where people need to temporarily leave their homes for health and safety reasons to facilitate disruptive adaptations to be completed in the private sector.

Additional payments where housing authorities have reached statutory limits for housing adaptations (Over £50,000) where the applicant is on a low income and there is still a financial shortfall. In such circumstances the cost of the additional HSC contribution may need to demonstrate that the adaptations option is a more cost effective option than other forms of HSC care for the client.

Contributions to the installation and maintenance of re‐deployable environmental control systems in any sector.

Policy guidance to support the allocation of resources to people in need

Additional DHSSPS policy guidance would assist with the equitable management of an environment where resources are increasingly constrained and in particular the ability to ensure that an appropriate level of resources can be targeted to various levels of assessed need. Policy guidance is therefore required on:

General eligibility criteria and thresholds including consideration of related immigration, asylum, and domiciliary care issues.

Criteria for the provision of adaptations/assistive technology (Community OT (NI) Managers Forum 2007).

Meeting assessed need with non‐adaptations housing solutions.

Managing challenges to interagency provision.

Policy infrastructure to support interagency working

Historically inter‐agency policy on joint working arrangements have been outlined in DHSSPS Circulars (DHSSPS, 1998) and operationalised through service level agreements between the Boards, the Trusts and the NIHE (NIHE/HPSS Boards/Trusts,

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1996). The most appropriate framework(s) to define current interagency responsibilities and working arrangements including the housing association sector need consideration due to the scale of organisational change.

Additional policy guidance should also be considered to support the future development of more integrated interagency case management, particularly in relation to the respective roles and responsibilities of stakeholders when jointly considering housing options in relation to assessed need.

Issues for NIHE and housing association tenants and providers

Duties as a landlord

Social housing adaptations are provided as a matter of good practice to meet general landlord responsibilities, for example health and safety responsibilities and throughout the UK social housing providers contribute to housing adaptations provision to varying extents. There is a clear expectation throughout the UK that a proportion of housing resources, particularly resources from revenue will be identified for the provision of adaptations. How far the duties of a landlord extend regarding the provision of more costly adaptations remains unclear. Policy guidance for England states where the local authority believes that Registered Social Landlords should make a contribution to the costs of adaptations in their own properties this should be negotiated and established through formal agreement (Wilson, 2010).

Duties from Disability Discrimination Act 1995 amended by the Disability Discrimination (Northern Ireland) Order 2006

There may also be a range of minor adaptations which should be provided under the above legislation (Equality Commission, 2011). On reviewing the guidance available in Northern Ireland in relation to other parts of the UK there is now some variance in guidance for social landlords which would require an Equality Commission update.

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Legal rights of social housing tenants/landlords to access Disabled Facilities Grants

England and Wales

On closer examination of the legal status and application of the Disabled Facilities Grants, both in Northern Ireland and other parts of the UK, it is clear that in England and Wales social housing tenants or their landlords have a legal right to apply for Disabled Facilities Grants, although a distinction regarding funding streams can sometimes be made depending on whether the social housing provider is a registered social landlord (often housing associations) or local authority. A series of government and other policy documents make the rights to Disabled Facilities Grants explicit (ODPM, 2004, Heywood and Macintosh 2008, Wilson, 2010).

“Access to assistance in the provision of adaptations should not depend upon the tenure of the disabled person. A Local Authority may determine that it will fund adaptations to council owned property other than through the DFG mechanism. However this should not result in a worse service to the occupants than that received by applicants who live in other tenures. This applies to both the level of support and the time taken to provide the service” (Wilson, 2010 p.3)

“The obligation to provide DFGs to eligible applicants for eligible work …. Is primary, absolute and remains irrespective of whether other assistance is provided by social services authority or other body such as a Registered Social Landlord.” (ODPM 2004, p. 11)

“It is not lawful for persons in any tenure to be obstructed in making an application for assistance through a DFG.” (Wilson, 2010 p4)

At present an inconsistent range of practices have emerged in England where social housing tenants may have their adaptations funded from Registered Social Landlords, DFGs and/or Social Services.

“Guidance on use of the Disabled Facilities Grant (DFG) has been ambiguous, resources inadequate and different policies of 355 housing authorities and 1,300 housing associations have led to a situation where tenants have suffered long waits because of uncertain and divided responsibilities.” (Heywood and McIntosh p.4.)

“The funding of adaptations in housing association homes was once the simple responsibility of the landlord. The emergence of other possible sources has caused confusion.” (Heywood and McIntosh, 2008)

Numerous reports and reviews in England have identified the problems arising from this confused policy framework for social housing tenants (ODPM, 2004, Wilson, 2010 p4, Heywood, 2001, Heywood and Macintosh 2008).

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The use of DFG or mixed funding sources rather than dedicated funding streams for social housing adaptations have resulted in a range of difficulties in England which include:

Resource constraints ‐ where DFG resources cannot meet demand on their own.

Organisational barriers – lack of clarity regarding funding responsibilities resulting in time delays for tenants and providers. Structural factors can also restrict national initiatives which would promote consistency.

Additional expense ‐ processing social housing adaptations through the DFG pathway may cost an additional (£300‐£600) per case on administration.

Additional delays – the additional administrative stages required to process a social housing application through the DFG route would require more time.

Lack of clarity ‐ over maintenance and aftercare of grant aided facilities

Monitoring expenditure/budgeting – multiple sources of adaptations funding in the social housing sector would make monitoring and financial planning very complex.

Wales

In Wales there is no longer an equivalent of the Housing Corporation, but there is a grant for housing association adaptations administered directly by the Housing Directorate of the National Assembly for Wales. It is the Physical Adaptation Grant (PAG) and is payable out of Social Housing Grant (SHG)

Prior to the major review of DFGs in Wales, the situation was similar to the current position in England with some RSLs using DFGs. (Welsh Assembly Government, 2010)

“There is some tension around the fact that housing association and local authority tenants are not expected to claim DFG but still retain a legal right to it” (Welsh Assembly Government, 2010 p.9)

Scotland

In Scotland, separate arrangements for council and housing association tenants mean that financial assistance tends to come from the Housing Revenue Account (for council tenants) and from housing associations’ maintenance budgets and Housing Association Grant (for housing association tenants). However, where a tenant’s needs have been assessed as a priority to be met, and no funding is available through the normal channels, a tenant can apply for financial assistance under the 2006 Act. The Scottish Government’s intention is that such applications should be exceptional, as current levels of Private Sector Housing Grant are not intended for widespread use for tenants of social landlords.

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*Note however that this is meant to be exceptional. The Council would have to consent to the work and approve a grant.

Northern Ireland

Historically DFGs have only been applied in owner occupied or privately rented properties in Northern Ireland as separate funding streams for social housing tenants adaptations have been assured via the NIHE or HAG systems, however it would appear that the Housing (Northern Ireland) Order 2003 makes provision of DFGs for both owner occupiers and tenants as outlined below.

Disabled Facilities Grants: Owner’s and tenant’s applications (Housing (Northern Ireland) Order 2003

50. (1) The Executive shall not entertain an application for a Disabled Facilities Grant unless it is satisfied—

(a) that the applicant has, or proposes to acquire, an owner’s interest in every parcel of land on which the relevant works are to be carried out, or

(b) that the applicant is a tenant (alone or jointly with others).

The exact interpretation of a social housing tenant’s/landlords rights to apply for a DFG needs further legal clarification for Northern Ireland.

The current reasonably clear funding arrangements for housing adaptations organised by tenure are seen as a model of good practice for housing adaptations services in other parts of the UK.

If there were to be a change in the interpretation of legislation in Northern Ireland which in turn reshaped the existing funding and delivery mechanisms one would also need to consider:

Disruption of existing social housing delivery systems and contracts including the impact on in‐house NIHE design services and Egan contractors who currently deliver NIHE adaptations services.

Additional workload for the existing NIHE grants service processing social housing applications for Disabled Facilities Grants.

Issues for private sector clients Although the majority of DFG applicants receive full grant aid for adaptations there are a number of clients who state they cannot afford the contributions to their adaptations following means assessment and who subsequently withdraw from the process (NIHE, 2006, Disability Action, 2011). This may occur for example where clients have a small occupational pension. There are other situations where the mandatory grant limit cannot meet the actual cost of the adaptations. In such situations the client may wish to seek alternative forms of financial assistance to supplement DFG funding where they cannot meet the costs from personal contributions.

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There is clearly a requirement to further develop flexible housing strategies to allow home owners to routinely access suitable financial products to compliment Disabled Facilities Grants (ODPM, 2004).

England

The Regulatory Reform (Housing Assistance) (England and Wales) Order 2002

The powers under this legislation enable authorities to consider forms of discretionary financial assistance other than grant, but do not affect a person’s right to a mandatory DFG. This assistance may be in the form of a loan, either at market rates or at preferential rates, or by taking an equity stake in the property in return for providing help with renovation. The type of package available together with any other eligibility criteria will be determined at local level to reflect local housing market conditions. The assistance may be provided directly by the local authority or with others, so it will be possible for authorities to enter into partnerships with RSLs, other non‐profit‐making bodies or private lenders.

Authorities can also provide assistance to help home owners relocate to another home where in the opinion of an authority this represents better value for money than repairing or adapting the existing dwelling. The new property can either be already suitable to meet their needs or more suitable for adaptation.

As a result of the Order there are a number of subsidised lending options currently being developed and piloted in England and a recent CURS survey advised that 58 per cent of authorities in England were providing loans or loan/grant packages as part of their policies under the RRO.

Scotland

The Housing (Scotland) Act 2006

The Scottish Government has introduced new legislation to assist people with disabilities living in private housing. Section 73(2) of the Housing (Scotland) Act 2006 and the Housing (Scotland) Act 2006 (Scheme of Assistance) Regulations 2008 (SSI 2008/406 – the Regulations) set out the duties of a local authority in relation to works required to meet the needs of a disabled person. These duties are supported by Volume 6 of ‘Implementing the Housing (Scotland) Act 2006: Statutory Guidance for Local Authorities’, published by the Scottish Government on 29 January 2009. This legislation gives Scottish Authorities the powers to provide a range of flexible services similar to those provided under the Regulatory Reform order in England and Wales.

Northern Ireland

It is noteworthy that there is no equivalent of the Regulatory Reform (Housing Assistance) (England and Wales) Order 2002 or the Housing (Scotland) Act in

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Northern Ireland, and as a result there are subsequently fewer financial options and less flexibility than other parts of the UK for private sector clients.

Equity Release As a number of concerns have been identified with some of the equity release products currently on the market (Financial Services Ombudsman, 2008; Which, 2005) caution is required to ensure adequate regulation and protection of older people in the development of these options.

The NIHE has undertaken research into the potential of equity release for older home owners (Boyle, 2010) and identified scope to do further work in the field of assessing the need for and potential delivery models/options of equity release. The changing market conditions may influence the viability of equity release in Northern Ireland since this research was commissioned (NIHE, 2011).

Age UK Enterprises is considering embarking on the development and delivery of such a model, which will then be evaluated by the NIHE.

The DSD commenced a Review of Repair & Improvement in the Private Rented Sector between January and March 2010. The future status of this report is awaiting DSD/Ministerial consideration.

In advance of these private sector housing options being available for use in Northern Ireland, it is difficult to identify where the DHSSPS might contribute to certain types of private sector shortfalls before the interface between statutory NIHE grant assistance, personal contributions and other forms of housing financial assistance is clear.

Conclusion Having carefully considered the legislative and policy framework in each sector and between sectors, the DSD and DHSSPS consider that there is no requirement for additional primary legislation.

There is an adequate legislative framework in place to ensure the rights of eligible disabled people to avail of housing adaptations services in all tenures, where this is necessary and appropriate, following HSC Trust assessment and where provision is reasonable and practicable for housing providers and HSC Trusts.

In social housing, adaptations are one of a number of possible solutions to address assessed needs. Both housing and HSC Trust legislation can facilitate consideration of other accommodation options for disabled people, but only where such provision is considered reasonable.

A range of minor adaptations in the social housing sector which have been agreed as not requiring HSC Trust assessment are provided under the social housing providers duties as a landlord. These adaptations should be periodically reviewed.

The major funding streams for housing adaptations in housing and the HSC sectors in Northern Ireland, based on the current interpretation of legislation and policy, are

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relatively clear and efficient in comparison to funding models in some other parts of the UK and, therefore, they should be retained.

However, there is a need to further update and develop the policy framework within and, in particular, between the HSC and housing sectors to ensure improved service user involvement, clarity of responsibilities, consistency, co‐ordination and maximisation of cross sector resources, and the timeliness and efficiency of service provision.

In addition, there is also a need to ensure that housing adaptations policy is developed in a co‐ordinated manner, which interfaces as appropriate with health and social care policy areas such as community care, adult social care, disabled children, and housing policy areas such as homelessness, housing allocation, new build planning and supporting people.

Suggested Recommendations: Legislation and Policy

Recommendations to strengthen service user involvement

To strengthen the representation (on a pan‐disability basis) and engagement of disabled people in the decision making structures of stakeholder organisations and interagency bodies to advise on service planning, delivery and evaluation.

Action required:

To establish a Disability Forum to further strengthen representation of disability issues within the Housing Community Network.

HSC organisations to determine the most efficient user involvement framework in consultation with the Patient and Client Council.

Establish an expert panel of service users, Community Occupational Therapists, designers and relevant housing officers on an as and when required basis, to evaluate housing design standards and fixtures and fittings required by disabled people. The standards and performance criteria agreed will inform relevant procurement processes.

To further support the development of user interfaces with housing adaptations information services and in particular the development of an accessible housing register

All relevant statutory bodies will work within the key values and principles that underpin and define the partnership between Government and the voluntary sector set out in the 2011 document “Concordat between the Voluntary & Community Sector and the Northern Ireland Government” clearly recognising the roles and responsibilities of each partner.

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DHSSPS/DSD specific policy updates

Memorandum of understanding and new guidance

The DHSSPS and DSD will develop a memorandum of understanding (MoU) and produce a co‐ordinated circular which will clarify current policy guidance in key areas relating to housing adaptations services.

The MoU and guidance may outline (among other things):

Consideration of joint research and training initiatives.

Improvements to the coordination of strategic and operational data exchange.

For DHSSPS, the statutory and delegated organisational responsibilities of DHSSPS/HSC Board/Public Health Agency/HSC Trusts (following the Review of Public Administration) and for DSD, the delegated organisational responsibilities of NIHE /PSIS/ housing associations for housing adaptations provision.

DHSSPS & HSC Board policy framework to support, in a Community Care context, the interpretation and clarification of the Health and Personal Social Services (Northern Ireland) Order 1972 (Article 15) and Section 1 and 2, Chronically Sick Disabled Persons (Northern Ireland) Act 1978 in relation to eligibility criteria and the provision of adaptations versus other housing solutions to address assessed need.

The range of services provided by HSC Trusts and housing organisations.

The policy and governance infrastructure required to ensure equitable and consistent decision making in relation to HSC Trust assessments of need and provision of housing adaptations services.

The monitoring, commissioning and reporting infrastructure required by the DSD organisations to ensure that Key Performance Indicators (KPIs) are met.

The DHSSPS position in relation to financial contributions to private sector housing adaptations and temporary alternative accommodation where a disabled person must vacate their private sector property to facilitate adaptations.

The monitoring, commissioning and reporting infrastructure required by other HSC Organisations to ensure that DHSSPS can maintain an overview of Priorities for Action targets in relation to Community OT assessments and housing adaptations provision.

The DHSSPS/DSD organisational framework for future joint interagency working between HSC organisations and housing providers (including registered housing associations) e.g. service agreement/partnership agreements /JHASG.

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Development of a co‐ordinated DHSSPS/DSD policy and related governance framework to support an integrated cross sector case management / option appraisal system.

The DHSSPS/DSD requirement for formal user involvement in service planning, commissioning, delivery and evaluation including that of housing services.

Other measures:

Explore the potential to establish a Housing Options Service, on a pilot basis, as a means of supporting older people households in particular, in making future housing choices.

The DHSSPS will undertake a policy impact assessment regarding the transfer of responsibilities to social housing providers for minor housing adaptations provision, which do not require referral to HSC Trust occupational therapy services.

Agree and consistently apply a select list of minor works across all social housing tenures which do not require referral to HSC Occupational Therapy Services and agree a consistent interface between HSC Trusts on adaptation provision and the DFG system in the private sector

DHSSPS/DSD to conduct a joint review of complex assistive technology which promotes independent living, in consultation with stakeholders and others.

Complete co‐ordinated DHSSPS/DSD policy guidance for private sector assistance, including decant arrangements, during major disruptive housing adaptations provision.

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Legislation & Key Policies

Department of Health, Social Services and Public Safety

www.dhsspsni.gov.uk

The following legislation places statutory duties on the DHSSPS which have in turn been delegated to the HSC Board and HSC Trusts where appropriate.

The Health and Personal Social Services (Northern Ireland) Order 1972

General social welfare

Article 2: A ‘person in need’ within the meaning of the 1972 Order is a person who:

is in need of care and attention arising out of an infirmity or age;

suffers from illness or is substantially handicapped by deformity or disability; or

being a person who has asked for assistance, is, in the opinion of the Trust, a person to whom any of the social care services provided by it may be made available.

Article 15: Make available advice, guidance and assistance to such an extent as considered necessary and for that purpose make arrangements to provide or secure the provision of such facilities (including the provision of or arranging for residential or other accommodation, home help and laundry facilities) as it considers suitable and adequate (Article 15(1)). This may include arrangements for the provision of social care by any other body or person in accordance with terms and conditions agreed by the Trust (Art.15 (1A)).

Article 15(2) of the 1972 Order enables a Trust to provide assistance under Article 15(1) to a ‘person in need’ requiring assistance in kind, or in exceptional circumstances constituting an emergency, in cash. However before giving assistance to, or in respect of, a person in cash the Trust shall have regard to his eligibility for receiving assistance from any other statutory body, and, if he is so eligible, to the availability to him of that assistance in his time of need.

EEA National or Non‐EEA Nationals

Article 15(6) of the 1972 Order, which was inserted by the Immigration and Asylum Action Act 1999 (“the 1999 Act”), excludes certain categories of foreign nationals, (that is, those “subject to immigration control” within the meaning of section 115(9) of the 1999 Act) from receiving services under Article 15(1) of the 1972 Order if their need for assistance arises solely due to destitution. In brief, determining whether an EEA National or Non‐EEA National can receive a service from a Trust can be a complex task. Decisions will be dependent on:

the immigration status of individuals and relevant provisions in immigration and health and social care legislation;

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the personal circumstances and needs of an individual or his family; and

the rights of persons under the European Convention on Human Rights (“the ECHR”) and additionally, in the case of EEA Nationals, their rights under European Community Treaties (“Treaty Rights”).

Article 42(1): It is important, however, to recognise the effect of Article 42(1) of the 1972 Order. Unless otherwise prescribed, (i.e. by regulations made by DHSSPS), services under the 1972 Order are available only to persons who are ordinarily resident in Northern Ireland.

Article 67: Co‐operation between Health and Social Services Boards and district councils

In exercising their respective functions, Health and Social Services Boards, HSS trusts, special agencies, district councils, Education and Library Boards, and the Northern Ireland Housing Executive shall co‐operate with one another in order to secure and advance the health and social welfare of the people of Northern Ireland.

Article 70 The DHSS&PS may make a contribution of such amount as it considers appropriate towards any expenditure incurred by the Northern Ireland Housing Executive or a housing association in respect of the provision, maintenance and management of housing accommodation for, or the provision of special facilities for, persons in need.

Articles 4 b), 15, 67 & 70 are available at: www.legislation.gov.uk/nisi/1972/1265

The Chronically Sick and Disabled Persons (Northern Ireland) Act 1978

Section 1: Places duties on the DHSSPS to identify the numbers and identities of disabled people and ensure information on relevant services are provided.

Assessment of needs in relation to housing adaptations services are normally led by HSC Community Occupational Therapists as the HSC Trusts nominated officers to deliver this statutory duty. Nominated officers may also include Sensory support staff across the region, comprised of a range of professionals such as, Rehabilitation Workers, Social Workers, Social Work Assistants and Environment Technical Officers. Certain Sensory Support workers may also have a designated role with regard to the recommendation of certain types of equipment and minor adaptations for people with sensory impairment.

Section 2: Makes provision for the DHSS&PS to provide assistance to chronically sick and disabled people in arranging for the carrying out of any works of adaptation in their home or providing any additional facilities to secure their greater safety, comfort or convenience.

Following recommendations for housing adaptations from HSC Trust nominated officers these arrangements are delivered through the NIHE and housing associations as a landlord or in the case of private sector clients lifts, ceiling track hoists and minor works are provided by HSC Trusts directly. The NIHE deliver Disabled Facilities Grants for larger adaptations in the private sector.

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Section 2 also creates the legislative framework for the provision of assistive technology (Independent Living Equipment).

Section 3 requires the Housing Executive to have regard to the needs of the chronically sick or disabled when considering the provision of new build social housing for an area. Mobility and wheelchair standard housing were developed as a response to this duty.

Sections 1, 2 & 3 are available at: www.legislation.gov.uk/ukpga/1978/53

Disabled Persons (Northern Ireland) Act 1989

Section 3 makes provision to allow disabled persons or their authorised representatives to make representations to relevant authorities with regard to the assessment for, or provision of personal social services.

Section 8 places a duty of the board to take into account the abilities of a carer, where a disabled person is living at home and receiving a substantial amount of care on a regular basis from another person (who is not a person employed to provide such care) and to have regard to the ability of that other person to continue to provide such care on a regular basis.

The rights of carers to have their needs formally assessed with regard to their abilities to provide and to continue to provide care for a disabled person or child have been further strengthened under the Carers and Direct Payment Act (NI) 2002 including the extension of direct payments to carers in defined circumstances.

Section 3 & 8 are available at: www.legislation.gov.uk/ukpga/1989/10/contents

People First: Community Care for Northern Ireland in the 1990s

This DHSSPS policy establishes the principle that “people are helped to stay in their own home as long as possible, or in as near a domestic environment as possible so that residential, nursing home and hospital care is reserved for those whose needs cannot be met in any other way”

Chapter 5 outlines the critical role of housing partnerships in delivering effective community care. It acknowledges the importance of improved accessibility in new build housing and that adaptations to existing stock represent an important contribution to community care.

Chapter 5 is available at: www.dhsspsni.gov.uk/ec‐community‐care

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The Manual Handling Regulations Operations 1992

Duties of employers

S. 4.Each employer shall—

so far as is reasonably practicable, avoid the need for his employees to undertake any manual handling operations at work which involve a risk of their being injured; or

where it is not reasonably practicable to avoid the need for his employees to undertake any manual handling operations at work which involve a risk of their being injured

make a suitable and sufficient assessment of all such manual handling operations to be undertaken by them

take appropriate steps to reduce the risk of injury to those employees arising out of their undertaking any such manual handling operations to the lowest level reasonably practicable,

The steps required reducing the risk of injury to disabled people and their carers (both formal and informal) include the deployment of moving and handling equipment and the redesign of the home environment where appropriate. This legislation has impacted on the design standards of dwellings for assisted wheelchair users in particular.

S. 4 is available at: www.legislation.gov.uk/uksi/1992/2793/contents/made

The Children (Northern Ireland) Order 1995

This legislation requires HSC Trusts to provide a range of family support services for children in need.

Article17: The definition of children in need includes disabled children.

Article 18: In exceptional circumstances services provided may include giving cash assistance.

Schedule 2.7: The Act places a duty on service providers to minimise the effects on disabled children of their disabilities, and give children the opportunity to lead lives which are as normal as possible.

Articles 17, 18 & Schedule 2.7 are available at: www.legislation.gov.uk/nisi/1995/755/contents/made

Carers Recognition and Services Act 1995

This legislation was not enacted in Northern Ireland ‐ Policy guidance was subsequently strengthened by further primary legislation.

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Carers and Direct Payment Act (Northern Ireland) 2002

Services for carers

2. (1) Where an authority carries out an assessment under section 1(1) in respect of a carer, it shall consider the assessment and decide—

(a) whether the carer has needs in relation to the care which he provides or intends to provide;

(b) if so, whether they could be satisfied (wholly or partly) by services which the authority may provide; and

(c) if they could be so satisfied, whether or not to provide services to the carer.

In providing a housing adaptations service to meet the needs of disabled people these facilities may also address the needs of the carer, particularly in relation to moving and handling risk assessments under the Manual Handling Operations Regulations 1992.

Section 2 is available at: www.legislation.gov.uk/nia/2002/6/enacted

DHSSPS Personal and Public Involvement (PPI) 2007

Effective service user and public involvement is central to the delivery of safe, high quality services and as such is a key element of clinical and social care governance which provides the framework for quality improvement and assurance of the quality of services commissioned or provided by HSC organisations.

Statutory requirements to consult and involve people are already enshrined in both Equality and Disability legislation. The proposed statutory duty of public involvement and consultation in the Health and Social Services (Reform) (Northern Ireland) Order 2007 places a new requirement on all HSC organisations. It is therefore timely for the DHSSPS (the Department) to provide guidance to support HSC organisations to maintain and strengthen the voice of service users and carers in the new arrangements for the commissioning and delivery of services under the Reform of Public Administration (RPA).

The circular provides HSC organisations with guidance to strengthen and improve service user and public involvement in the planning, commissioning, delivery and evaluation of services as part of their clinical and social care governance.

Health and Social Care Reform Act (Northern Ireland) 2009

The statutory responsibilities and functions of the DHSSPS and HSC bodies required by restructuring are outlined in sections 1 – 21, while, in relation to user involvement, Health and Social Care Organisations are required to have in place Draft Consultation Schemes on Personal and Public Involvement (PPI)* in accordance with Articles 19 and 20 of the legislation.

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http://www.legislation.gov.uk/nia/2002/6/enacted


Change in Language

Article 1 of the 2009 Order dissolved the Health and Social Services Boards and replaced them with the Health and Social Care Board.

Schedule 6 to the 2009 Act made a general amendment of certain references to health and social services etc., as follows:

(1) In any provision of Northern Ireland legislation—

for “personal social services” or “social services” substitute “social care”;

for “health services” substitute “health care”;

for “Health and Social Services trust” substitute “Health and Social Care trust”;

for “HSS trust” substitute “HSC trust”;

for “HSS contract” substitute “HSC contract”;

for “HSS employee” substitute “HSC employee”.

(2) Sub‐paragraph (1)(a) does not apply to any reference to the name of the Department.

(3) Sub‐paragraph (1) does not apply—

to any reference in the title of an Act, Order in Council or other statutory provision;

to any reference in this Act or to any reference which is subject to amendment or repeal by or under any other provision of this Act; or

where the context otherwise requires.

The general duty of the DHSSPS is set out at section 2(1)(a) of the Health and Social Care (Reform) Act (Northern Ireland) 2009 (“the 2009 Act”)1 “to promote in Northern Ireland, an integrated system of:

health care designed to secure improvement—

in the physical and mental health of people in Northern Ireland, and

in the prevention, diagnosis and treatment of illness; and

social care designed to secure improvement in the social well‐being of people in Northern Ireland.”

1 The 2009 Act can be accessed at: http://www.legislation.gov.uk/nia/2009/1/contents

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http://www.legislation.gov.uk/nia/2009/1/contents


In the exercise of DHSSPS social care functions under section 2(1)(b) of the 2009 Act, Trusts, by way of delegation from the HSC Board, are required under the provisions the Health and Personal Social Services (Northern Ireland) Order 1972 (“the 1972 Order”)2 to:

make arrangements to such an extent as considered necessary, for the prevention of illness, the care of persons suffering from illness or the after‐care of such persons (Article 7 (1));

Articles 19 & 20 are available at: www.legislation.gov.uk/nia/2009/1/contents

2 The 1972 Order can be accessed at: http://www.legislation.gov.uk/nisi/1972/1265/contents

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http://www.legislation.gov.uk/nia/2009/1/contents

http://www.legislation.gov.uk/nisi/1972/1265/contents


Housing Legislation: Department for Social Development

www.dsdni.gov.uk

The current Housing (Northern Ireland) Order of 2003 builds on earlier Housing (Northern Ireland) Orders in 1981, 1988 and 1992 which also have relevance to this document.

The Housing Order (Northern Ireland) 1981

Standard of fitness for human habitation

Article 46.—(1) Subject to paragraph (2), a house is fit for human habitation for the purposes of this Order unless, in the opinion of the Executive, it fails to meet one or more of the requirements in sub‐paragraphs (a) to (i) and, by reason of that failure, is not reasonably suitable for occupation—

a. it is structurally stable;

b. it is free from serious disrepair;

c. it is free from dampness prejudicial to the health of the occupants (if any);

d. it has adequate provision for lighting, heating and ventilation;

e. it has an adequate piped supply of wholesome water;

f. there are satisfactory facilities in the house for the preparation and cooking of food, including a sink with a satisfactory supply of hot and cold water;

g. it has a suitably located water‐closet for the exclusive use of the occupants (if any);

h. it has, for the exclusive use of the occupants (if any), a suitably located fixed bath or shower and wash‐hand basin each of which is provided with a satisfactory supply of hot and cold water.

Article 46 is available at: www.legislation.gov.uk/nisi/1981/156

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http://www.dsdni.gov.uk/

http://www.legislation.gov.uk/nisi/1981/156


The Housing (Northern Ireland) Order 1988

The Housing Order places a statutory duty on the NIHE to provide temporary and/or permanent accommodation for certain groups of homeless persons, depending on an assessment of each person’s case. In general, the legislation will potentially assist persons who are homeless or threatened with homelessness. Priority status can be granted to a person who can prove homelessness/threatened homelessness [article 3] and who falls within the list of persons defined as having a priority need in the Housing Order [Article 5] and who became homeless through no fault of their own (unintentionally) [Article 6]. Those who satisfy the three tests of:

homelessness;

priority need; and

intentionality

are considered to have Full Duty Application status.

Article 5 states that a person will have a priority need for accommodation in the following circumstances: a person, or someone who lives with or might reasonably be expected to live with the person, is vulnerable due to old age, mental illness, disability or any other special reason (vulnerability will be examined in terms of finding and keeping accommodation and dependency while homeless; old age is defined as persons over 60 years of age);

In a situation where a disabled person cannot secure necessary adaptations to their home they will often meet the criteria for full FDA status.

Articles 3, 5 and 6 are available at: www.legislation.gov.uk/nisi/1988/1990/contents/made

The Housing (Northern Ireland) Order 2003

Article 50

This makes provision in respect of owners’ and tenants’ applications for Disabled Facilities Grant.

It prohibits the Housing Executive from considering an application for a Disabled Facilities Grant unless it is satisfied that:

The applicant owns the relevant land; or,

The applicant is a tenant of the dwelling.

The purpose of this is to ensure that the owner/tenant does not need to acquire an owner’s interest.

Article 51

This Article defines “disabled occupant” as the disabled person for whose benefit it is proposed to carry out any of the relevant works.

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Article 52

Article 52 requires owner‐occupier applicants for Disabled Facilities Grants to submit a certificate as to ownership and intended occupation of the dwelling or flat.

The Housing Executive is prohibited from considering an owner’s application for disabled facilities unless this is accompanied by an owner’s certificate for the relevant dwelling.

An owner’s certificate certifies that the applicant has “a qualifying owner’s interest” and that the disabled occupant will live in the dwelling as his only or main residence throughout the grant condition period or as long as his health and circumstances permit it.

Article 53

This makes the same provision as above but with reference to a “tenant’s certificate”.

It also states that the Housing Executive should not consider a tenant’s application for grant unless the tenant’s certificate is accompanied by an owner’s certificate from the landlord.

However, the Housing Executive can consider a tenant’s application without the owner’s certificate where “the Housing Executive considers it unreasonable to seek such a certificate”.

Article 54

This Article sets out the purposes for which an application for Disabled Facilities Grant must or may be approved.

Disabled Facilities Grant is mandatory for the following purposes:

Facilitating access to or from the dwelling;

Making the dwelling safe for the disabled occupant and other residing with him;

Facilitating access to the principal family room;

Facilitating access to a sleeping room;

Facilitating access to (and use of) a lavatory and bathroom;

Facilitating the preparation of food;

Improving any heating system to meet the occupant’s needs or providing one suitable to his needs;

Facilitating the occupant’s use of a source of power, light or heat;

Facilitating access and movement by the disabled occupant around the dwelling to care for a person normally resident and who needs care;

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Discretionary Disabled Facilities Grant is available for making the dwelling or building suitable for the accommodation, welfare or employment of the disabled occupant in any other respect.

If the Housing Executive considers the relevant works to be more (or less) extensive than is necessary to achieve any of the purposes set out in this Article, it may, with the applicant’s consent, treat the application as varied so that the relevant works are limited to such works as seem to the Housing Executive to be necessary for that purpose.

Article 55

This provides for the Housing Executive to approve applications for mandatory and discretionary Disabled Facilities Grant.

The Housing Executive is prohibited from approving an owner’s application from a person proposing to acquire an owner’s interest until it is satisfied that he has done so.

The Housing Executive is also prohibited from approving a Disabled Facilities Grant unless it is satisfied that:

The works are necessary and appropriate for the occupant’s needs (assessment of this is by the “relevant welfare authority);

It is reasonable and practicable to carry out the works having regard to the age and condition of the dwelling.

The Housing Executive may not approve a common parts application for Disabled Facilities Grant unless satisfied that the applicant has a power or duty to carry out the relevant works.

Articles 50, 51, 52, 53, 54 &55

Available at: www.legislation.gov.uk/nisi/2003/412/contents/made

The Housing (Amendment) (Northern Ireland) Order 2006

The Order transfers the administrative arrangements for the payment of grant (including housing adaptations grants) to housing associations from the Department of Social Development to the Northern Ireland Housing Executive.

Schedule Arrangements for Payment of Grants to registered housing associations.

Available at: www.legislation.gov.uk/nisi/2006/3337/article/2

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http://www.legislation.gov.uk/nisi/2006/3337/article/2


DSD Housing Association Guide 2011

The Development Guide contains a section on design standards for new build properties including wheelchair standards housing and lifetime homes.

The Housing Management Guide contains an adaptations guide for housing association property.

Currently there are some variations in the design standards used for the adaptations of housing association property and housing in other tenures which are outlined in the NIHE Inclusive Design through Home Adaptations Good Practice Guide. (DSD, 2011)

See Development Guide for Design Standards including Lifetime Homes and Wheelchair Standard Housing.

www.dsdni.gov.uk/index/hsdiv‐housing/ha_guide/hag‐index/hagds‐design‐standards‐contents.htm

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https://www.communities-ni.gov.uk



Department of Finance and Personnel

www.dfpni.gov.uk

The Building Regulations Northern Ireland 2000

Part R: Access and Facilities for Disabled People.

For the first time a range of minimal access measures were introduced in new build private housing to promote access for disabled people. The design standards for new build social housing are higher in the form of lifetime homes. Lifetime Homes standards were introduced in the social housing sector in 1998 for new build housing. A number of research studies (Blythe, O’Brien, McDaid and Walsh, 2002, Northern Ireland Housing Council, 2010) have supported the uplift of building regulations to lifetime homes standards across all tenures in the interests of design harmonisation, which would facilitate equity and help to reduce the scale of future housing adaptations requirements. In practice Lifetime Homes need to be complimented by wheelchair standard housing, the designs of which have been evolving to meet the needs of assisted wheelchair users and carers. Policy and design standards for new build wheelchair standard housing are outlined in the DSD Housing Association Guide.

The Building (Amendment) Regulations Northern Ireland (2006)

A number of amendments to the building regulation were implemented in 2006 including improved guidance on building design for sight loss. There were few changes to guidance for dwellings.

Available at: www.legislation.gov.uk/nisr/2006/355/regulation/10/made

Download DFP Technical booklet R 2006 with design guidance

BS 8300:2009 Design of Building and their approaches to meet the needs of disabled people ‐ Code of Practice.

Building Regulations, policy and good practice in both building and housing design for disabled people is supported by regular reviews of British Standards.

An overview is available at: www.bsigroup.com/en/Standards‐and‐Publications/Committee‐Members/Construction‐committee‐members‐area/Overview‐of‐BS‐8300/

Details for purchasing the standards are available at:

shop.bsigroup.com/en/ProductDetail/?pid=000000000030217421

Northern Ireland Procurement Policy 2009

In May 2002 the Northern Ireland Executive agreed to a revised public procurement policy for Northern Ireland Departments, their agencies, non‐departmental public bodies and public corporations.

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https://www.finance-ni.gov.uk/

http://www.legislation.gov.uk/nisr/2006/355/regulation/10/made


Public procurement is “the process of the acquisition, usually by means of a contractual arrangement after public competition, of goods, services and works and other supplies by the public service”. Examples of each of these different kinds of procurement are given below:

Supplies procurement (office supplies, vehicles, hospital equipment)

Services procurement (e.g. externally managed ICT systems, consultancy, full facilities management services), and

Works procurement (e.g. construction & maintenance of the infrastructure and Government Estate).

This central government policy framework facilitates joint procurement within and between government agencies and is applicable to housing adaptations service delivery.

Available at: www.dfpni.gov.uk/index/procurement‐2/cpd/cpd‐policy‐and‐legislation/ni‐pp‐policy.htm

Office of the First Minister and Deputy First Minister

www.ofmdfmni.gov.uk/

This department is now responsible for monitoring equality legislation enacted before the department was established.

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https://www.executiveoffice-ni.gov.uk/


The Disability Discrimination Act 1995

This Act prevents discrimination against disabled persons in the provision of services.

Part I Disability: changes to the definition of disability have occurred which are now at variance with the definition of disability underpinning the Chronically Sick and Disabled Persons Act (Northern Ireland) 1978 in relation to duration of functional impairment.

Part III: Goods, facilities and services, which influence the accessibility of both HSC and housing service premises and methods of delivering housing adaptations services.

Section 1 deals with reasonable adjustments in housing provision.

Section 21: Duty of providers of services to make physical alterations.

Section 27: Alterations to premises under lease.

NB: From 1 October 2010, the Equality Act replaced most of the Disability Discrimination Act (DDA) in every part of the UK except Northern Ireland although the Disability Equality Duty in the DDA continues to apply.

Human Rights Act 1998

A number of housing adaptations judicial reviews have cited articles in the Human Rights Act including:

Article 3

“No one shall be subjected to torture or to inhuman or degrading treatment or punishment.”

Article 8

“1. Everyone has the right to respect for his private and family life, his home and his correspondence.”

Article 1 of the First Protocol provides:

“Every natural or legal person is entitled to the peaceful enjoyment of his possessions. No one shall be deprived of his possessions except in the public interest and subject to the conditions provided for by law and by the general principles of international law.”

Articles 3, 8 and 1 of the first protocol

Available at: www.legislation.gov.uk/ukpga/1998/42/contents

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Section 75 Northern Ireland Order 1998

Section 75 and Schedule 9 to the Northern Ireland Act 1998 came into force on the 01 January 2000 and placed a statutory obligation on public authorities in carrying out their various functions relating to Northern Ireland, to have due regard to the need to promote equality of opportunity:

between persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation;

between men and women generally;

between persons with a disability and persons without; and

between persons with dependants and persons without.

In addition, without prejudice to this obligation, Public Authorities are also required to have regard to the desirability of promoting good relations between persons of different religious belief, political opinion, and racial group.

S 75, Schedule 9

Available at: www.legislation.gov.uk/ukpga/1998/47/contents

Immigration and Asylum Act 1999

Available at: www.legislation.gov.uk/ukpga/1999/33/introduction

Office of the First Minister and Deputy First Minister (2005) Ageing in an Inclusive Society: Promoting the Social Inclusion of Older People

This strategy sets out the approach to be taken by Government to promote and support the inclusion of older people in Northern Ireland. It is the product of extensive consultation, research and expert views about the lives of older people and is accompanied by an action plan which sets out, in real terms, the actions government departments will take to promote the inclusion of older people.

Section 4 highlights the importance of healthy ageing. In particular, it emphasises the way in which the Government’s strategy on a Healthier Future prioritises older people in the design and delivery of health and social services in primary, acute and community care. It also highlights the importance of ageing on the type of services that will be required for the future, the need for integrated packages of delivery and the importance of quality standards.

Section 5 highlights the importance of improving older people’s lives at home. It includes the way in which services are delivered, the quality of accommodation that older people live in and the importance of housing adaptations services.

Available at: www.ofmdfmni.gov.uk/index/equality/age/age‐ageing‐in‐an‐inclusive‐society.htm

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http://www.legislation.gov.uk/ukpga/1999/33/introduction




Disability Discrimination (Northern Ireland) Order 2006

Duty of Public Authorities: The Disability Equality Duty

Section 5:

49a From 1 January 2007 the DDO placed a new duty on public authorities to have due regard, when carrying out their functions to the need to promote positive attitudes towards disabled people and the need to encourage participation by disabled people in public life. These are referred to as the “disability duties”.

49b Public authorities had to submit to the Equality Commission an action plan indicating how they proposed to fulfil the duty. The Commission must keep under review the effectiveness of this duty. The enforcement procedure relating to Section 75 of the Northern Ireland Act does not apply to this new duty.

Article 5: Duties of Public Authorities

Article 14: Discrimination in relation to letting of premises

Article 15: Modify or end small dwellings exemptions

Article 16: Improvements to let dwellings

Article 18: Meaning of Disability

Available at: www.legislation.gov.uk/nisi/2006/312/contents/made

UN Convention on the Rights of Disabled People (2010)

A human rights convention is a piece of international law which sets out the duty of countries to protect human rights. Once a country ratifies a convention, it formally agrees to do what the convention requires. The UK ratified the convention on 8 June 2009 and its optional protocol on 7 August 2010.

Article 4 ‐ General obligations

1. f) To undertake or promote research and development of universally designed goods, services, equipment and facilities, as defined in article 2 of the present convention.

1. g) To undertake or promote research and development of, and to promote the availability and use of new technologies, including information and communications technologies, mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost.

1. h) To provide accessible information to persons with disabilities about mobility aids, devices and assistive technologies, including new technologies, as well as other forms of assistance, support services and facilities.

1. i) To promote the training of professionals and staff working with persons with disabilities in the rights recognized in the present convention so as to better provide the assistance and services guaranteed by those rights.

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3. In the development and implementation of legislation and policies to implement the present convention, and in other decision‐making processes concerning issues relating to persons with disabilities, States Parties shall closely consult with and actively involve persons with disabilities, including children with disabilities, through their representative organizations.

Article 9 ‐ Accessibility

1. To enable persons with disabilities to live independently and participate fully in all aspects of life, States Parties shall take appropriate measures to ensure to persons with disabilities access, on an equal basis with others, to the physical environment, to transportation, to information and communications, including information and communications technologies and systems, and to other facilities and services open or provided to the public, both in urban and in rural areas. These measures, which shall include the identification and elimination of obstacles and barriers to accessibility, shall apply to, inter alia:

a. Buildings, roads, transportation and other indoor and outdoor facilities, including schools, housing, medical facilities and workplaces;

b. Information, communications and other services, including electronic services

Article 19 ‐ Living independently and being included in the community

States Parties to the present convention recognize the equal right of all persons with disabilities to live in the community, with choices equal to others, and shall take effective and appropriate measures to facilitate full enjoyment by persons with disabilities of this right and their full inclusion and participation in the community, including by ensuring that:

a. Persons with disabilities have the opportunity to choose their place of residence and where and with whom they live on an equal basis with others and are not obliged to live in a particular living arrangement.

b. Persons with disabilities have access to a range of in‐home, residential and other community support services, including personal assistance necessary to support living and inclusion in the community, and to prevent isolation or segregation from the community.

c. Community services and facilities for the general population are available on an equal basis to persons with disabilities and are responsive to their needs.

Article 20 ‐ Personal mobility

States Parties shall take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities, including by:

a. Facilitating the personal mobility of persons with disabilities in the manner and at the time of their choice, and at affordable cost;

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b. Facilitating access by persons with disabilities to quality mobility aids, devices, assistive technologies and forms of live assistance and intermediaries, including by making them available at affordable cost;

c. Providing training in mobility skills to persons with disabilities and to specialist staff working with persons with disabilities;

d. Encouraging entities that produce mobility aids, devices and assistive technologies to take into account all aspects of mobility for persons with disabilities.

Article 26 ‐ Habilitation and rehabilitation

1. States Parties shall take effective and appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life. To that end, States Parties shall organize, strengthen and extend comprehensive habilitation and rehabilitation services and programmes, particularly in the areas of health, employment, education and social services, in such a way that these services and programmes:

a. Begin at the earliest possible stage, and are based on the multidisciplinary assessment of individual needs and strengths;

b. Support participation and inclusion in the community and all aspects of society, are voluntary, and are available to persons with disabilities as close as possible to their own communities, including in rural areas.

c. States Parties shall promote the development of initial and continuing training for professionals and staff working in habilitation and rehabilitation services.

d. States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation.

Available at: www.un.org/disabilities/default.asp?id=259

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http://www.un.org/disabilities/default.asp?id=259


Department of the Environment/Department for Regional Development

www.doeni.gov.uk

www.drdni.gov.uk

DOE/DRD (2000) Creating places: Achieving Quality in Residential Environments

This guide describes the contributions to quality and sustainability that developers in Northern Ireland will be expected to make through the design of new residential developments.

Available at: www.planningni.gov.uk/index/policy/supplementary_guidance/guides/guides_places.htm

Relevant rulings on judicial reviews are available at the Northern Ireland Courts and Tribunal Service Available at: www.courtsni.gov.uk

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http://www.doeni.gov.uk/

http://www.drdni.gov.uk/

http://www.planningni.gov.uk/index/policy/supplementary_guidance/guides/guides_places.htm

http://www.planningni.gov.uk/index/policy/supplementary_guidance/guides/guides_places.htm

http://www.courtsni.gov.uk/


Other Relevant Web Links A comprehensive electronic repository of UK wide legislation and policy which relates to housing adaptations and related social care is currently being developed by the College of Occupational Therapists Specialist Section ‐ Housing

We are grateful to COTSS‐Housing for kind permission to reproduce these web links for Northern Ireland.

Department of Health, Social Services and Public Safety.

www.dhsspsni.gov.uk

DHSSPS A Healthier Future: A Twenty Year Vision for Health and Wellbeing in Northern Ireland 2005‐2025

www.dhsspsni.gov.uk/show_publications?txtid=7282

The Quality Standards in Health and Social Care 2006

Supporting Good Governance and Best Practice in the HPSS

Bamford Review of Mental Health and Learning Disability (NI): Published Reports 2007

Living Fuller Lives: Dementia and Mental Health Issues in Older Age Report - June 2007

www.dhsspsni.gov.uk/index/bamford/published‐reports.htm

Investing for Health: Strategy Review 2010

www.dhsspsni.gov.uk/index/phealth/php/ifh.htm

Domiciliary Care Agencies Minimum Care Standards 2011

www.dhsspsni.gov.uk/sqsd‐standards‐care‐standards

Priorities for Action 2010 / 2011

Priority 2 sets out targets for AHP/OT assessments

Priority 6 sets out targets for the provision of wheelchairs, minor adaptations and lifts for people with disabilities.

www.dhsspsni.gov.uk/index/hss/priorities_for_action.htm

Autism Act (Northern Ireland) 2011

Section 1 &2

www.legislation.gov.uk/nia/2011/27/contents/enacted

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http://www.dhsspsni.gov.uk/index/bamford/published-reports.htm

http://www.dhsspsni.gov.uk/index/phealth/php/ifh.htm

http://www.dhsspsni.gov.uk/sqsd-standards-care-standards

http://www.legislation.gov.uk/nia/2011/27/contents/enacted


Department for Social Development

www.dsdni.gov.uk

The Housing Support Services (Northern Ireland) Order 2002

www.legislation.gov.uk/nisi/2002/3154/contents/made

The Domestic Energy Efficiency Grant (Amendment) Regulations (Northern Ireland) 2008 (Warm Homes Scheme)

Amends legislation from 2002

www.legislation.gov.uk/nisr/2008/67/contents/made

Lifetime Homes Standards

www.dsdni.gov.uk/index/hsdiv‐housing/ha_guide/hag‐index/hagds‐design‐standards‐contents/hagds‐lifetime‐homes.htm

Wheelchair housing

www.dsdni.gov.uk/index/hsdiv‐housing/ha_guide/hag‐index/hagds‐design‐standards‐contents/hagds‐wheelchair‐housing.htm

Supported Housing

www.dsdni.gov.uk/index/hsdiv‐housing/ha_guide/hag‐index/hagds‐design‐standards‐contents/hagds‐supported‐housing.htm

Adaptations Process for Housing Associations

See Housing Management Guide

www.dsdni.gov.uk/index/hsdiv‐housing/ha_guide/haghm‐contents/hagag‐contents.htm

Supporting People

Available at the Northern Ireland Federation of Housing Associations website: www.nifha.org/research‐and‐policy/supporting‐people/home/

Department of Trade, Enterprise and Investment

www.detini.gov.uk

Manual Handling Operations Regulations (Northern Ireland) 1992

Health and Safety Executive Northern Ireland

www.hseni.gov.uk/about‐hseni.htm

or www.legislation.gov.uk/uksi/1992/2793/contents/made

HSENI (The Health and Safety Executive for Northern Ireland) is an executive Non‐Departmental Public Body sponsored by the Department of Enterprise, Trade and

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http://www.legislation.gov.uk/nisr/2008/67/contents/made









http://www.nifha.org/research-and-policy/supporting-people/home/

http://www.detini.gov.uk/

https://www.hseni.gov.uk/content/about-hseni

http://www.legislation.gov.uk/uksi/1992/2793/contents/made


Investment (DETI). HSENI is the lead body responsible for the promotion and enforcement of health and safety at work standards in Northern Ireland.

Department of Finance and Personnel

www.dfpni.gov.uk

Office of the First Minister and Deputy First Minister

www.ofmdfmni.gov.uk/

(Northern Ireland) Executive’s Contribution to the UK Government Report to the UN committee (2011)

www.ofmdfmni.gov.uk/executives_contribution_to_the_uk_government_report_to_the_united_nations_committee_‐_amended.pdf *(PDF 188Kb)

Department of the Environment

www.doeni.gov.uk

Department for Regional Development

www.drdni.gov.uk

DOE (2001) Planning Policy Statement 7 Quality Residential Environments and DOE (2008) Addendum to PPS 7 Residential Extensions and Alterations.

www.planningni.gov.uk/index/policy/policy_publications/planning_statements/pps07_addendum.htm

Planning Policy Statement 21 Sustainable Development in the Countryside

www.planningni.gov.uk/index/policy/policy_publications/planning_statements/common‐policypps21.htm

Departmental circulars

DHSSPS Circulars

HSS (OS5A) 2/76 Housing For Physically Handicapped Persons. (Now obsolete)

HSS (OS5A) Housing for Physically Handicapped Persons: House Renovation Grants. (Now obsolete)

HSS (OS5A) 4/77 Housing for Physically Handicapped Persons: House Renovation Grants. (Now obsolete)

HSS (OS5A) 4/78 Registration of Handicapped Persons. (This circular is current)

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http://www.dfpni.gov.uk/




http://www.doeni.gov.uk/

http://www.drdni.gov.uk/

http://www.planningni.gov.uk/index/policy/policy_publications/planning_statements/pps07_addendum.htm

http://www.planningni.gov.uk/index/policy/policy_publications/planning_statements/pps07_addendum.htm

http://www.planningni.gov.uk/index/policy/policy_publications/planning_statements/common-policypps21.htm

http://www.planningni.gov.uk/index/policy/policy_publications/planning_statements/common-policypps21.htm


HSS (PH) 3/79 Housing for Physically Handicapped Persons: Housing Renovation Grants.(Now obsolete)

HSSE (DHMU) 6/98 – Care in the Community: Housing for People with Disabilities. (This circular is current)

Circular HSS (ECCU) 2/2008 Regional Access Criteria for Domiciliary Care. (This circular is current)

Relevant DSD Policies

The Housing Association Guide which is now largely split into smaller guides can be found below:

www.dsdni.gov.uk/index/hsdiv‐housing/ha_guide.htm

Other Relevant Policies

NIHE Policies (all available at www.nihe.gov.uk )

NIHE Housing and Health: Towards A Shared Agenda 2000

NIHE Supporting People, Changing Lives. The Supporting People Strategy 2005‐2010

H&R Adaptations Policy 2007

NIHE DFG Grants Policy Handbook 2007

H&R NIHE Case management (In draft) June 2008

H&R NIHE Options Appraisal (In draft) September 2009

Older People Housing Policy Review Action Plan (2008‐ 2010)

NIHE Corporate Objectives

NIHE Warm Homes Fuel Poverty Strategy

NIHE Disability Action Plan 2011/2012 ‐2013/14

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http://www.nihe.gov.uk/


Service Agreement between the NIHE and HSC Trusts

1.0 Service Agreement

1.1 This agreement is between the _______ Health & Social Services Board (the Board), ______________ Health & Social Services Trust (the Trust) and ____________ Region of the Northern Ireland Housing Executive (the Executive). It sets out respective responsibilities for housing and adaptation services for people with physical disabilities, learning disabilities and mental health problems. The Board, the Trust and the Housing Executive believe that through collaborative work, best use can be made of scarce resources which can be targeted on those in greatest need. The agreement reflects the statutory responsibilities of the organisations under relevant Health & Social Services and housing legislation.

1.2 The signatories agree to co‐operate within the letter and spirit of this document subject to prevailing financial constraints.

2.0 Roles and Responsibilities

2.1 Boards’ statutory responsibilities for housing adaptation services under this agreement have been delegated to Trusts.

2.2 The Trust is responsible for assessing the housing adaptation needs of persons with disabilities referred to it, for deciding the urgency of each case and for making recommendation to the Housing Executive. The Trust will nominate an officer (the Nominated Officer) ‐ normally the Occupational Therapy Manager, who will have responsibility for the execution of its functions under this agreement. The Nominated Officer will co‐ordinate housing adaptation needs assessments. The Nominated Officer is responsible for informing the Housing Executive of the priority awarded in each case, as appropriate, or where a housing service is not required. Neither the Nominated Officer nor the occupational therapist carrying out the assessment will comment on any medical condition. The Trust is responsible for the removal of any equipment installed by it when that equipment is no longer required.

2.3 The Housing Executive is responsible for providing an adaptation service in relation to its property and assisting those living in private property who are eligible for financial support through grant aid.

The Housing Executive is responsible for assessing the technical feasibility of adapting property to the recommendations made by the Nominated Officer and in respect of its property for determining the material to be used.

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There may be a number of alternative options to meet ht housing need of an individual assessed by the Nominated Officer and the individual, is responsible for deciding the most suitable housing option.

When it is necessary to change the agreed plans, there must be consultation with the individual and Nominated Officer who should be advised of the revised options available. The Housing Executive will continue to keep the individual and Nominated Officer fully informed of progress and ensure that adaptations are completed as quickly as possible.

3.0 Adaptation Work to NIHE Property

3.1 Minor Adaptations

Requests for minor adaptations made to the Housing Executive’s District Office will be co‐ordinated by the District Manager who is responsible for:‐

a. responding to individuals’ requests and obtaining preliminary information;

b. referring appropriate cases for assessment to the Nominated Officer; and

c. completing minor adaptation works and advising the Nominated Officer accordingly.

If further problems are expressed by the client which cannot be met through the provision of minor adaptations the case will be referred to the Nominated Officer for further assessment.

3.2 Major Adaptations

The Housing Executive’s Regional Welfare Officer is responsible for co‐ordinating the major adaptation work procedures and will:‐

a. Prepare a client brief in liaison with the Nominated Officer and in conjunction with the Client Technical Services Manager;

b. co‐ordinate action to contract stage;

c. consult with the individual before and during the work; and

d. advise the Nominated Officer when work is completed or cancelled.

3.3 Faststream Procedures

The Housing Executive recognises that there are a small number of cases where the normal response times for dealing with requests for adaptations are too long. In April 1996, the Housing Executive introduced “Faststream” procedures to ensure shorter completion times for urgent minor and major adaptation works. All extensions will be carried out under the faststreaming procedures.

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3.4 Economic Appraisal

The Housing Executive is required to carry out an economic appraisal for major extensions only. Where an extension is required, liaison between the Nominated Officer and the Regional Welfare Officer will enable economic appraisals to be completed within a reasonable timescale. The Nominated Officer should notify the regional Welfare Officer immediately by phone and then confirm in writing. This will enable economic appraisals to be completed within two weeks. The Housing Executive may consider best solutions as part of its economic appraisal.

3.5 Stair / Vertical Lifts

The responsibility for the provision, installation, maintenance and insurance of stair or vertical home lifts in its property rests with the Housing Executive.

When a Housing Executive property is sold to a tenant, the ownership of any stair or vertical home lift installed by the Housing Executive will transfer to the Trust. The Trust will assume responsibility for the equipment following written confirmation of the transfer. The Housing Executive will provide the Trust with all relevant information prior to completion of sale.

3.6 Heating Adaptations

Upgrade/Change of Heating System/Appliance on Medical Grounds

Requests for a change or upgrade of a heating system / appliance on medical grounds alone will not be considered.

Upgrading or Change of Heating System/Appliance on Functional Grounds

The installation of central heating systems will not be appropriate in any circumstances.

The Housing Executive’s improvement programme continues to reduce the need for a change of/upgrading of a heating system/appliance through the adaptation process.

However, when there is a request to upgrade or change a heating system/appliance, contact should be made with the Nominated Officer only where the Housing Executive is satisfied that the person may have a functional problem.

Upgrading an Inadequate System

Upgrading an inadequate heating system should only be considered where:‐

(1) the person is permanently and severely disabled and has severely limited functional ability.

The principle is to provide adequate heating for the disabled person in rooms they would normally use. This policy allows for the heating system to be changed where it cannot be upgraded.

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Changing a Heating System

Changing a heating system should only be considered where:‐

(1) the person is permanently and severely disabled and has severely limited functional ability;

(2) the disabled person is unable to manage the existing heating system;

and

(3) they live on their own or with another disabled person.

4.0 Response Times

4.1 Minor Works

When the Housing Executive receives either a direct request or a referral from the Nominated Officer arrangements will be made to complete the works within four working weeks.

Where the minor works entail the provision of:

a fixed ramp;

a shower either over or to replace a bath;

a suitable bath, toilet, wash hand basin, or closomat; or

storage space for a wheelchair or other assistive technology;

these alterations will be completed within ten working weeks.

4.2 Faststream ‐ Minor Adaptations

Where the Housing Executive receives an urgent request from the Nominated Officer, arrangements will be made to complete the work in a shorter time.

Urgent very minor adaptations (e.g. handrails) will be completed within two working weeks.

Where the minor works entail the provision of overbath showers or replacement of baths by showers, these alterations will be completed within four working weeks. The provision of a fixed ramp will be completed within ten working weeks.

4.3 Major Works

When the Housing Executive receives a referral form the Nominated Officer arrangements will be made to start the most common major adaptation within the following timescale:‐

a. vertical inter‐floor lifts/stairlifts 5 months

b. upgrading of heating system 4 months

c. major internal rearrangements 9 months

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4.4 Faststream ‐ Major Adaptations

Where the Nominated Officer makes an urgent referral, arrangements will be made to start the work within a shorter time period. The Housing Executive will aim to start the four most common urgent adaptations within the following timescales:‐

a. vertical inter‐floor lifts / stairlifts 3 months

b. upgrading of heating systems 3 months

c. major internal rearrangements 3 months

d. all extensions 30 weeks

5.0 Adaptation Work to Private Property

5.1 Responsibilities

The Housing Executive Grants Office is responsible for co‐ordinating requests for adaptations to private properties occupied by people with a disability.

Grants Managers have the following general responsibilities:‐

a. deciding whether a property qualifies for grant aid;

b. referring the applicant’s details for assessment to the Nominated Officer;

c. determining the most suitable grant option based on a survey of the property and the recommendations of the Nominated Officer;

d. assessing the applicant’s contribution to the grant based on a test of resources; (clients will be encouraged to have a preliminary test of resources prior to referral in order to prevent unnecessary work by them);

e. providing a schedule of works eligible for grant aid and determining the amount of grant payable to the applicant;

f. consulting with Nominated Officers as to proposals contained in plans etc.;

g. arranging and undertaking appropriate inspection visits and arranging for interim and final payments;

h. informing the Nominated Officer of the commencement and completion of grant work and requesting confirmation of satisfaction from the Nominated Officer;

i. informing the Nominated Officer when grant is cancelled; and

j. deciding whether or not Urgent Works Approval is necessary in respect of all or any part of the work.

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5.2 Urgent Works Approval

Normally applicants applying for grant aid are encouraged not to begin works before Formal Approval, because this may debar them form obtaining a grant. However, the Housing Executive recognises that there may be exceptional circumstances where it could be necessary to carry out certain works prior to formal grant approval being issued. In such circumstances Grants Managers may, at their discretion, convey an Urgent Works Approval in the case of a Disabled Facilities Application where the works are of an essential urgent nature.

Urgent Works Approval will only be considered by the Grants Manager where it has bee specifically recommended by the Nominated Officer.

It should be emphasised that the Urgent Works Approval is subject to a number of conditions. These conditions include the following:‐

a. The issue of Urgent Works Approval does not guarantee that Formal Grant Approval will be given.

b. No grant monies can be paid out until formal grant approval has been issued by the Housing Executive.

Where substantial works are necessary or, if the property is statutorily unfit and / or the person with a disability has complex needs, the Grants Officer and the Nominated Officer may arrange joint meetings on site.

5.3 Stair/Vertical Lifts and Hoist Tracking

Where a Trust installs a stair or vertical home lift or overhead motorised hoist in a private home, it remains the property of the Trust, which will also be responsible for the inspection, maintenance, insurance and removal of the same when no longer required.

5.4 Heating Adaptations

Upgrade/Change of Heating System /Appliance on Medical Grounds

Requests for a change or upgrade of a heating system/appliance on medical grounds alone will not be considered.

Upgrading or Change of Heating System/Appliance on Functional Grounds

The installation of central heating systems will not be appropriate in any circumstances.

Requests to change or upgrade a heating system/appliance may come to the Housing Executive’s Grants Department by the way of application for Disabled Facilities Grant of Minor Works Grants. Such requests shall only be referred to the Nominated Officer where the Housing Executive is satisfied the person has a functional problem.

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Upgrading an Inadequate System

Upgrading an inadequate heating system should only be considered where:‐

(1) The person is permanently and severely disabled and has severely limited functional ability.

The principle is to provide adequate heating for the disabled person in rooms they would normally use. This policy allows for the heating system to be changed where it cannot be upgraded.

Changing a Heating System

Changing a heating system should only be considered where:‐

(1) the person is permanently and severely disabled and has severely limited functional ability;

(2) the disabled person is unable to manage the existing heating system; and

(3) they live on their own or with another disabled person.

5.5 Response Time

The Housing Executive has set out minimum standards you can expect at key stages in the Grants system. The Housing Executive aims to complete the documentation and activities relating to the Disabled Facilities Grant within the following timescales:‐

1. Preliminary Enquiry

The Housing Executive aims to acknowledge receipt of the preliminary enquiry form within 10 working days.

At this stage the Grants Office will refer the case to the Nominated Officer. On receipt of the OT recommendation the Grants Office will arrange inspection.

2. Schedule of Works

From inspection of the property the Housing Executive aims, subject to receipt of information or reports required, to issue the schedule of works within 12 weeks.

3. Formal Approval

Upon submission of all required documentation the Housing Executive aims to issue formal approval and notification of the applicant’s contribution towards the grant aided works within 6 months.

4. Inspection of Completion of Works

The Housing Executive aims following receipt of a request for an interim or final payment of grant to inspect the property within 2 weeks.

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5. Payment of Grant

The Housing Executive aims to make interim and final payments when the work is deemed to be satisfactorily completed. The Housing Executive will make payment within 4 weeks of inspection, providing all relevant invoices, guarantees and certificates have been received.

6 Standards for Occupational Therapy Service Assessments

Standards reflect those laid down in the “Charter Standards for Community Services” which came into effect April 1996.

7 Following Assessment

For individuals in NIHE property, the Nominated Officer will forward the recommendations to the appropriate District Manager for minor works, and to the Regional Welfare Officer for Major Works.

For individuals in private property the Nominated Officer will forward recommendations to the appropriate Grants Manager.

Where, for any reason, adaptations cannot be carried out and rehousing, where appropriate, is refused, the Trust may consider alternative assistance, within the resources available, to help the individuals cope in their existing accommodation.

8 Affirmation

This agreement between the Northern Ireland Housing Executive, ___________ Health & Social Services Board and ______________ Health & Social Services Trust will run from _______________ and will be subject to annual review.

Signed by: _____________CHIEF EXECUTIVE

for and on behalf of the Health & Social Region, Services Board

Date: ____________

Signed by: _____________CHIEF EXECUTIVE

for and on behalf of the Health & Social Services Trust

Date: _____________

Signed by: ____________

REGIONAL DIRECTOR

for and on behalf of the Northern Ireland Housing Executive

Date: _____________


SECTION 4 ‐ Resourcing adaptations and routine assistive technology

Information management

Definitions

The Social Model of Disability

Oldman (2002) argues that the social model of disability can be a vehicle for analysing and improving housing policies for older people, making environments less disabling. She proposes that the social model considers, not just the home itself, but the neighbourhood and social context in which it is set. The social model recognises that the domestic environment, when inappropriate, can restrict an individual’s access to vital social and personal relationships, leading to poor mental health (COT 2006).

Adaptations can be classified in a number of ways: capital or revenue, minor and major. Adaptations are currently classified differently by organisations and indeed different divisions within organisations.

Major and minor adaptations – the distinction is based on the nature of the works required and sometimes on specific financial thresholds in order to ensure appropriate financial authorisation of adaptation expenditure.

Within social housing, the NIHE differentiates between major and minor adaptations based on the nature of the work required and they are funded through different funding streams. Minor works are delivered through the District offices and major works through the Area offices.

Housing associations carry out both major and minor adaptations using a series of financial thresholds to classify adaptations which trigger different processes as outlined in the DSD Housing Association Guide.

Within the private sector (Disabled Facility Grants) there are no minor adaptations classifications and works are categorised by cost bands rather than by type of adaptation.

Within HSC Trusts, major adaptations such as lifts can be classified as either a major adaptation or assistive technology. There are variances in financial thresholds across HSC Trusts which impacts upon the adaptation classification.

Assistive Technology

The definition for assistive technology (AT) is as follows: “Assistive Technology is any product or service designed to enable independence for disabled and older people.” This UK definition was drafted in 2001 at a King’s Fund meeting by a broad group of voluntary sector organisations representing disabled and older people in order to prioritise personal outcomes set by the user of technology within a framework of

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‘independence’. There are both high and low technology forms of AT. Environmental control systems e.g. remote door, window opening and service controls would be a form of high tech electronic assistive technology while a simple bath aid would be low tech AT.

A cross sector review of ‘high tech’ assistive technology including environmental control systems also referred to as electronic assistive technology (EAT) falls outside the terms of reference for this review.

Within this review however, routinely provided and relatively low tech assistive technologies such as bathing products and lifts will be considered because of their considerable interrelationship with routine housing adaptations provision.

A number of issues arise as a result of these differential classifications both within and between organisations.

1. Difficulties coordinating financial planning

2. Difficulties benchmarking/comparing resource allocation between providers

3. Difficulties accounting for expenditure

4. Avoidable service delays due to differential financial approval systems

5. Inequitable service provision for service users when adaptations/assistive technology provision is determined by differential financial thresholds

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Housing adaptations resources

The mechanisms by which housing adaptations services are funded across housing tenures and Trusts vary considerably.

The high level processes used by both sectors are outlined in the flow charts below.

Figure 12: NIHE high level funding flow chart

NIHE departments prepare and agree the budget bids

Budget bids submitted to Finance for agreement & approval

Finance agrees budget submissions and presents to NIHE Board

Finance submits the funding bid to DSD who take a view on the funding submission

DSD submits the funding bid to the Minister for approval

DSD confirms NIHE funding bid approved

ADP Funding Process – Public Sector Adaptations

Disabled adaptations for Housing Executive tenants are primarily funded through two funding streams – Block 3 Capital & Block 2 Revenue.

Block 3 Capital funding relates specifically to adaptation extensions & PODs (modular extensions) and the budget bid is programme based. Block 2 Revenue funding relates to changes of heating, lifts and showers, this budget bid is based upon historical data and estimates.

The 5 Area Management Accountants agree budget bids with the Area Manager prior to submission to Finance. Financial Planning & Analysis collate the information for all areas and exercise challenge function when reviewing them. The figures are compared with previous years and checked for reasonableness. The Block 3 Capital budget is compared with Department for Social Development (DSD) guidelines.

Once the funding submission has been agreed it is then submitted to the Director of Finance for approval. If agreed/approved the Director of Finance submits the approved funding bid to the senior management team (Chief Executive’s Business Committee) for ratification prior to submission to the NIHE Board. If

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agreed/approved the Director of Finance submits the approved funding bid to NIHE Board for final approval.

If NIHE Board approves the funding submission then Central Finance will submit the bid to the DSD, who will take a view on it. DSD present the funding bid to the minister for approval and advise NIHE accordingly.

ADP Funding Process – Private Sector Adaptations

Disabled Facilities Grants are funded from the Capital Block 4 budget. They are mandatory grants and cover all types of adaptation both large extensions and work to provide lifts and showers. The budget is demand led.

The 5 Area Management Accountants assess requirements with Grants Managers and submit budget bids to central Finance. Central Finance collates the figures from all areas and prepares an analysis of the bids between mandatory and discretionary grants for funding priorities.

The Assistant Director (Private Sector Improvement Service) and Director of Design and Property Services responsible for the grants function meets with Central Finance to agree the budget bid and the funding submission to determine if it is reasonable/ can be delivered. The bid is also reviewed in conjunction with the DSD funding guidelines.

Once the funding submission has been agreed it is then submitted to the Director of Finance for approval. If agreed/approved the Director of Finance submits the approved funding bid to the senior management team (Chief Executive’s Business Committee) for ratification prior to submission to the NIHE Board. If agreed/approved the Director of Finance submits the approved funding bid to NIHE Board for final approval.

If NIHE Board approves the funding submission then Central Finance will submit the bid to the DSD, who will take a view on it. DSD present the funding bid to the minister for approval and advise NIHE accordingly.

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DHSSPS Flow of Funds

Figure 13 below highlights how funds flow through the system to Health and Social Care Trusts in Northern Ireland allowing them to provide the required services.

Figure 13: HSC Trusts Funding Flowchart

UK resources

NI resources

HSCB & PHA agrees funding with Trusts to reflect Government policy & local priorities

NI Government Ministers decide how to split resources between Northern Ireland DHSSPS Resources

PHA commissioning

funding

HSBC commissioning

funds

Family health

services*

DHSSPS allocation to HSCB & Public Health Agency

HM Treasury allocates resources to different English departments and applies the Barnett formula, which is used to allocate resources to Northern Ireland, Scotland and Wales

HSC Trusts resources

* From 1 July 2010 FHS have been fully devolved from DHSSPS to HSCB

The amount of funds allocated to Northern Ireland, Scotland and Wales is determined by the Barnett Formula. The formula uses crude population figures to determine the proportion each country receives and does not take into account different levels of health need that may exist between the countries.

The HSCB and PHA deploy their commissioning resources across the HSC Trusts and other providers of service, in order to respond to the health and social care needs of the Northern Ireland population.

Funds allocated to Trusts are deployed at Programme of Care (POC) level. POCs are divisions of health and social care into which activity and financial information are assigned to provide a common management framework. They are used to plan and monitor health and social care, by allowing targets to be set, performance measured and services managed on a comparative basis. In total, there are nine Programmes of Care across Northern Ireland.

Budgeting within NI Trusts generally follows an incremental approach. The overall baseline funding/allocation for a Trust will have been based on historical data, trends and ‘rolls forward’ into subsequent years. Adjustments to these ‘roll forward’

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allocations in any particular year may include pay/price uplifts, adjustments for new service development monies, efficiency measures for particular expenditure etc.

In terms of community equipment and housing adaptations, resources for these will be an integral element of the overall funding allocation to Trusts and as such budgeting for these at Trust level will be on an incremental basis. There is currently not a specific commissioning approach for these and indeed elements will be included within different Programmes of Care.

HSC /Housing trends

Impact of CSR

Potential for co‐ordinated bids

Strategic financial environment

Commissioning arrangements

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Total expenditure on all types of adaptations and assistive technology by stakeholder

Table 6: Adaptations expenditure by organisation and type (thousands)

Organis‐ation

Year Extensions Showers Heating Lifts Minor Works

AT Total

£k £k £k £k £k £k £k

NIHE Public 2007‐ 2008

4,489 3,177 3,462 806 2,141 14,075

2008‐2009

6,743 2,519 2,265 794 2,341 14,662

2009‐2010

6,451 3,485 3,288 678 2,565 16,467

NIHE (Public) Total

17,683 9,181 9,015 2,278 7,047 45,204

NIHE (DFG) 2007‐2008

13,499

2008‐2009

14,149

2009‐2010

21,629

NIHE (Private) Total

49,277

Housing associations

2007‐2008

139 1,589 93 297 2,119

2008‐2009

104 1,994 36 67 306 2,508

2009‐2010

291 1,307 25 31 200 1,857

HA Total 534 4,890 61 191 803 6,484

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Table 7: HSC Trust Adaptations and Assistive Technology expenditure by Organisation and Type (thousands)

HSC TRUST

Year Sensory loss equipment

Tracking Hoists 1

Lifts 2 Minor Works

Assistive Technology (OT component)

Total

BHSCT 2009/10 86 98 681 164 1,853 (676) 2,882

SEHSCT 2009/10 48 50 210 175 1,951 (832) 2,434

SHSCT 2009/10 54 20 245 200 1,509 2,028

NHSCT 2009/10 51 55 595 275 1,300 2,276

WHSCT 2009/10 54 56 192 150 1,683(161) 2,135

Total 293 279 1,923 964 8,296 11,755

The expenditure figures provided for Community Loans Equipment cover Occupational Therapy, Physiotherapy and Nursing. When interpreting the expenditure figures for Assistive Technology (AT), it should be noted that there is variation across Trusts in terms of the type of expenditure included within this category. Expenditure may include not only community loan equipment but also patient appliances, aids and appliances, servicing and maintenance etc. As such, consideration of the quantum of expenditure on AT as well as any comparisons between respective Trust expenditure must be viewed with caution in light of these variations.

Housing adaptations investment trends in other parts of the UK and the Republic of Ireland.

Direct comparisons between expenditure on adaptations in Northern Ireland and the rest of the UK are not possible for a number of reasons. In England Local Authority tenants can also access DFG resources. Comparisons are also not available as valid figures are not obtainable across all tenures in some parts of the UK. Another difficulty in making comparisons is that some regions report figures by calendar year and others by financial year.

The expenditure and numbers of housing repair and improvement grants approved for disabled adaptations in Scotland has increased over the last three financial years. Expenditure from 2007/08 to 2009/10 was £63.3m for 17,000 grants.

In England the expenditure has also increased over the past three calendar years. Expenditure was £845m over approximately 120,000 grants from 2007 to 2009. The approximate estimated need for funds within Local Authority stock is £125m per year.

The pattern in Wales has shown a decrease over the last three financial years on DFG expenditure, with a 5% decrease noted between 2008/09 and 2009/10. Expenditure

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from 2007/08 to 2009/10 was £103.9m. Expenditure for the same time period in the public sector was £320m.

Funding for adaptations in the Republic of Ireland has also been significant and despite the current economic climate is still a high priority. In March 2010 the Minister for Housing announced an unprecedented capital provision of €100 million for grants to improve or extend the private homes of older people and people with a disability in 2010. This does not include expenditure by local authorities on improving and extending their own social housing stock. The allocation represents a 31% increase on the initial allocations to local authorities in 2009.

Inter‐Relationship of HSCT Assistive Technology (AT) & Housing Resources

In considering the full range of options available to statutory authorities to meet the needs of disabled people, one needs to consider both assistive technology and housing adaptations resources together, as they are inter‐related services and need to be jointly planned to ensure the best use of public resources.

The interdependence of these services has been recognised in Scotland with the publication by the Scottish Executive in 2003 of “Equipped for Inclusion: Report of the Strategy Forum: Equipment and Adaptations” and in England by the Audit Commission report “Assistive Technology Independence and Well Being” (2004).

Both HSC Trusts and Housing providers require adequate resources deployed to the appropriate level to address daily living difficulties following HSC Trust assessment of need. If there are shortages of resources in either sector, cost transfer can occur which can ultimately cost more in total public expenditure.

Regardless of tenure, HSC Trust Occupational Therapists consider portable assistive technology as a first option to address difficulties with daily living activities, before progressing to minor or major adaptations. These assistive technology options have a number of advantages:

They can be deployed rapidly, where Trusts are adequately resourced.

There is minimal disruption to the person’s home.

In the case of bathing difficulties, equipment can allow the retention of the bath for other family members and avoid the need to replace baths for future tenants.

They can be a cost effective alternative to major housing adaptations.

They can often be recycled to meet future client requirements thereby reducing future purchase costs and ensuring optimum value for money throughout the life of the equipment.

There are number of areas where this interdependency between HSC Trust provision and housing provision is particularly notable.

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Resolving bathing difficulties

HSC Trusts may address bathing difficulties in certain instances by a simple combination of bathing equipment and grab rails. Depending on the extent of need, more complex equipment may be required and there are situations where due to functional needs and environmental constraints, major adaptations e.g. level access showers may be the best option in addressing the needs of disabled people and carers. This approach facilitates a graduated deployment of resources to reflect the scale of need. See Figure 14 ‐ Resolving bathing difficulties.

In some situations the HSC Trust provision of a bath seat and grab rail for as little as £18 could genuinely address bathing difficulties rather than necessitating housing provision of a £3,000 level access shower and associated HSC provided shower seating. This can rise to £25,000 where an extension is required to accommodate a dual bath and shower facility.

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Figure 14: Resolving bathing difficulties

Item Illustrative Cost Photograph

Ground floor extension with dual shower and bath facility

£25,000

Bath replaced with level access shower and HSC Trust Shower seat

£ 2,200

Bath lift £290

HSC Trust shower seat £24

Bath seat £15

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Item Illustrative Cost Photograph

Bath board

£10

Grab rails in bath £3

HSC Trust provision of shower seating systems

HSC Trusts provide both standardised and customised shower seating solutions to ensure that disabled people and carers can safely and conveniently utilise shower facilities funded by housing providers.

The cost range of these shower seating systems can range from approximately £20 to £60. There are also more expensive systems (£300‐£400+) which are used less frequently. The volume of shower seats provided in a one year period e.g. 2008/2009 was approx. 4,900 covering a variety of brands/models. This equates to an annual HSC Trust expenditure of approx. £146,000.

HSC provision of various types of bathing equipment helps to make major savings by comparison to the provision of a shower and shower seat in every instance. It is estimated that the cost of resolving bathing difficulties with HSC Trust bathing equipment for 10,128 items was £304,623 in 2009/10. As there may be more than one item per person/household approximate savings only can be identified in comparison to shower facilities.

By comparison, had this package not addressed the needs of people with bathing difficulties, the cost to housing of addressing bathing difficulties with level access showers for the same number of people would have been considerably more plus an additional cost to HSC Trusts to provide the associated shower seats at between £202,560 and £607,680.

Resolving difficulties climbing stairs

In private sector housing, HSC Trusts may provide minor adaptations and lifts following Occupational Therapy assessment. The provision of suitable stair rails for a couple of hundred pounds may often prevent or defer the need for more costly solutions.

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Here again there are interdependencies between HSC Trust provision and Disabled Facility Grants expenditure on extensions. The HSC Trust provision of a straight flight lift at £1,700 for supply and installation (or approx £5,000 for ten years aftercare) may address need without the requirement for an extension. An illustrative cost would be £22,800 for a routine ground floor bedroom and en‐suite toilet and shower facilities.

There are 4,548 HSC Trust lifts currently in use in private sector housing in Northern Ireland of which 3,943 are stair lifts and 605 are vertical lifts. Had the HSC Trusts not provided these resources, most of these homes would have required some form of extension funded through the Disabled Facilities Grant system.

It should be noted that there are occasions where lifts will not be an effective or safe solution for a disabled person or their carers and extensions may be the best solution. The longer term costs of inter‐floor lifts, which can vary between £15,105 –£22,400 over a ten year lifecycle, also need to be carefully considered against a bricks and mortar extension, particularly if the lift needs to be replaced every 10 years.

Where straight flight lifts are safe and appropriate they have the following advantages over extensions:

Speed of provision – where providers are adequately resourced.

Less disruptive works required – one or two days in the client’s home versus workmen on site for months.

Less complex process for clients.

A more cost effective solution in terms of total public expenditure.

Provision is not means assessed by HSC Trusts.

Lift resources can be redeployed to other people in need when no longer required.

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Figure 15: Resolving difficulties climbing stairs

Item Illustrative cost Photograph

Prefabricated re‐locatable bedroom and en‐suite extension

£37,500

Ground Floor Bedroom and en‐suite shower

£31,000

Ground floor WC/Shower £19,000

Inter‐floor lift £ 10,000

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Item Illustrative cost Photograph

Curved rail stair lift £ 4,500

Straight flight stair lift £ 1,800

Stair rails

Curved

Straight flight

£150

£65

HSC Trust/DFG provision of housing adaptations

HSC Trusts provide a range of minor adaptations to promote safety and independence in the home including handrails and grab rails and fixings for HSC Trust provided AT. There is an inter‐relationship between HSC Trust Estate Services provision and the DFG system and both services will often provide complimentary adaptations in the same property.

The Price Waterhouse Cooper (PWC) Audit of Occupational Therapy Services identified that HSC Trusts provided high volumes (10,000+) of relatively low cost minor adaptations. With adequate HSC Trust resources these adaptations can be provided rapidly to facilitate hospital discharge or to help prevent home accidents.

The indicative administrative cost for Estate Services to process routine minor works is £10 per case. More complex works such as ramps requiring surveys and reports may take £75 per case (Source Northern Health and Social Care Trust 2010).

These types of minor works are not progressed through NIHE DFG system unless they form part of larger packages. This saves on NIHE administrative costs and time. In England ‘the cost of processing a DFG is high (possibly around £300‐£600) and is a wholly inappropriate tool for delivering minor adaptations’. (Heywood & Mackintosh 2008)

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It would therefore appear that the complementary systems of HSC Trust and NIHE DFG provision offer a cost effective means of service delivery in comparison to other parts of the UK.

Procurement methods

Organisation Procurement Methods of Adaptations

NIHE: H&R EGAN contract based on varying tendered rates. These rates are index linked. There is no upper threshold on expenditure or means testing of tenants.

Major adaptations works (extensions)

Contracts have recently been let to cover all works of this nature. The contract is for 4 years from 25 August 2010. There is one contractor per NIHE Area and the Project Management of the works lies with Design Services.

Minor adaptations, including showers

These are included in the ‘All Trades’ contracts and managed by District Office.

Heating

Heating for the disabled is included in the Major Heating Contracts. Managed through the Heating Unit.

Stair‐lifts

Single contractor for all areas.

Vertical lifts

Single contractor for all areas.

NIHE: PSIS

The Housing Executive does not procure the services of a contractor, which remains the responsibility of the applicant. However, where the cost of the work exceeds £5,000, a contractor registered with one of the five approved Warranty Schemes must be employed. Costs are regulated by a regional schedule of rates and an upper financial threshold for grants. Applicants are means assessed except for children.

H.A. Housing associations are moving towards measured term contracts as a standard procedure. Such contracts should be let for a period of up to three years and be on a basis of best value for money. The total contract period must not exceed five years. No regional schedule of rates is applied. No upper threshold on expenditure or means testing of applicants.

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Organisation Procurement Methods of Adaptations

HSC Trusts

Variable procurement methods. Some Trusts moving to ‘Measured Term’ contracts for minor works. No regional schedule of rates is applied. There are variable upper financial thresholds for minor works. There is no means assessment.

The lifts task group identified variances in procurement methods. Costs for similar products varied as a result of differential installation standards and aftercare arrangements. (See inter‐agency review of the provision and cost effectiveness of Home Lifts).

Procurement Good Practice Case Study

Measured term contracts for minor occupational therapy adaptations to private dwellings.

This form of contract was initially developed within the Northern Health and Social Care Board developing standards, value and audit ability. The contract is now being developed for Trust wide application.

It has also been developed and tested for the Southern Health and Social Care Trust.

Prior to 2010 SHSCT had three separate legacy Trust contracts. These contracts varied in cost, response times to clients and in the quality of work. In December 2009 planning began to develop a new Trust contract for minor works. The outcome of this planning was a measured term contract for an agreed range of minor works. The tender was drawn up and a contractor selected as per DHSSPS procedure.

The contractor was appointed and commenced with the Trust on the 1st April 2010. As a result of this contract the Trust has achieved a high level of compliance with the PFA Housing Adaptation Minor Works Target, reduced overall expenditure by 40%, and received positive feedback from service users on the timeliness, quality of work and the professionalism of the contractor.

Examples of value for money:

A reduction in second visits due to standard documentation completed by therapists and detailed information in contract documentation.

Cost per adaptation: under the legacy contract a quote for one outside handrail was £355, in the new contract the price is £105.

The NIHE have recently embarked on procuring their adaptations on an EGAN framework. Early indicative cost analysis appears to be more cost effective in relation to the previous means of delivery. As yet there is no information on the final outturn costs and as this is a new contract, judgement should be reserved until further evaluation is undertaken of completed schemes.

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Conclusion There are significant procurement variations in the delivery of housing adaptations and AT services. When procurement systems for similar areas are examined on a cross sector basis good practice methods can be identified and shared. Cost variations were also identified which warrants further examination to promote value for money. A pro‐active review of procurement methods can result in more rapid effective services for disabled people, more efficient use of professional time and cost savings for public services.

Existing accessible housing resources

There has been considerable investment in the creation of accessible housing stock since the 1970s in the form of adaptations to property and new build provision of mobility and wheelchair standard housing in NIHE stock from the 1970s to 1998. From 1998 housing associations led the new build housing programme using a combination of lifetime homes and wheelchair standard housing. There is less choice of new build private sector housing with high levels of accessibility, although from 2001 the building regulations introduced basic access standards for private sector housing for the first time.

A strategic overview of the overall level of accessibility available within Northern Ireland’s housing stock is required to plan for the rapidly growing demands of our ageing population.

In determining the accessibility of housing stock in Northern Ireland there are a number of data sources:

NIHE House Condition Surveys 2001, 2006, 2009

Housing management property databases

Registers/databases of lifts

These sources all contain valuable data on accessible features in housing e.g. ground floor WCs and general descriptions of house types e.g. bungalows.

However we do not enjoy a comprehensive overview of the access standards of our housing stock. Current Key Government measures including ‘Decent Homes’ standards and the housing ‘Health and Safety Rating Standard’ do not measure accessibility standards.

‘The English House Condition Survey’ 2007 included criteria for visitable, accessible and adaptable homes and reported that 0.5% of homes in England are “accessible and adaptable” (Habinteg, 2010). The majority of homes in England (84%) would not allow someone using a wheelchair to get to and through the front door without difficulty. We do not know how Northern Ireland’s housing stock would compare to England.

The inclusion of criteria to measure the access standards of our housing stock would assist strategic planning.

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Data that is available

The 2006 House Condition Survey (HCS) identified that 12% (86,688) of homes across all tenures have had some type of adaptation.

This is consistent with the previous 2001 survey.

Table 8: NIHE stock by type

The table below identifies NIHE stock by dwelling type:

Dwelling Type Area

Belfast South East

South North East

West TOTAL

Sample (in numbers)

500 600 700 900 800 3,500

Bungalow 2,280 4,748 4,812 3,863 3,885 19,588

10.4% 25.7% 32.7% 21.7% 26.4% 22.4%

Cottage 0 216 81 276 141 714

0.00% 1.20% 0.50% 1.60% 1.00% 0.80%

Flat 3,949 3,473 1,222 3,349 864 12,857

18.1% 18.8% 8.3% 18.8% 5.9% 14.7%

House 15,413 9,494 8,246 10,155 9,614 52,922

70.6% 51.4% 56.0% 57.1% 65.3% 60.5%

Maisonette 124 325 103 133 151 836

0.6% 1.8% 0.7% 0.7% 1.0% 1.0%

Split level 60 202 269 0 72 603

0.3% 1.1% 1.8% 0.0% 0.5% 0.7%

TOTALS 21,826 18,458 14,733 17,776 14,727 87,520

100% 100% 100% 100% 100% 100%

Bungalows, accessible flats, cottages and houses with adaptations are of particular value in addressing the needs of older and disabled people.

Figures from housing associations for the total stock of lifetime homes and wheelchair standard housing

The total number of wheelchair accessible homes until 2008/09 is 1,691.

Lifetime Homes are more difficult to determine but the total is approximately 6,000.

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Maximising the use of accessible housing To make maximum use of our accessible stock it is critical that we can identify the standard, location and access features of these resources.

Two current initiatives will help develop improved intelligence in this regard.

1. Geographical Information System Mapping (GIS)

GIS is a computer system that provides the means of accessing, editing, analysing and presenting geographic information. In its simplest form, GIS is a very efficient and effective means for viewing and reproducing maps.

GIS is now accepted as an essential element of future government service provision. In common with other government departments, the Housing Executive is committed to the development and implementation of evidence‐based policy. We are therefore increasingly dependent on geographical information, along with research and other means of gathering evidence, to get the in‐depth understanding needed to develop policy, achieve objectives, assist targeting of resources and monitor performance.

Regarding people in need and resource allocation, GIS can be used to show concentrations and geographic patterns of various health and socio‐economic indicators such as pockets of deprivation, hotspots of certain illnesses and the distribution of people with special needs based on their address or postcode. Utilising the evidence produced via geographic analysis highest risk areas can be targeted for resource allocation, access in miles to nearest services can be calculated and spatial models can be produced that show the optimum location for service provision given the location of need.

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Figure 16: NIHE Lift Deployment in Belfast

Application of GIS mapping to adaptations

GIS can be used to map a range of housing adaptations resources, for example lifts. It is important that the geographical deployment of lifts can be efficiently tracked to assist with the planning of maintenance, insurance inspections, recycling and replacement programmes. Such an initiative will also assist the development of a future accessible housing register. A Geographical Information Systems mapping pilot has been undertaken region wide to identify the deployment of lifts.

This data provides a firm evidence base to support decision making regarding the deployment of resources to meet need.

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2. Accessible housing registers

Accessible housing registers have been established in a number of parts of the UK to enable housing authorities to make better decisions when matching accessible properties with the individual needs of disabled people and to improve choice. For an example of a well developed model see the London Accessible Housing Register. Available at http://www.london.gov.uk/priorities/housing/housing‐need/lahr

The rationale for and benefits of an accessible housing register for social housing are more fully outlined in Section 6.

http://www.london.gov.uk/priorities/housing-land/renting-home/london-accessible-housing-register


SECTION 5 ‐ Design standards, costs and communication

Introduction In order to establish current practice in terms of design standards and communication, a cross tenure review was undertaken to ensure:

Adaptation solutions effectively meet client and carer’s needs

Organisational accountability and transparency are enhanced where possible

There is fairness, equity and consistency of approach

Opportunities for clarity and coordination of interagency processes are maximised

Improvements to expedite service delivery are identified

Best use is made of available resources

Background/Evolution of Housing Standards Housing adaptations design guidance has been evolving since the1970s with the publication of Selwyn Goldsmith’s “Designing for the Disabled”. This developed as a response to the Chronically Sick and Disabled Persons Act 1970 Section 2(e). The architect Selwyn Goldsmith developed templates for both mobility housing and wheelchair housing. These standards have been very influential in the design of public (social) housing since the 1970s in particular the Department of the Environment’s Housing Development Directorate (HDD) Occasional Papers 2/74 (Mobility housing) and 2/75 (Wheelchair housing).

Mobility housing was ordinary housing built to prevailing public authority housing cost limits and space standards but designed so that it was accessible for ambulant disabled people to live in. Wheelchair access was possible to the entrance, principal rooms, bathroom and WC without the use of steps.

Subsequent to the early principles of mobility housing the concept of Lifetime Homes developed and applied to social housing in Northern Ireland since 1998. These were followed by The Building Regulations Part R, introduced in April 2001 (updated 2006) for all new dwellings. The Building Regulations legislate for basic access standards in dwellings.

More recently a new British Standard publication BS 8300 Code of Practice for the Design of Buildings and Approaches to Meet the Needs of Disabled People in 2001 (updated in 2009) was introduced. This study has been underpinned by substantial research on the needs of disabled people and strengthens the evidence base for access standards.

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Currently there is a four pronged strategy to address the needs of disabled and older people in Northern Ireland as outlined in the diagram below.

Part R Lifetime Homes

Adaptations Wheelchair housing

Standards of Housing Design

A brief summary of the various design standards applicable to new build and adaptations across sectors within Northern Ireland that promote accessible housing is provided below in chronological order.

Lifetime Homes The Lifetime Homes Standard seeks to enable `general needs` housing to provide, either from the outset or through simple and cost‐effective adaptation, design solutions that meet the existing and changing needs of diverse households. This offers the occupants more choice over where they live and can facilitate visitors who may be wheelchair users.

Lifetime Homes are not a substitute for purpose‐designed wheelchair standard housing. Lifetime Homes standards have limitations when needs become more complex and therefore some people may require the use of purpose‐designed wheelchair dwellings. Planners and providers should ensure that provision is made to meet this need.

Careful allocation of tenancy is critical to avoid the nugatory requirement for high cost adaptations as a consequence of allocating a Lifetime Home to a client with more complex needs.

Part R Building Regulations The Building Regulations (Part R) implemented in Northern Ireland in April 2001(updated 2006), introduced basic access requirements for the first time in new

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build domestic dwellings in the private sector. This improved standard primarily promoted social inclusion and the concept of ‘visitability’. It meant that visitors who may be wheelchair users could easily visit friends in dwellings built to these standards. These features have significant benefits for ambulant users also, in particular the provision of the ground floor WC.

A recent business case by the Northern Ireland Housing Council (2010), “Why the Private Sector should build to Lifetime Homes Standards” has identified the benefits of introducing Lifetime Home standards to all new build housing, so as to reduce the scale of future housing adaptation requirements.

Wheelchair dwellings The standards developed by Goldsmith in the 1970’s were further amended by Stephen Thorpe in the Wheelchair Housing Design Guide (1997) and amended along with Habinteg Housing Association (2006). More recently following a five year research and development programme which actively involved service users in Northern Ireland between the NIHE/DSD, new design standards for 3 person/2 bedroom wheelchair dwellings were agreed and incorporated into the Housing Association Guide adopted by the Department for Social Development (Nov 2009). This solution, designed specifically for wheelchair users provided an improved circulation space for a wider range of wheelchair users with enhanced health, safety and convenience for carer’s/family members. It also provided improved inclusion/equity across tenures. There are also added economic benefits of a reduction in costs of housing adaptations where inclusive new build wheelchair standard housing options are available. Four person plus wheelchair standard housing and communal access and facilities for disabled people in medium density environments have not yet been through a systematic evaluation.

Interrelationship between new‐build and adaptations It is more cost effective to include design features and space standards in new build housing to cater for the needs of people with disabilities. However in the current financial climate and the potential decrease in capital expenditure, there is likely to be a reduction in new build social housing provision. It is incumbent upon policy makers and agencies to review and amend adaptation design guidance because of the increased pressure on adaptations and the following reasons:

Changes in legislation and policy

Advances in treatment and care

Advances in technology

Societal and culture changes

Care for people in the community

Increased personal choice

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As a result of these drivers, the Northern Ireland Housing Executive published a number of design guides in collaboration with their partners in Health and Social Care. More recently the involvement of service users have contributed and enhanced this design process.

“Inclusive Design through Home Adaptation – A Good Practice Guide” (2003), reviewed existing design guidance on adaptations to determine current good practice. The review team acknowledged areas of limitations within the publication e.g. adaptations for children and people with sensory and cognitive disabilities.

The standards outlined in this publication were formally agreed by the NIHE and the HSC Trusts as core benchmark standards for housing adaptations in NIHE properties and grant‐aided private sector across tenures. Subsequent research from the “Wheelchair User Study 2006” and other UK research studies into design for sight loss and dementia will necessitate minor amendments to the existing design guidance.

In the housing association sector, adaptations are informed by a different set of design standards set out in the DSD’s Development Guide. The Design Standards element provides guidance on standards for elderly‐specific, wheelchair‐ specific and supported housing design requirements. Reference is made to the publication by Stephen Thorpe and Habinteg Housing Association “Wheelchair Housing Design Guide – 2nd edition” (2006).

However this design guidance is primarily concerned with new build scenarios.

These different approaches have resulted in a lack of consistency of design standards across tenures and difficulties for OT’s in recommending adaptations. There is a clear benefit in adopting agreed design standards to suit all housing tenures. This issue has been identified in the objectives set for the design, cost and communications working group.

There were two key areas of work identified namely;

1. Design standards and costs

2. Design communications

Two sub groups were formed to deal with the above.

1. Design standards and costs

Developing a matrix of need and design standards

There is a requirement for agreed design standards to be fit for purpose, to meet the needs of disabled people and carers across agencies. Due to a variance in standard solutions being applied across tenures, it is timely to systematically review existing design standards to ensure equitable provision and value for money solutions.

Having reviewed previous design solutions throughout Northern Ireland, three categories emerged which capture the majority of user need:

Ambulant user with mobility equipment

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Independent wheelchair user

Assisted wheelchair user

Consequently a draft Design Space Standard Matrix (DSSM) was developed. This provides the most effective means of summarising the relationship between the user needs and activity space provision. This matrix was subsequently tested with a panel of disabled people. (See Table 9, Design Space Standards Matrix)

This was developed to include common adaptation recommendations in terms of room type (e.g. WC/shower rooms and bedrooms). These are model space standards which will meet the needs of the majority of users. However this does not preclude the opportunity for bespoke or specialised solutions, where required, to address complex needs.

This matrix will act as a tool to be referenced by housing providers and HSC Trusts in determining the recommendation and agreeing the appropriate design solution.

Table 9: Design Space Standards Matrix

ROOM DESIGN TEMPLATE 1

DESIGN TEMPLATE 2

DESIGN TEMPLATE 3

A WC 1500mm x 2000mm (3m2)

900mm x 1500mm (without

walking aid) (1.35m2)

1800mm x 2000mm (3.6m2)

2000mm x 2200mm (4.4m2)

B WC / Shower Room (wet floor option)

1700mm x 1900mm (3.23m2)

2300mm x 2200mm (5m2)

2500mm x 2500mm (6.25m2)

Bedroom

C Single Standard Bed 3000mm x 3600mm (10.8m2)

3300mm x 3800mm (12.54m2)

3800mm x 3600mm (13.68m2)

D Single Hospital Bed 3100mm x 3900mm (12m2)

3400mm x 3800mm (12.92m2)

4100mm x 3700mm (15.17m2)

E Double 3800mm x 3600mm (13.68m2)

3900mm x 3900mm (15.21m2)

3950mm x 4200mm (16.59m2)

F 2 standard single beds in a twin room

3900mm x 3800mm (14.82m2)

4200mm x 3800mm (15.96m2)

4500mm x 3800mm (17.1m2)

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ROOM DESIGN DESIGN DESIGN TEMPLATE 1 TEMPLATE 2 TEMPLATE 3

G Hospital beds (1 standard bed & 1 hospital bed in a twin room)

4000mm x 4100mm (16.4m2)

4300mm x 4100mm (17.63m2)

4600mm x 4100mm (18.86m2)

Another objective was a cost analysis carried out on provision of major adaptations across tenures. Samples were selected according to adaptation type as follows;

Single bedroom / WC shower room

Double bedroom / WC shower room

Representative completed schemes across tenure were chosen to reflect typical adaptations which have been provided. These were compared against the proposed Design Space Standard Matrix to identify potential over‐provision/under‐provision in relation to the model space standards.

An excerpt of a double bedroom adaptation scheme for the NIHE in the South East Area is clearly identified in the table below.

Table 10: Potential cost savings

Example from South East Area – Project No. Ref: 24.38.312

ROOM INDEPENDENT

WHEELCHAIR

USER

APPROVED SCHEME DESIGN AREA

RECOMM‐ENDATION

COST SPACE/ COST VARIANCE

Double Bedroom

3900mm x 3900mm

(15.21m2)

3650mm x 4460mm

(16.28m2)

WC / Shower Room

2300mm x 2200mm

(5m2)

2450mm x 1940mm

(4.75m2)

Ground floor double wheelchair accessible bedroom and en‐suite shower room

+(0.82m2)

Total Cost £42,683

+ £1,664.29

Whilst this table shows potential cost savings, comparison cannot be undertaken on a cross tenure basis as the costing mechanism is different for each tenure. This study did not include the detailed cost analysis of the number of underlying variables such as site works, additional improvements to the existing dwelling and procurement method.

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2. Inter‐agency/design communications

Interagency design communications required review to identify operational areas where current liaison arrangements caused difficulties or delays.

The full range of communication between stakeholders at the various stages was reviewed. The key interaction milestones identified were:

Initial needs assessment

Option appraisal

Recommendation

Design and costing

Approval of plans for agreed option

Onsite planning & delivery

Approval of completed works

The review determined that the interagency adoption of generic standards of communication will address a number of problematic areas within these key inter‐agency interfaces which singly are minor but accumulate to create avoidable delays in adaptation delivery. Such an approach will ensure consistency and quality of the information to be shared.

In order to achieve this, an Inter‐agency Design/Communication Toolkit was developed which, addresses the significant operational issues arising out of current interagency liaison arrangements. A key area impacting on communication is the Option appraisal which is dealt with in more detail in Section 7b: Case Management. While the initial priority for the toolkit was to deal with inter‐agency design communications it progressed to include a number of other standardised templates to address other areas of inter‐agency communications. The primary products contained within the proposed Design/Communication Toolkit will be published as an inter‐agency practice guide following a pilot evaluation.

Benefits

There are benefits to be achieved by the universal implementation of an agreed format and content for interagency recommendations. These are as follows:

Streamlining and standardisation of information exchanged between stakeholders.

Ensures best use made of available funds.

Allows designer flexibility to achieve best value design solution.

Resolving common recurrent communication issues currently delaying delivery of adaptations.

Information requirements will now be proportionate to the cost and complexity of the works being recommended ‐ the more complex or expensive the recommended

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option, the more detailed the information required. A standard format for interagency recommendations will help minimise incidents of unnecessary over‐provision but will also benchmark minimum space standards and therefore avoid the waste associated with under provision across tenures. The use of the OT template alongside the Design Space Standards Matrix will reduce the administrative requirements in terms of clarification and duplication of activity for all concerned. A key benefit is the proposed template also allows designer flexibility in achieving best value design solutions within the existing footprint of the dwelling where appropriate.

Occupational Therapist (OT) recommendations template A need was identified for an agreed approach for OT recommendations through development of an agreed template which meets all stakeholders’ information requirements. In order to understand the need for change it is necessary to understand the different requirements for stakeholders. Communication formats for organisational approvals are considered under the Governance and Case Management chapters.

Recommendation template format and OT specifications

Consideration was given to proportionate requirements for major and minor adaptations. Two forms have been provided – one for minor adaptations and one for major adaptations. The forms are a coherent structure with the minor works form being a simple abbreviated version of the full form used for major adaptations.

Health & Social Care Trust (HSCT) use a range of OT specifications for certain types of work. It was decided to produce six standard specifications to be used to support the OT recommendation. The specifications were developed following analysis of the existing wide variety of specifications currently in use. Standardisation of specifications will ensure consistency of approach across Trusts and will form an integral part of the Design Communications Toolkit.

Limited quality assurance tests on the recommendation templates have been carried out with practitioners to ensure that they are understandable and that the explanatory notes are clear and understandable. Full assessment of their effectiveness cannot be conducted until the pilot test of the templates and standardised OT specifications along with the Design Space Standards Matrix is complete.

Option appraisal & the design solution

The technical feasibility and economic viability of adaptation proposals and related design solutions are fundamentally inter‐twined with investigations of the optimal design solution. Often estimated costs formulated at initial option appraisal stage will need to be revised when more detailed investigations are conducted on the physical environment. Since value for money is an important consideration of any

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option appraisal, high cost adaptations need to be given careful consideration. As the result of the option appraisal process there may be occasions where the preferred solution may not be viable for technical or economic reasons.

Design brief to assist architects & designers

Currently there is no guidance regarding the content of adaptation drawings and plans making decision‐making problematic. The information provided to OT’s needs to be consistent to allow the OT to agree/make an informed endorsement. To this end a design brief has been developed to ensure that architects/designers clearly understand the content required in plans to enable stakeholders to make informed decisions.

IT infrastructure

Another basic issue for practitioners is the availability of compatible and adequate IT facilities to maximise opportunities for electronic communication, exchanges of plans and communication templates.

Implementation

A key element for the successful introduction of the Design Communication Toolkit is an effective and sufficiently resourced implementation plan supported and underpinned by joint training for Health & Housing professionals.

SECTION 6 ‐ Usage and re‐cycling of existing resources

SECTION 6 ‐ Usage and re‐cycling of existing resources It is acknowledged that the current financial climate presents many challenges and reinforces the need to be proactive in identifying innovative measures to address housing need within a constrained resource environment. This places greater emphasis on making better use of existing resources, including housing which has been adapted to meet the needs of a disabled person or adaptation equipment. Re‐use of such resources may take two forms:

1. Re‐use of existing adapted stock when the facilities are no longer required by person for whom they were originally provided

2. The re‐deployment of adaptations to other locations

Reuse of existing stock As there has been substantial investment in the provision of accessible housing stock to address the needs of disabled people since the 1970s, there is considerable interest in the effectiveness of these adaptations, their frequency of use and potential for reuse by other people in need. While the reuse of lifts is well established and will be explored later in the report, further examination of the reuse of other facilities is warranted.

Table 11: Social housing adaptation volumes

Tenure Extensions Showers Heating Lifts Total

NIHE 892 3,958 1,290 583 6,723

H.A. 28 2,055 16 51 2,150

Total 920 6,013 1,306 634 8,873

(Source: NIHE/DSD report on paid housing association claims 2007‐09)

The current property records and systems do not readily facilitate calculation of the duration of use of the adaptation for the person currently using it. In a Housing Adaptation Survey conducted in 2006 on NIHE and private sector stock however a high proportion of people who received adaptations (89%) stated that the adaptation greatly improved their independence in the home, thereby demonstrating the value for money achieved through the adaptations programme. The survey also captured data regarding how often adaptations were used by tenants and is detailed in the table below:

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Table 12: Frequency of adaptation usage

Frequency Number %

Everyday 3,344 92

2‐3 times a week 180 5

Once a week 10 0

Once a month 5 0

Only if you have to 31 1

Never 26 1

“Don’t know” 42 1

Total 3,638 100

Source NIHE Housing Adaptations Survey Report 2006

It is also acknowledged that while at the outset the installation of an adaptation will benefit the primary disabled person as demonstrated in tables below, given the age profile of NIHE households and the levels of disability it is possible that the adaptation may well benefit other family members in the future.

A total of 185,416 NIHE household members were identified province wide by age group profile in the 2009 Continuous Tenant Omnibus Survey. A significant concentration of NIHE household members were found in the 55+ age group which represents 28.5% of the total NIHE household members.

Table 13: Age Profile of NIHE Tenants

Age Group Total Household Members

Percentage

55‐59 years 9,812 5.3%

60‐64 years 10,416 5.6%

65+ years 31,594 17.6%

Total 51,822 28.5%

Source CTOS Survey 2009

A total of 63.5% of NIHE households confirmed that one or more members of the household had a self‐reported disability or a long term illness. This represents an increase of 5.5% compared to 58% reported in the 2008 CTOS Survey. This compares to 21% of the overall population (NISRA 2007).

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Table 14: NIHE households with members who have a disability or long‐term illness

Households with members who have a disability or long term illness

Total

Percentage

Households with 1 member 43,588 49.9%

Households with 2 members 10,510 12.0%

Households with 3 or more members 1,418 1.6%

TOTAL 55,516 63.5%

Source CTOS Survey 2009

In the event that it can be determined that the remaining household members are unlikely to require the adaptation, it is clearly desirable that the relevant housing provider fully maximises the use of the asset when it becomes available.

There are a number of ways in which adapted social housing stock can be re‐used:

1. Through allocation of a vacant adapted property

If an adapted property becomes available, under the general rules of the Housing Selection Scheme the dwelling should normally be offered to the relevant applicant with the highest points. However, it is good housing management practice to make best use of stock, particularly adapted stock. Under the Housing Selection Scheme, the NIHE and housing associations have authority to depart from this general rule in certain specific circumstances i.e.

Exceptionally, such a departure is highly desirable in order to match the special and specific needs of an applicant with the facilities and amenities accessible in a particular dwelling or location.

In practical terms this means that if an adapted property becomes available, then even though there are other applicants with higher points for whom the property might be suitable the property can be allocated to a lower pointed applicant who needs that type of adapted property.

A number of additional issues need to be considered by the housing provider when trying to hold a property for a disabled person, which may result in a longer term void. Issues include vandalism and resulting refurbishment and loss of rental.

2. Transfer

It may not always be immediately apparent that an adapted property is no longer required by the disabled person. Whilst the responsibility to notify the housing provider of any change of circumstances rests with the tenant, this may not always happen. In some situations the first indication that the disabled person has left the property may be through other agencies.

There are a number of situations whereby a transfer can take place:

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If the tenant requests a transfer because they no longer require the adapted property, then staff at the local office can grant a degree of priority (management transfer status) under the Housing Selection Scheme. Policy also permits the payment of a financial incentive to assist the person with moving costs.

If it becomes apparent that the disabled person no longer resides in the property an approach can be made to the family to ascertain if they would consider transferring and that the property can be used by another disabled person. If the family are agreeable then the transfer can be processed as above.

Legislation (Ground 8, Schedule 3 of Article 28 of the Housing Order (NI) 1983) enables the NIHE to seek re‐possession of a property occupied by the secure tenant in the event that in such circumstances the remaining household members are unwilling to move.

A direct/mutual exchange takes place when one secure tenant agrees with another secure tenant to exchange dwellings. If an adapted property is identified which may suit the needs of a disabled tenant and a direct exchange is requested, a joint visit can be carried out with the Occupational Therapist to determine if the property meets the needs of the disabled person. If suitable, the direct exchange can proceed. If the property does not meet the needs of the disabled person then NIHE can withhold consent to the direct exchange under Ground 4, Schedule 3A of the 1983 (NI) Housing Order.

Evidence currently available would suggest that an adapted property is likely to provide long term benefits for a disabled person and given the profile of our tenants, other members of their household. Instances clearly arise, however, where a property with significant adaptations is no longer required by a household, because the disabled member of that household has moved elsewhere or is deceased.

In exploring the potential for maximising the use of such properties for disabled persons, a number of factors need to be considered, including:

Security of Tenure/Tenants Rights – Once a tenant has completed the 12 month introductory tenancy period they become a secure tenant and therefore have legal rights under statute i.e. the right to security of tenure under the Housing (NI) Order 1983. Security of tenure means that the NIHE cannot end the tenancy without a court order for possession unless the property has been abandoned. However, as previously highlighted the Housing Executive can seek repossession of an adapted property when it is no longer required by the disabled person for whom it was provided. Repossession on such grounds has rarely if ever been enforced given the sensitivities involved, the likely legal challenges and the challenges involved in securing suitable alternative accommodation for the family concerned. This would be less likely in the use of pre‐fabricated re‐locatable extensions.

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Costs – Tenants displaced in such circumstances would incur costs in moving home and would be entitled to home loss/disturbance payments. Additionally the property vacated may require further “fine tuning” of the adaptations undertaken to make it suitable for the prospective new tenant.

Impact on community cohesion/sustainability – While such relocation is unlikely to occur on a large scale, it would nevertheless run contrary to the longstanding Government objective of promoting sustainable communities in that tenants with a disabled household member would see their inclusion in a particular community being dependent on that member of the household continuing to live in the family home.

The above factors aside, however, the review has identified the need for a re‐examination of current policies to determine the extent to which maximum use can be made of adapted stock. A pre‐requisite in any such approach is the need to have up‐to‐date information on the location of adapted properties across the social and ideally private housing sectors, as well as the nature of adaptations undertaken. Such information is currently limited, stored in various databases, and not readily available to officers dealing with requests for housing or adaptations.

Accessible housing register

Rationale

At present many people either live in unsuitable accommodation or find it extremely difficult to move due to the lack of accessible housing.

Accessible housing is key to equal opportunities for disabled people.

The Disability Discrimination Act (DDA) was amended in 2006 with an extension to its remit known as the Disability Equality Duty. This duty requires public sector bodies, including housing authorities to promote equality for disabled people. Housing authorities are required to take steps to meet disabled peoples needs even if this requires more favourable treatment. Without this duty many disabled people could continue to live in unsuitable premises.

There are a number of case management processes in use which will need to be reviewed and streamlined to create a framework to fully utilise and explore all of the housing options available in order to meet the housing needs of the individual. This process involves a comprehensive assessment of the applicant’s needs, identification of the most appropriate solution to meet their needs and a “hands on” approach to assist the applicant to achieve the agreed solution.

Given the current financial situation public sector bodies will have limited funding which will impact upon the delivery of the adaptations and in particular high cost adaptations. This will result in longer waiting times for adaptations and will ultimately place greater demand for properties that are already adapted or have been purpose built to a wheelchair/life‐time home or mobility standard.

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Housing authorities will have to be more creative / innovative in achieving feasible housing solutions to meet the needs of the individual. One way of achieving this objective would be through the introduction of an Accessible Housing Register.

Benefits

An Accessible Housing Register will provide numerous benefits not only to the individual but also the Housing Authority:

Fulfil the duty under the Disability Equality Duty to promote equality for disabled people

Develop an improved knowledge of housing stock

Better use of stock ‐ It will help to ensure that accessible and adapted properties are let to people who need them, enabling them to make the most effective long term use of resources invested in major adaptations and accessible housing.

More cost effective approach

Identify unmet need

The benefits of an Accessible Housing Register for the individual include:

Prioritising disabled people for accessible homes

Providing disabled people with information about all aspects of accessibility in a consistent format

Providing effective channels for advertising and marketing accessible housing options across all tenures.

Benefit all disabled groups

Better visualisation of the option

Best fit – matching the disabled persons needs with the correct housing solution

Maximises choice for the disabled person

An Accessible Housing Register is an information tool to enable housing authorities to make better decisions with the aim to match accessible properties to the individual needs of people. The AHR is a way of storing and displaying specific information on the characteristics of a particular property.

The main AHR categories include:

Wheelchair accessible throughout

Wheelchair accessible essential rooms

Lifetime homes

Easy access

Step free

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Minimal steps

General needs housing

The property has not yet been assessed

Re‐use of adapted stock in the private sector Private sector stock, unlike social housing, does not readily lend itself to re‐use of adaptations. However data on the access features of private sector housing, if made available at the time of sale, would help to inform disabled people of the suitability of the property and maximise choice.

Scottish single survey

Since December 1st 2008 anyone wishing to market a residential property in Scotland has to provide prospective purchasers with a detailed Home Report.

This single survey must contain “Accessibility Information” which provides details on:

The number of steps to the main entrance

The distance from the property to unrestricted parking

Door widths greater than 750mm

The location of toilet facilities in relation to living and sleeping accommodation

The cost of providing the Home Report is met by the seller. For information see; http://www.homereportscotland.gov.uk

Recycling There is increasing interest in resources which have a potential for recycling, both as a result of sustainability policies and to maximise existing resources in a period of economic downturn. These resources also have value in offering a rapid response with minimal disruption for disabled people where there is an urgent or short term need.

While many forms of adaptations form permanent structural features in the home, a range of adaptations and assistive technologies have the potential for recycling/redeployment and portable assistive technologies, for example; bathing equipment provided by the HSC Trusts may address the needs of disabled people before housing adaptations need to be considered.

Adaptations and assistive technologies which have the potential to be redeployed when no longer needed include:

Various types of lifts.

HSC Trust equipment.

Environmental control systems.

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http://www.scotland.gov.uk/Topics/Built-Environment/Housing/BuyingSelling/Home-Report


Prefabricated re‐locatable extensions.

Modular/portable ramps.

Prefabricated re‐locatable wet rooms (shower, wash hand basin and WC).

Lifts An Inter‐Agency Task Group on Lifts was formed to jointly review the resources, technical standards, procurement, installation, aftercare and recycling of lifts, share good practice and consider future areas for collaboration. The full report of the lifts task group is available at: www.nihe.gov.uk www.dhsspsni.gov.uk

In terms of volume and resources, lifts currently constitute a significant area of provision and recycling activity. Lift recycling programmes are relatively advanced in Northern Ireland and may be more extensively utilised than in other parts of the UK. This may be partly explained by the fact that certain types of lifts are still funded by Disabled Facilities Grants (vertical lifts) in other parts of the UK.

Lifts are currently procured and provided through separate delivery systems i.e. HSC Trusts, NIHE, and housing associations. The accumulative number of lifts currently deployed in Northern Ireland is 6,065 across all service providers (HSC Trusts, NIHE & housing associations). The total number of lifts installed in 2009/10 is detailed below:

Straight/Curved Vertical Total

New 550 90 640

Recycled 340 49 389

Total 890 139 1,029

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http://www.nihe.gov.uk/



Resource deployment

The provision of lifts makes a major contribution to the creation of accessible housing in Northern Ireland. Lifts therefore form a key part of the adaptation service.

Figure 17: Number of lifts in Northern Ireland by type & provider 2010

3,943

605

997

476

35 9

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

HSC trust NIHE Housingassociations

Stairlifts Vertical lifts

(Source: Lifts Task Group)

Lift recycling

significantly by year and by provider as the availability of lifts for

le

/2010 the highest levels of recycling occurred with straight flight

with HSC Trusts reporting a

vings in 2009/10 between the installation of a new lift as opposed to

Lift recycling variesrecycling is beyond the control of service providers. As regards the duration of lift use by service users, some lifts may be used for decades by younger disabled peopwhile lifts may also be required to support shorter term or palliative care requirements.

In the year 2009stair lifts. HSC Trusts reported recycling levels ranging from 23% to 58%. The NIHEreported 45% as an average across Northern Ireland.

Inter‐floor lifts are the next most recyclable type of liftrange from 21% ‐ 29% and the NIHE 60%. Curved rail stair lifts have the lowest rate of recycling with HSC Trusts reporting a range between 12% and 29% and the NIHE reporting 8%.

The financial saa re‐cycled lift are detailed below:

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Type of lift Estimated cost

New stair‐lift ent and installation) £2,030 (procurem

Recycled stair‐lift £692 (removal, refurbishment and re‐installation)

New Vertical Lift £9,562

Recycled Vertical Lift £5,609

The rhouse er Audit of Occupational Therapy Services i cy e of 40% for all lifts and ceiling track hoists in

ould be recognised there are insurance, maintenance, storage

riations

stive technology loans Community compliance with

or

es d Logistics Services – it should be noted

city of the existing supply market to provide the scope

l”/complex and “low level”/simple equipment.

DHSSPS Price Watedentified an average re

Coopcling rat

2006/07.

No figures on recycling are available for housing associations.

Resources for aftercare and recycling

While the levels of lift recycling are impressive, it shsignificant costs required for lift aftercare including and re‐installation. Lift replacement costs also need to be considered after approximately 10 years. It is critical that adequate resources are made available for aftercare to support a safe and effective recycling programme. Significant vain aftercare costs have been identified by various providers which would merit further investigation.

HSC Trust assiA common consolidated approach to the management of Trustequipment is required to ensure equity of service provision andassociated standards to patients and carers throughout Northern Ireland.

This service should integrate delivery, installation (where required), collection, decontamination and storage of equipment by a single provider, per Trust areapreferably on a multi‐Trust or regional basis. Several options exist in respect of service delivery including the following:

Service provided fully “in‐house” by either Trust(s) or Business ServicOrganisations Procurement anthat the latter currently has an established, fully automated cleansing service in operation. On average 15,000 items are recycled per annum ata value of £2.5m.

Service provided externally i.e. through the private sector contract. The capability and capaand scale of service required to ensure equity of provision is however unclear at this stage.

A hybrid approach i.e. combining elements of the above to manage thefull range of “high leve

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There is an urgent need to address this issue to resolve the current fragmented approach within Trusts and the potential risks with this lack of central Trust/ regional control.

Environmental control systems

There is a need for HSC regional planning, provision and redeployment of environmental control systems due to the specialist and high cost nature of these systems and their aftercare. HSC expenditure on high tech Electronic Assistive Technology averaged £29,975 over the years 2008/09 and 2009/2010. A separate dedicated cross‐sector review of high tech, Electronic Assistive Technology (EAT) is required.

Re‐locatable modular extensions (PODS)

The Northern Ireland Housing Executive piloted eleven prefabricated modular extensions or PODS, within its own stock, in 2007 to complement its traditional adaptations programme. The decision to pilot these new methods of construction followed a joint research programme with Salford Council and the Building Research Establishment (BRE). The average age of respondents was 63 years, the youngest 35 and the oldest 87. Three PODS consisted of a shower room and toilet and five were double bedroom with en‐suite shower rooms. The shortest period of time it took from assessment to provision was approximately 6 months and the shortest time on site was one week.

The objective of the exercise was to monitor the impact of off‐site fabrication and to gather tangible information on;

The feasibility of using off‐site construction

The comparison of costs against traditional construction

The reduction of disruption to clients

Client acceptability

The implication for Statutory Approvals

Potential reuse

An initial evaluation was carried out on completion of the modular extensions. Set against the above objectives, the benefits identified were as follows;

Reduction in the on‐site construction time with resultant reduction in disturbance for families.

Construction is less affected by weather; significantly most modular extensions were installed during winter.

Quality assurance of the construction process in a more controlled environment.

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A user survey carried out on a sample of 8 people who received a modular extension was generally positive, (Case Study 1), but because of the small sample size findings can not be universally applied.

No need for decanting provided significant internal alterations are not required to other parts of the dwelling.

Potential to re‐use the modular extension at another location when no longer required.

General Issues

There are many issues which have arisen as part of this pilot study which will need to be addressed in order to enhance the modular extension relocation process and the potential to deliver new modular extensions in the future.

There was some evidence suggesting that the initial construction of modular extensions were about 20% more expensive than traditional construction.

There were no advantages in terms of speed when it came to applying for Statutory Approvals of these modular extensions but please note that Salford have sought type approval for PODS in relation to building control approval.

The new NIHE Adaptation Framework Contract is proving to be much more competitive in the delivery of traditional constructed adaptations than the previous Measured Term Contract.

By comparison Salford Council who have 60 modular extensions in‐situ and who made a decision in 1999 to deliver all major adaptations using modular extensions have reverted back to traditional build methods for the initial delivery of these extensions. This was as a consequence of the downturn in the construction industry and hence more competitive pricing for traditional build methods. The manufacturers of modular units have not reduced their costs accordingly and are currently not as competitive as the traditional build sector.

The relocation of Salford’s modular extensions are still being carried out at competitive rates as this package of work has been tendered separately using a fixed term contract.

Learning from Salford’s experience, we need to explore the potential for modular manufacturers to offer more competitive pricing which can compete with traditional build costs.

Other factors which need to be considered include:

Design/technical

Procurement

Legal/policy

Financial

Delivery pathways

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Statutory Approvals

Issues arising with relocation

Two modular extensions have been relocated to date and a third has moved into storage until a suitable client / dwelling is found to accommodate this unit.

In addition to the general factors above other issues specific to relocation include:

A requirement to refurbish the POD to current building control standards

Significant costs when two moves from original to a new location is required

Delays due to not having a dedicated procurement system for these works and a means of programming PODs alongside traditional build extensions

No agreed schedule of rates for relocation

Relocations to date have been technically successful but there are on‐going concerns regarding the recurring movement of larger timber framed PODs.

Conclusion

While outline procedures were developed to support the pilot, in order to further develop operational procedures in this area, it is clear that an overarching policy and procurement framework is required.

The Department for Social Development as part of the Interdepartmental Review of Adaptations are minded to recommend the use of modular extensions as a first response where major adaptations are required.

However early indicative comparative costs for initial provision and relocation of modular extensions versus traditional build extensions demonstrate that modular extensions are not the most economic solution at present, because of the:

current economic environment resulting in more competitive pricing for traditional build solutions

deficit in terms of specific procurement arrangements for these types of modular extensions

lack of a competitive schedule of rates for this type of work

requirement to upgrade relocated modular extensions to current Building Regulations

need for more streamlined delivery and relocation processes avoiding recurring relocation costs

limited volume and standardisation of production

However the use of modular extensions has benefits in the following scenarios;

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urgent short term use

minimising disruption

potential speed, assuming a streamlined process

where traditional build techniques are not technically feasible

no need for decanting provided significant internal alterations are not required

for other parts of the dwelling

quality assurance of the construction process in a more controlled environment.

Modular re‐locatable extension case study A modular re‐locatable extension was considered for a terminally ill tenant who could not be discharged home from the hospice as the family home did not meet the tenant’s needs. The tenant wanted to spend time at home with the family. It would not have been possible to re‐house the tenant in suitable alternative accommodation in the time frame involved due to constrained availability of stock within the areas of choice. The Occupational Therapist submitted a recommendation for a downstairs shower room and WC. A traditional build extension was initially considered however given the timeframe involved it was agreed that a pre‐fabricated re‐locatable extension could offer a rapid response. The timescale from OT recommendation to installation was 14 weeks. The family were absolutely delighted with the pre‐fabricated extension as it enabled the tenant to maintain independence within the home and spend a considerable period of quality time at home with the family.

This modular extension has now been relocated for use by another tenant who has difficulty functioning within the home environment.

Modular ramps

Modular ramps offer the potential for a rapid response to urgent or short term need for example, hospital discharge and life limiting illness. The ramp can then be moved to the next home where it is required and minimal costs are incurred in making good the original site. Modular ramps could also be designed to interface with prefabricated re‐locatable extensions.

In practice a number of units have been deployed by HSC Trusts (nine in 2009 /2010) and by the NIHE in various settings and field tested.

Prefabricated wet rooms

Prefabricated wet rooms, which the manufacturers claim can be installed between 5‐8 hours, have entered the market in Northern Ireland recently. They can be provided as part of an internal in‐shell solution or as an extension. They have also the potential to be redeployed when no longer required.

SECTION 7A ‐ Governance


Overview Corporate governance is the system by which an organisation is directed and controlled, at its most senior levels, in order to achieve its objectives and meet the necessary standards of accountability, probity and openness.

The Audit Commission has defined corporate governance as ‘The systems and processes by which bodies lead, direct and control their functions, in order to achieve organisational objectives, and by which they relate to their partners and the wider community’. (DHSSPS, 2010)

Is principally concerned with ensuring that all Arms’ Length Bodies (ALBs) have the basic building blocks in place for good governance through development and implementation of a comprehensive system of internal control.

Contains key criteria and supporting guidance to assist organisations to establish whether they have in place a sound system of governance and internal control that is based on the principles of best corporate governance. This will help the organisation’s board, through its Chief Executive, to sign the annual statutory Statement on Internal Control (SIC).

Together with the Risk Management and Financial Management standards, provides the basis for statutory reporting for the SIC as set out by the Department of Finance and Personnel in DAO (DFP) 05/01 and DAO (DFP) 25/03.

Background The need to ensure and demonstrate effective governance arrangements originated in the private sector, due to concern over a series of corporate failures where inadequate governance measures were considered to be a contributory factor.

Since 1997/98, all Chief Executives of bodies sponsored by government departments have been required, as accountable officers, to sign an assurance statement (on behalf of the board) to assure their stakeholders on the matter of internal financial controls. This responsibility has since moved beyond financial issues to the production of a wider statement covering organisational controls. In DAO 5/2001, the Department of Finance and Personnel required that Northern Ireland Departments, like their GB counterparts, should adopt the key provisions of the Combined Code (incorporating Turnbull). The Turnbull report states that ‘a sound system of internal control depends on a thorough and regular evaluation of the nature and extent of the risks to which the company is exposed’. It further states that the purpose of internal control ‘is to help manage and control risk rather than to eliminate it’.

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The Assurance Framework

The Assurance Framework, the adoption of which is mandatory as of April 2009, provides a mechanism for identifying and understanding the principal risks, and key controls to manage those risks, to achieving the principal objectives. In addition, it provides a mechanism for collecting and marshalling the evidence, required for the Statement on Internal Control, that a board is fully aware of the totality of its organisational risks and has based its conclusions on all the appropriate evidence.

Current Governance Arrangements

Northern Ireland Housing Executive

The range of governance arrangements within the NIHE include:

Approvals

Dossier of Controls (Maintenance Policy & Procedures)

Delegated levels of authority

Chief Executives Business Committee

Area Clearance Meetings

Area Approval Meetings

Policy and procedures

Organisational policies & procedures (Policy guidance/clarification available from Policy Unit within the Housing Centre)

Standards of service

Referral procedures for exceptional cases

Quarterly area welfare officer meetings

Audit and Inspection

Audits (Technical, Test of Resources, system, internal & Local Government)

Management inspection (Minor adaptations included in RIU inspection programme)

Pre/Post inspections by Maintenance Officers to ensure good contractor performance

Post inspections of major adaptations by Grants Officer & Occupational Therapist

Competition certificate

System control reports actioned

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Performance

Key Performance Indicators & service targets

Performance reporting (Quarterly to Performance Review Group)

Financial management

MPMNI requirement (Control of expenditure)

Schedule of rates

Monthly monitor of Response Maintenance Spend

Customer service

Grants Warranty Scheme

Consumer surveys


The range of governance arrangements within housing associations include:

Approvals

Delegated levels of authority

Policy and Procedures

Housing Association Guide

Audit and Inspection

Pre/post adaptation inspections

DSD audits

Performance

Performance reporting (Quarterly to DSD)

Health and Social Care Trusts

A HSC Governance Task Group was established to gather information on the governance/controls assurance for housing adaptations, including the decision‐making and approval process within each Trust in relation to the assurance framework.

A list of governance criteria was used to formulate a questionnaire to be completed by each Trust. Follow up visits were organised with Trusts to discuss and clarify any gaps in information provided on the questionnaires.

Following the completion of this information gathering, recommendations have been made for each criterion and this will form the basis of a HSC Trust Action plan.

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The range of governance arrangements identified within Health and Social Care include:

Approvals

Chief Executives Senior Management Team meetings

Delegated levels of financial and clinical authority

Development of skill mix in the workforce to manage levels of clinical complexity

Clinical supervision and Individual Performance Review

Peer group panels

Housing adaptations panels

Policy and procedures

Priorities for Action targets (PFA) for assessment and HSC adaptations provision

Regional access criteria

Clinical pathways for various types of adaptations provision (Draft)

Regional criteria for the provision of adaptations

Manual handling risk assessment

Protocols for joint visits with housing providers

Regional OT forums

Supervision and CPD procedures

Audit and inspection

Quarterly governance meetings

Commissioning visits of major adaptations

Registers: to monitor equipment quality/inspections.

Audit

Risk management registers

Medicines and health care products regulatory agency monitoring

Regulation and Quality Improvement Authority Inspections

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Performance

See PFA targets above

Weekly performance reporting

Health Professions Council regulation

Financial Management

Delegated levels of financial authority

Tendering procedures

Customer Service

Service user panels

Personal and public involvement

Research

Consumer surveys

Complaints procedures

Issues

As outlined above all organisations involved in delivering adaptations across both sectors have a clear governance framework which includes appropriate controls, checks and reporting. It is also evident that models of good practice exist within both housing and health and social care sectors. However there remain a number of issues:

Lack of understanding / knowledge of respective governance arrangements across sectors.

Health and Social Care governance arrangements vary between the five different HSC Trusts. It is worth noting that the implementation of the Review of Public Administration and the amalgamation of Trusts have had an impact on recruitment and substructures, which in turn has had an impact on how governance / controls assurance for housing adaptations including the decision making and approval process have been developed within each Trust. Trusts are at variable stages of development with regard to standardisation of procedures and practice.

Governance arrangements also vary considerably across the housing sector and within the housing associations.

There is also inconsistency in standards of service across and within the sectors although HSC PFA targets for Occupational Therapy assessment have standardised assessment standards and procedures across tenure.

Standards of service do not necessarily reflect user expectations.

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The quality and validity of inter‐agency data exchange needs to be improved in a number of areas e.g. OT waiting times for assessment by tenure, adaptation completion dates

Principles

Given the cross‐sector nature of adaptations and the level of expenditure involved a co‐ordinated approach to governance is recommended. Any such co‐ordinated approach should be based on shared principles.

The following principles should be considered to underpin a co‐ordinated approach:

Consideration of service user needs should be in the context of their entire adaptations “journey” (across both sectors) and performance measures should reflect key stages of this journey.

Resources should be targeted to those in greatest need.

An appropriate co‐ordinated accountability framework should be established within which internal control systems operate and which encompasses management structures and practices.

Core and supporting processes required to produce the desired outcomes are required, including risk management.

There should be sufficient capability both in terms of resources and skill mix to ensure that the processes and internal controls work effectively.

The system of internal controls should be continuously monitored and reviewed to ensure that the joint processes are working properly and to learn and, where necessary, improve the accountability arrangements, processes or capability in order to deliver better outcomes.

Effective formal and informal communication and consultation across sectors.

Sufficient independent and objective assurances as to the robustness of the processes in key areas.

SECTION 7B ‐ Case management


Introduction Case management approaches have developed both within the NIHE and HSC Trusts (in the form of care/case management) to address the needs of people with complex needs and in particular those situations where substantial resources are required either from one agency or on a cross sector basis. There are a number of shared concepts at the heart of both sectors’ approaches such as:

Specialist organisational arrangements to manage complex case work

Case finding – defining complex case work

Cross sector working arrangements – e.g. joint visits

Option appraisals

Delegated levels of authority to authorise high cost solutions

Development of specialist skill mix to address complex needs

While both sectors share these approaches, the definition of complex cases, optional appraisal methods, delegated levels of authority and the consistency of cross sector working arrangements vary.

The purpose of this chapter is to review how case management processes have evolved in both sectors, identify variations in the understanding of complex case work and option appraisals, highlight cross sector interfaces and recommend how we can build on existing good practice to strengthen interagency working. In developing new arrangements the centrality of service users and carers needs to be fully considered. While there will be very real resource constraints in the current environment, disabled people must be offered as much choice and control as possible.

Processing routine case work It should be noted that the vast majority of routine case work is progressed through agreed single agency or interagency pathways see below (Figure 18). These pathways were consolidated as a result of the DHSSPS/NIHE Interdepartmental Review of the Housing Adaptations Service in 2002.

The pathways in turn are underpinned by clinical decision making in HSC Trusts and housing support decision making.

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Figure 18: Routine Housing Adaptations Pathways

NIHE PUBLIC ADAPTATION PATHWAY

OT submits recommendation

for housing adaptation to NIHE

Feasibility Study overseen by AWO

Option Screened

NIHE Consultant appointed

Plans drawn/agreed with tenant & OT

Pre‐site meeting (Key stakeholders &

tenant)

NIHE PRIVATE ADAPTATION PATHWAY

HA ADAPTATION PATHWAYS

OT recommendation submitted to NIHE

Grants Office

Home visit arranged for technical

inspection of the property

Request & agree sketch plans

Issue schedule of works and test of

resources documentation

Certification & issue of final payment

Tenant or other sources e.g. OT notifies HA of functional difficulties

HA issue referral to OT

OT report & recommendation received

Works <£10kStatutory approval obtained.

Tenders invited Contractor completes work.

Where appropriate HA refer to DPG for payment

Works>£20kConsultant appointed

Plans/documents prepared OT/client agree proposals

HA submit to DPG DPG advance proposal

Statutory approval obtained Tenders invited

Contractor completes work HA refer to DPG for payment

DPG approve payment

HIA notification

HA decision to pursue alternative

solution

HA to adapt property

Scheme approval sought

AWO organises decanting

Contractor appointed

Completion of work

Scheme on site

Issue tests of resources

contribution & complete DFG submission

Seek applicant/OT approval of sketch

plans

Issue formal approval

Final inspection

Works £10‐20KConsultant appointed

Plans/documents prepared OT/client agree proposal

Statutory approval obtained Tenders invited

Contractor completes works HA refer to DPG for payment

DPG approve payment

Options appraisal carried out if value over £4k

PATHWAY

Referral

Occupational Therapy

Assessment

Treatment intervention and

evaluation

Options appraisal for complex &

non complex case work

Redeployment of resources

Recommendation and specifications

to Housing Providers

End of works visit by AWO & OT

Approval of plans

Final HSC Trust commissioning

visit and discharge

Aftercare

HSC TRUST

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While routine delivery pathways all require effective intra and interagency communications a proportion of clients with more complex needs will require additional arrangements on a singular or cross sector basis.

NIHE Case Management Within the NIHE it became apparent that for an increasing proportion of clients in the overall District caseload the standard approach of applying the normal policies and procedures was proving to be inadequate.

It was recognised that by virtue of significant complexity and/or the vulnerability of the applicant some cases required a more intensive case management approach whereby:

All the circumstances of the case are thoroughly examined

All possible options are thoroughly considered and appraised with the applicant to solve their needs

Practical casework assistance is provided to the client in order to achieve the desired outcome

While NIHE case management has been developed to support a broad range of people with complex needs who need additional housing support and/or care, a significant number of people who require housing adaptations fall within this category and are therefore included within the case management approach.

One particular group who it’s considered require a case management approach are wheelchair users. Analysis carried out as part of the Wheelchair User Survey, NIHE 2007, highlighted wheelchair users on applicant/transfer lists as requiring case management for all cases due to the complexity of demand and supply and the need to address needs through a mix of housing transfers, adaptations and new build schemes.

To assist officers in applying this approach, detailed guidance has been drafted on Adaptations Policy (NIHE 2007 draft), Case Management Policy (NIHE 2008 draft) and Options Appraisal (NIHE 2009 draft).

Health and Social Care case management “The idea of a ‘key worker’ emerged during the 1970s as a single contact point for an individual client faced with an array of agencies offering different services. In the 1980s the concept evolved into that of the case manager. A case manager is the principal contact for the client. He or she takes responsibility for designing and assembling a package of services tailored to the clients needs; and for ensuring that these services are effectively co‐ordinated, delivered and monitored” (DHSS, 1991 P29).

Case management is deemed to be particularly appropriate where an individuals needs are complex or significant levels of resources are involved to ensure that an individuals needs are regularly reviewed and that resources are managed effectively.

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Case management also became more critical with the development of multi‐disciplinary teams in Health and Social Care.

There has been some confusion regarding the terms care and case management. Care management described the whole concept embracing key functions of assessing need; care planning and managing, co‐ordinating and reviewing services at Area and Unit level. The term case management is used to describe the activity, included within the concept of care management, of that of advocate and co‐ordinator of services for an individual client who needs this level of support.

“Care management” and the assessment of individual needs have rightly been described as the cornerstones of the delivery of quality care and therefore central to the effective implementation of the proposals contained in DHSSPS People First policy in Northern Ireland in the 1990s. (DHSS, 1991 P2)

DHSS policy at this time states that “housing is often the key to independent living” If dependent people are to be helped to continue living in the community their homes must be places where they can go on caring for themselves and where it is possible to provide the support they need. It was recognised that “people may only be able to stay in their own homes if they are suitably adapted.” The role of new build accessible housing suitable for disabled people was also recognised. (DHSS, 1991 P37)

DHSSPS policy and guidance for case management has recently been reviewed (DHSSPS 2010). The revised guidance reaffirms the principles of the People Fist guidance but seeks to further co‐ordinate and streamline multi disciplinary assessments through the use of the Northern Ireland single assessment tool.

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Definitions In determining that a case management approach is necessary one must establish whether the client’s needs are complex. In practice however the understanding of complexity varies across the sectors, as can be seen in Table 15.

Table 15: Definitions

COMMUNITY OT MANAGERS DEFINITION OF COMPLEX CASE

HOUSING DEFINITION OF COMPLEX CASE

Client has progressive serious medical condition with resultant long term physical disability problems.

When deciding whether a person may be a potential Complex Needs applicant the housing authority have to be flexible due to the variety & nature of the conditions that may be experienced by applicants.

There are multiple carers required Where the applicant is, for example; frail, elderly, has learning difficulties or extensive physical disabilities and requires intensive support.

There is more than one disabled person in the house

Where the applicant is involved with 2 or more Primary Care Teams within Social Services e.g. Elderly Care Team, Disability Team, Mental Health Team or Occupational Therapist.

There are manual handling issues and risks identified

The range and intensity of points scored on Support/Care & Function Matrix.

Clients have significant behavioural and diagnostic issues

Where the applicant, or household member, has recently been admitted, to a hospital or another institution, for respite care or is due for such an admission

There is a requirement for:

Specialist equipment

Customised wheelchair

Prescription of Electronic Assistive Technology

Other details of the case appearing to warrant further investigation into potential Complex Needs.

Environmental issues: topography, space constraints, design/layout

Intensive multi‐agency working

Protracted negotiations with family

Respite issues need to be addressed

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Interagency interfaces Having mapped out routine pathways for various types of adaptations delivery in various tenures it is clear that key interagency interfaces have been established which facilitate communications and option appraisals to address complex need.

Figure 19: Housing/Health Interfaces

NIHE AWO/HSC TRUST

INTERFACES

1ST point of contact AWO receives

recommendation for adaptation from OT and minor works process through District Office

Joint visit by AWO/OT/Technical

staff

Options appraisal (Multi‐disciplinary

meeting)

Agreement of plans (Client/OT)

Decanting (Possible input from

OT)

Pre‐site meeting

Final inspection (OT/AWOT)

NIHE GRANTS/HSC

TRUST INTERFACES

1ST point of contact Case Officer receives a recommendation for adaptation from

OT

Joint visit by Technical

Officer/Senior Technical Officer/OT

Agreement of plans (Client/OT) Grants

Quarterly meetings complex case review

and process.

Option appraisals where DFG not

viable (Appendix 2)

Copy of approval to OT service

1ST point of contact Housing association refers tenant to OT

Service

OT submits recommendation to housing association

for adaptation

Options appraisal

Agreement of plans (tenant/OT)

Procedures for complex case work to be forwarded by

Carolyn

INTERFACES H.A./HSC TRUST COMBINED HSC

TRUST / DFG PACKAGE

Joint visit

Interventions Multi‐disciplinary

meetings

Decanting

Final inspections DFG

Joint site visits e.g. tracking system

Agreement of plans

1st point of contact Assessment

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Options appraisals The concept and use of options appraisal is common in all sectors and there are in fact a significant range of options available within each sector. While there is a basic understanding of the options available in each sector and this has developed significantly over time, neither sector is fully aware of all the options available within the other sector at any one point in time when managing complex case work.

Figure 20 below details the types of options available across all the sectors, some of which are specific to a particular sector and some of which are shared.

Figure 20: Housing & health options appraisal process

HSC TRUST OPTIONS

NIHE OPTIONS HA OPTIONS PRIVATE SECTOR OPTIONS

Signposting

Advice & education

Rehabilitation

Assistive Technology

Reablement

Care provision

Minor works

Adaptations

Major work

Adaptations (internal & external)

Support re‐housing

Placement: Residential/Nursing Home

Minor Adaptation

Lift installation

Major Adaptation

Transfer (NIHE/HA – including Supported Housing) (& adapt if applicable)

New Build (& adapt if applicable)

Acquisition, including merging property with adjoining house (& adapt if applicable)

Private Sector Placement

SPED

Housing Support Package (provided in conjunction with above options)

Adaptations to non LTH property (minor/major)

Adaptations to LTH property (minor/major)

Transfer (NIHE/HA) (& Adapt if applicable)

New Build (& adapt if applicable)

Bespoke new build

Purchase an off‐the‐shelf (OTS) or Existing Satisfactory Purchase (ESP) (& adapt if applicable)

Disabled Facilities Grant

Self funded adaptations

Purchase more suitable property or self‐fund new build option

Apply for social housing (& Adapt if applicable)

Private Sector Placement

Acquisition, including merging property with adjoining house

Existing owner/occupied property (& Adapt if applicable)

SPED

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The glossary of terms describes some of these options in more detail.

Protocols for joint working The NIHE/DHSSPS Joint Fundamental Review of the Housing Adaptations Service identified a number of recommendations in 2002 which have strengthened the understanding of respective roles, processes and, specifically, the need for joint visit protocols.

These joint working arrangements have, over time, resulted in a better understanding of options available across the sectors.

Step by step guides were also developed as a result of this review, to support joint‐working and improve information for service users.

The review acknowledged that while joint visits were not required in every case, it was good practice to arrange interagency joint visits and liaison where casework was complex.

As part of that review, triggers for joint visits were outlined at the different stages of the adaptation process (Appendices 6 & 7). These still remain valid today. While there has been an increase in the number and level of complexity of individuals needs living within the community, conversely the knowledge base and expertise among health and housing professionals has also developed. As a result while joint‐working remains integral and face to face joint visits may still be required this can be complimented by other communications methods. Pivotal elements in complex case management are the detail and timing of information being shared between sectors.

Role of specialist posts / skill mix The emergence of specialist posts reflects the need for both internal and external co‐ordination of complex case work, including the need to access expert opinion and to move towards a more strategic overview of options.

Health and Social Care Trusts

HSC Trusts use skill mix when allocating case work, with more experienced and senior staff managing the most complex case work. While occupational therapists in a variety of settings can recommend simple minor adaptations to facilitate early hospital discharge and promote independence and safety, more senior occupational therapists in community settings have responsibility for complex case work and associated major adaptations in accordance with the statutory responsibilities of their HSC Trusts.

Community Occupational Therapy Services are increasingly forming part of integrated community care teams. Within these integrated teams it is essential that governance arrangements are in place to ensure that statutory functions are recognised and maintained.

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A community OT manager’s forum survey in April 2009 identified that there were approximately 189 qualified occupational therapists with varying degrees of input to housing adaptations services alongside other clinical responsibilities (See Figure 21).

Figure 21: Community Occupational Therapists with an input to housing adaptations by Trust and speciality (April 2011)

0 5 10 15 20 25 30 35 40 45 50

Belfast

Northern

Western

Southern

South East

Paediatrics Adults Learning Difficulties Others (eg Dementia)

The Regional Care Pathway (Draft 2009) identified the competency level required for the Specialist Occupational Therapists caseworker who would recommend major adaptations. One of the indicators within the level states:

“Considers and interprets all of the information available using systematic processes of reasoning and reaches justifiable conclusions including the making of a differential diagnosis and the listing and rank of possible alternatives if appropriate and explains the outcomes to individuals.” (NHS KSF 2004 – Assessment and Treatment Level 4)

Throughout the UK there has been a movement towards the creation of specialist Housing OT posts. These post‐holders have contributed to a range of developing areas such as the establishment of accessible housing registers, housing allocation, specification of new build housing requirements for disabled people and case management support for housing colleagues when considering complex housing options.

In Northern Ireland when cases are more complex it is acknowledged that there is a requirement for additional support to explore the alternatives to best meet the individual needs of the client and carer in close partnership with housing agencies.

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This may be addressed through Community OT line management arrangements or alternatively through a Clinical Specialist Occupational Therapist in Housing. One such post, the first of its kind in Northern Ireland has been operational since January 2009 and there are plans to fully evaluate this post with internal and external partners. The outcome will be considered by Trusts regionally.

In accordance with the Strategy for the Allied Health Professions in Northern Ireland: Supporting and Developing the Workforce, the development of specialist Occupational Therapy expertise in this area will be supported by a range of post graduate training initiatives, including short courses and Masters level modules, at the University of Ulster. Training needs will be identified through HSC Trust training plans to the DHSSPS to be considered for commissioning. This will shape the future skill mix which supports a strategic shift towards the provision of integrated care and independent living support in community settings.

Housing (NIHE) ‐ public sector

Two key roles have developed within the NIHE in relation to adaptations in complex cases. Both these posts operate at the Area level, the Housing Support Officers (HSO) deals with complex needs cases and the Area Welfare Officers process major adaptations (as indicated previously applicants/tenants may fall within both categories).

In such cases the relevant officer will take a “hands on“ approach, liaising with the individuals/families concerned as well as the relevant external agencies, examining and appraising the various options (on the basis of a comprehensive assessment of need) and assisting in bringing about a solution.

The HSO undertakes the first two critical elements of case management therefore comprehensive assessment of the applicant’s needs and identification of the most appropriate solution to meet those needs.

Area Welfare Officers provide an intensive case management approach in relation to major adaptations referred by Occupational Therapists for NIHE tenants. Their caseload does not therefore include any other tenant of the Housing Executive who has disability issues that are being exacerbated by their current housing circumstances nor do they deal with an applicant from the private sector with similar disability issues.

These posts have developed over time and generally consider cases independently. An increasing emphasis on the case work approach has enabled both roles to operate on a joint basis, to achieve solutions for people with complex needs.

PSIS NIHE Grants

The grant applicant can utilise the services of FOLD or Gable to assist them with the completion of their Disabled Facility Grant (DFG) application. Their service is free to the grant applicant, although the Housing Executive pays for the service through individual service level agreements. Where this facility is provided it will be expected that the grant applicant will authorise either FOLD or Gable to act for them. On

147


receiving this authorisation the Grants Office will liaise directly with the particular agency in the processing of the application. These agencies can provide additional assistance in obtaining an architect and/or contractor to undertake the works.

While within the private sector there is no specialist post created to liaise with the OT Service as exists within the public sector, the Grants Offices, under their new file management system operate a ‘Case Officer’ system within their new Private Sector Management System. Under this system each grant applicant is allocated a Case Officer within the Grants Office with their role being to proactively manage the processing of each case from receipt of OT recommendations to the payment of grant. This requires that they maintain regular contact with their grant applicants to encourage and identify any problem areas as quickly as possible and resolve any issues.

Housing Associations

All associations must have appointed a member of staff to oversee all adaptations and provide a ‘contact point’ for enquiries. These may either be maintenance staff or housing staff depending on the individual association but they must be competent and have the range of skills necessary to enable them to fulfil their role.

Rationale for change As outlined above there have been significant improvements in identifying and addressing the situations where people have complex needs, including the establishment of joint‐working methods to address these. A range of factors would suggest the need for further improvements in this area. These include:

1. The fact that people with more complex needs are living longer in domestic settings in increasing numbers. This is set to increase due to demographics and government policy.

2. The level of user involvement and the service users understanding of roles (across and within both sectors) and their understanding of the rationale influencing housing options.

3. The need for a joint policy and procedures framework for managing exceptional cases.

4. Governance arrangements, to ensure a transparent decision making process which ensures confidence for service users, providers and government.

5. A consistent approach to option appraisal thus ensuring fairness and equity

6. Optimisation of available resources particularly in the context of decreasing resources within each sector.

7. The process of identifying and disseminating inter‐agency good practice.

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Issues While the above recommendations, if implemented, would undoubtedly improve the service provided for people with disabilities, a number of issues will, clearly, have to be addressed to make them achievable;

Defining complexity

Work towards an agreed shared definition of complex

Triggers for case management/optional appraisal

Agree consistent (fiscal & complexity) thresholds for case management

Quantification of volumes of high cost /complex case work (by tenure).

Consider impact of establishing thresholds on speed of service delivery for clients and additional costs for service providers to implement thresholds if set too low.

Policy framework

Establish a policy framework to support the options appraisal process and decision making on the most appropriate option.

Consider Equality & Section 75 legislation.

Consultation with disabled people regarding what would be considered “reasonable” when considering the parameters of various options.

Political acceptability of new arrangements.

Procedural framework

Consideration of organisational arrangements for case management development which are sustainable and cost effective for providers to deliver.

Standardisation of options appraisal process particularly in relation to situations where this should be carried out jointly.

Interagency data exchange, in terms of its timeliness, relevance, appropriateness, consistency and format. (See Design Standards, Costs and Communications Task group findings and recommendations).

Planning and development of interagency IT interfaces.

Efficiency of process, avoiding unnecessary bureaucracy.

Methods of improving co‐ordination and thus delivery timeframe.

149


150

Implementation of the inter‐departmental review recommendations – proposed methodology Subject to Inter‐departmental approval of the key findings and recommendations the JHASG/Core Group will continue to oversee the implementation of agreed recommendations.

The JHASG will meet at least twice a year to oversee progress on recommendations.

The expertise developed within the cross sector task groups will be built upon and re‐focused to achieve agreed review outcomes in the following areas:

Joint development of the policy and governance framework

Inter‐agency case management

Resources, procurement including re‐cycling

Design standards, costs and design communications

Once established the task group co‐chairs will develop detailed implementation plans.

The Housing Adaptations Liaison Manager will facilitate the work of the task groups.

Administrative support for the implementation of the review will be required.


Appendix 1 ‐ Index of governance criteria

Criterion 1 (Accountability)

There are clear accountability arrangements in place throughout the organisation.

Criterion 2 (Stakeholders)

The board identifies the needs of its stakeholders on an ongoing basis and determines a set of key objectives and outcomes for meeting these needs, including how it meets its duty of quality.

Criterion 3 (Processes)

The board ensures that there are proper processes in place to meet the organisation’s objectives and secure delivery of outcomes.

Criterion 4 (Capability)

The organisation is capable of meeting its objectives and delivering appropriate outcomes.

Criterion 5 (Monitor, review, learn, improve)

The organisation learns and improves its performance through continuous monitoring and review of the systems and processes in place for meeting its objectives and delivering appropriate outcomes.

Criterion 6 (Independent assurance)

The board ensures that it has proper and independent assurances on the soundness and effectiveness of the systems and processes in place for meeting its objectives and delivering appropriate outcomes.

Criterion 7 (Outcomes)

The board can demonstrate that it has done its reasonable best to achieve its objectives and outcomes, including maintenance of a sound and effective system of internal control.

151

APPENDICES

Appendix 2 ‐ Housing Adaptations: Standards of Service

Time frame for assessment and provision of housing adaptations (November 2010)

Stakeholder HSC Trust Assessment

Minor Works Lifts Major Adaptations

NIHE H&R ‐ 10 weeks urgent showers

40 weeks urgent showers

8 weeks other minor works

22 weeks

Stair lifts

Inter‐floor lifts

12 weeks urgent heating. 35 weeks standard plus heating. 52 weeks standard heating.

50 weeks extensions


‐ 8 weeks for urgent, 26 weeks for routine – including OT involvement (as Table 9 of DSD Adaptation Guide, July 2010)

52 weeks dependant on statutory approvals and including OT involvement (as Table 9 of DSD Adaptation Guide , July 2010)

52 weeks dependant on statutory approvals and including OT involvement (as Table 9 of DSD Adaptation Guide, July 2010)

HSC Trusts April 2008 26 weeks

April 2009 13 weeks

April 2010 9 weeks

10 working days ‐ urgent work

22 weeks ‐

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NIHE PSIS (Grants)

Description Time

Registration of application, notification of appointment and preliminary Test of Resources after receipt of an Occupational Therapist’s recommendation

2 weeks

Inspection of property 4 weeks

Schedule of Works following inspection of property 12 weeks

Approval following submission of property documentation 6 months

Inspection of property after notification that work has been completed

2 weeks

Payment following inspection and receipt of payment documentation

4 weeks

153

APPENDICES

154

Appendix 3 ‐ Treatment planning: Decision Tree

NO

YES

NO

YESYES

NO

YES

YES

YES

NO

NO

NO

YES

YES

YES

NO

YES REHABILITATIVE APPROACH

Does client identify as an area of concern and is it realistic?

Does client need to learn new techniques to

compensate for lost skills?

No further input required.

Education & Training

Can skills be improved to increase level of performance?

Does client need equipment to compensate for deficit?

Does environment need to be adapted to facilitate

performance?

Provision of Equipment

Minor / Major

Adaptations

Refer to other

agency as OT input

not indicated

Is client agreeable to participate in treatment

programme?

REMEDIATION APPROACH

Is input to strengthen, increase ROM

and/or endurance?

Is input to improve motor control and movement patterns?

Biomechanical approach

Neurodevelopmental approach

Cognitive rehab approach

Is input to improve planning, organising

and/or coping?

Performance Area Dysfunction


Appendix 4 – The housing support process REFERRAL (STAGE 1)

APPLICATION FORM TRIGGERING COMPLEX NEEDS APPLICANT

NIHE HOUSING SUPPORT ‐ AREA OFFICE

POTENTIAL CLIENT IDENTIFIED

AGREED COMPLEX NEEDS CLIENT AFTER MULTI‐

DISCIPLINARY DISCUSSION (FORMAL OR INFORMAL)

IDENTIFY SUITABLE HOUSING OPTIONS

NEED IS FOR HOUSING WITH CARE SCHEME

GENERAL NEEDS ACCOMMODATION WITH SUPPORT

PACKAGE REQUIRED

Go back to Stage 1 (referral)

Go to Stage 2 Option 1

Go to Stage 2 Option 2

COMMUNITY CARE ASSESSMENT AND HOUSING NEED IDENTIFIED

APPLICATION FORM COMPLETED

REFERRAL INFORMATION COMPLETED

REGISTER ON ADMINISTRATIVE LIST FOR EACH POSSIBLE SCHEME (TAKING ACCOUNT OF VACANCIES / TURNOVER)

ALLOCATION PROCEDURE (SCHEME IDENTIFIED) HOUSING ASSOCIATION

JOINT MANAGEMENT PARTNER

NOT SUITABLE SUITABLE

ALLOCATION MADE

NO ALLOCATION MADE(WITHIN CERTAIN TIME FRAME)

ASSESSMENT / ALLOCATION‐ (STAGE 2) OPTION 2 ‐ GENERAL NEEDS OPTION

REGISTER ONTO GENERAL NEEDS WAITING LIST WITH COMPLEX NEEDS POINTS (COMPLEX NEEDS FLAG INDICATOR SET)

VACANCY ARISES

LIAISON TAKES PLACE BETWEEN HEALTH & SOCIAL SERVICES TRUST AND SOCIAL LANDLORD (NIHE OR HOUSING ASSOCIATION) FOR THE

PROVISION OF CARE AND SUPPORT SERVICES

CARE & SUPPORT SERVICES NOT IN PLACE

NO ALLOCATION

REMAIN ON WAITING LIST

CONTINUE LIAISON WITH TRUST MAINTAINING THE TENANCY

THE LANDLORD ROLE

CARE & SUPPORT SERVICES IN PLACE ALLOCATION MADE

HEALTH & SOCIAL SERVICES TRUST

ASSESSMENT / ALLOCATION ‐ (STAGE 2) OPTION 1 ‐ HOUSING WITH CARE

155

APPENDICES

Appendix 5 ‐ Protocols for joint liaison/visits between housing staff and occupational therapy staff during housing adaptations in the public sector (NIHE)‐April 2002. The exact people who need to liaise will vary, depending on the nature or stage of the adaptation.

NIHE owned property: The client

Occupational Therapist

Area welfare officer

District maintenance officer

Architect/consultant

Lift engineer

Equipment supplier

Stage of adaptation

Reasons for joint visit or liaison

Factors to consider

Pre‐Occupational Therapy recommendation

To determine technical feasibility of recommendations.

Consider other potential options, which may be viable.

Urgency of need

Minimum space standards

Complex external site issues

Other options e.g. housing transfer or lifts versus extensions

Under occupation in socially rented property

Consistency of interagency information for the client.

Post OT recommendation (Where additional issues are identified)

To try to find consensus. See above.

Conflicting family needs.

Non acceptance of recommendation by client

156


Stage of Reasons for joint visit or Factors to consider adaptation liaison

Checking plans Discuss complex activity space requirements or family needs to ensure specification meets need. This will also reduce time on amendments.

Complex plans only where there are complex human needs or environmental constraints

Conflicting family needs

Temporary decanting required

To identify temporary alternative accommodation, particularly if there are difficulties with decanting.

Family support

Temporary residential/nursing home care

NIHE accommodation

Refusal to decant

Alternative solutions

Construction work

Unforeseen problems, which can arise after work commences.


Completion of adaptation

To investigate instances where the client claims to have difficulty using facilities after routine advice is given.

Work not undertaken to specification.

Commissioning of specialist equipment.

To ensure appropriate commissioning of specialist equipment

Training in the use of specialist equipment

Complaints To provide consistent information and examine facts causes and remedies.

Causes of delay

Interagency information exchange

Technical constraints

Health & Safety constraints

Process of consultation Occupational Therapy – Community Occupational Therapy managers

forum (NI) meeting (April 2002)

Area Managers/Welfare Officers – housing management/technical services

157

APPENDICES

Appendix 6 ‐ Protocols for joint liaison/visits between housing staff, estate services and occupational therapy staff during private sector housing adaptations (April 2002). The exact people who need to liaise will vary, depending on the nature or stage of the adaptation.

Privately owned property: The client

Occupational therapist

NIHE grants office staff

H&SST estate services staff – lifts and minor works

Architect/designer

Equipment supplier

Stage of adaptation Reasons for joint visit or liaison

Factors to consider

To determine technical feasibility of recommendations.

Urgency of need

Minimum space standards

Complex external site issues

Consider other potential options.

Provision routes dependent on financial considerations

Other options e.g. lifts versus extension

Sub‐standard housing

Pre Occupational Therapist recommendation

Housing fitness issues, which may affect case planning.

Consistency of interagency information for the client.

Post OT recommendation (Where additional issues are identified)

To try to find consensus. See above.

Conflicting family needs.

Non acceptance of recommendation by client

Checking plans Discuss complex activity space requirements or family needs to ensure specification meets need.

This will reduce time

Complex plans only where there are complex human needs or environmental constraints.

Conflicting family needs

158


Stage of adaptation Reasons for joint visit or Factors to consider liaison

spent on amendments.

Temporary decanting required

To identify temporary alternative accommodation or arrangements.

Family support

Temporary residential/nursing home care

Refusal to accept temporary move


Construction work Unforeseen problems which can arise after work commences


Final check visits for commissioning of specialist equipment and or NIHE Grant payment in exceptional circumstances.

To ensure appropriate commissioning of specialist equipment and/or timely payment of grants where there are exceptional circumstances.

Work not to specification.

Training in the use of specialist equipment.

NIHE Grants will ensure work is complete before OT visit

Complaints To provide consistent information and examine facts causes and remedies.

Causes of delay

Interagency information exchange

Technical constraints

Health & Safety constraints

Process of consultation Occupational Therapy – Community Occupational Therapy managers forum (NI) meeting (April 2002)

Estate Services – Ronnie Brown DHSS&PS– Trust Estates Services – Via Occupational Therapist Managers Forum

Grants Officers – Grants Managers Meeting (March 2002)

159

APPENDICES

160

Appendix 7 ‐ Other housing options for people in the private sector

Source of Resources

Options

Client Self Funding

Funds adaptations without any statutory involvement.

Gets OT assessment/ recommendations and self funds.

Client Relocation to existing stock: Move to another property which is more suitable without need for adaptations by selling existing property or seeking a more appropriate private rental ‐ NB private sector stock is not built to Lifetime Homes or wheelchair standard. Basic Part R access standards only available in property since 2001. Market conditions problematic for house sales.

Client/NIHE Grants/HSC Trust

Relocation to a more suitable private sector home with relatively minor adaptations: Relocate to more appropriate existing property with smaller scale adaptations/equipment provided either by HSC Trust, NIHE Grants or both.

Client Relocation to new purpose built property with disabled persons’ facilities designed in at planning stage.

Client/NIHE Grants/HSC Trust

NIHE grants can provide assistance in exceptional circumstances. OT assessment/recommendations required.

HSC Trust HSC Trust package: OT assessment and provision of adaptations and community equipment e.g. rails at front steps, stair lift, bathing equipment.

HSC Trust/NIHE Grants

DFG/HSC Trust combined package: DFG funds level access shower and ramp, HSC Trust fund inter‐floor lift and other independent living equipment.

NIHE Grants DFG funding full package e.g. ramps, ground floor bedroom and en suite shower /WC

NIHE Grants DFG funding ‐ replacement dwellings: Existing home unfit not economically viable for adaptation/ unsuitable for human habitation.

NIHE, housing association

Relocate to suitable social housing: e.g. existing adapted stock, Lifetime Homes, wheelchair standard housing, sheltered/other communal dwellings. More accessible housing in this sector but substantial waiting lists.

HSC Trust Provision of nursing or residential care options.

Other New funding proposals may emerge from DSD review of private sector housing.

NB for clients in the private rental sector landlord consent can be an issue which can constrain options.


Appendix 8 ‐ Potential shared definitions of complex cases developed by the case management working group

HEALTH DEFINITION OF A COMPLEX CASE

HOUSING/HEALTH DEFINITION OF A COMPLEX CASE

HOUSING DEFINITION OF COMPLEX CASE

Progressive/ permanent & last disability

Significant behaviour/ diagnostic issues e.g. L.D, bariatric, autism

More than 1 disabled person in household

A complex case is where:

Client has progressive serious medical condition with resultant long term physical disability problems

There are multiple carers required

There is more than one disabled person in the house

There are manual handling issues and risks identified

Clients have significant behaviour and diagnostic issues, eg learning disability, bariatric & autism

There is requirement for:

Specialist equipment

Customised wheelchair

Prescription of Electronic Assistive Technology

Environmental Issues: Topography, Space Constraints, Design/Layout

Detailed multi‐agency working

Protracted negotiations with family

Respite issues needing addressed

Multiple carers/intensive support

Multi‐agency working

Complex hospital discharges e.g. spinal injury ‐ accommodation unsuitable to meet clients needs & where risk identified

Respite care issues

Significant manual handling

Constraints of existing accommodation

Specialised equipment

Specialised equipment

When deciding whether a person may be a potential Complex Needs applicant the housing authority have to be flexible due to the variety & nature of the conditions that may be experienced by applicants

Where the applicant is for example frail, elderly, has learning difficulties or extensive physical disabilities and requires intensive support. Other details of the case appearing to warrant further investigation into potential complex needs

Where the applicant is for example frail, elderly, has learning difficulties or extensive physical disabilities and requires intensive support

The range & intensity of points scored on Support/Care & Functional Matrix

Where the applicant, or household member, has recently been admitted, to a hospital or another institution, for respite care or is due for such an admission

161

APPENDICES

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APPENDICES

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Northern Ireland Housing Executive (2008) Continuous Tennant Omnibus Survey. Belfast: Northern Ireland Housing Executive.

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