Project partners

Project background                                                   

Home Improvement Agencies (HIAs) are locally based organisations (usually council, housing association or not-for-profit) that assist older and disabled people, those on low incomes and other vulnerable homeowners or private-sector tenants to repair, improve, maintain and/or adapt their homes. This enables many people to stay at home instead of going into care and enables people to leave hospital.

Across the country, and within Warwickshire, there are different models of HIA. The present methods of operation are uneconomic and unsustainable against a background of reductions in central government funding. All agencies involved in providing adaptation services knew the present service to be slow, unresponsive with duplication of services. Long waiting times were common across the county.

Warwickshire has a growing percentage of its population that will need the services of the HIAs. At present, three HIAs provide support across the county but each operates in a different way, provides different services and operates with differing administration and accountability systems. 

The district and borough councils are the principal funders of HIAs, although the county council contributes some funding as the administrative authority of Supporting People in Warwickshire. 

A multi-agency project was set up in September 2014 to explore if Home Improvement Agency services could be provided in a more consistent way with improvements in quality and value for money, as well as being more flexible, both in addressing future needs and being able to respond to changes in health and social care policy.

Introduction to the latest phase of review                   

A project board, made up of the district and borough heads of housing in Warwickshire plus a senior member of staff from the county council, was established to oversee the review of Home Improvement Agency services. This recognised that working in partnership and the joint commissioning of services were critical considerations. 

Following scoping the means of providing HIA services across the county, Warwickshire Heads of Housing commissioned CSM Consultants to provide consultation support for a lean systems thinking review of the county’s HIA service. The ‘check’ stage, undertaken to understand the system, was carried out in Rugby starting in December 2014 by a team of officers from the districts and boroughs, county council, Age UK (Warwickshire) and Orbit Care and Repair, assisted by a Grant Stanley from CSM. 

Project objectives                                                           

•             Use lean systems thinking methodology to create the most effective and efficient service possible for customers

•             To create sustainable efficiency savings to help each authority to meet its financial pressures

•             Speed up the end-to-end time for processes while retaining quality;

•             Maintain staff buy-in, empowering staff and effecting a systems-thinking cultural shift; and transfer skills from the consultant to the councils

•             The team has focused on one aspect of the service: a study of adaptations and the provision of statutory Disabled Facilities Grants [DFG] (which fund adaptations for applicants who pass a means test) in the private sector, reflecting the recognition that this service needed improvement. Other aspects of the Home Improvement Agency work will be considered later as part of the project.

The review took place from a customer perspective so current service provision was tested from this perspective throughout the review. 

Over a three-month period, the team carried out a study of the service across Warwickshire, to gain a clearer picture of:

•             How the services are provided now,

•             How the service could act more quickly to help people maintain independence,

•             Choice in achieving that independence, and

•             How to reduce risks (e.g. falls - 20% of falls presenting at A and E might have been avoided by the provision of a stair lift) as well as preventing admission into residential care where possible.

The study confirmed the recognition that there are significant issues with regard to long delays for customers (an average of 496 days from the start of the process to completion [‘end-to-end’]) and clarified the reasons for those delays. For example, it showed that with the number of agencies and officers involved in the process it can take 220 procedural steps from request for assistance to completion of works. 

Unsurprisingly, a number of applicants simply drop out (for example 172 out of 482 referrals in 2009/10). Key causes of delay were found to be:

•             47% caused by budget limitations

•             37% caused by contractor capacity

•             16% caused by technical issues (with property)

•             16% caused by staff absences

Interviews with case workers that provided HIA services, occupational therapists, the PHILLIS team and FirstStop showed some complementary elements of services but also a huge amount of duplication. In general, customers who receive help for an adaptation will get at least two or more of these services. A common assessment framework would have been effective in sharing client information. 

The review also considered root causes of the problems. Critically it became apparent that there was a conflict arising from the use of criteria used in social care to decide eligibility for their services and those applicable to adaptations. This has happened because occupational therapists provide an assessment and define the adaptation a customer need. As they work in a social-care environment, they use Fair Access to Care Services (FACS) eligibility criteria for adult social care. 

The review team found that this was not the right test to dictate whether a customer is eligible for an adaptation. The rules for adaptations are set out in different legislation. This recognition became a significant platform in finding a different way to provide the service. 

Pilot Project                                                               

The data indicated a need for a radical overhaul of how services to deliver adaptations (using Disabled Facilities Grants) are provided in Warwickshire. However change involving so many partners, with many different ways of working, was ambitious. It was decided to set up a pilot project in one of the districts. Nuneaton and Bedworth Borough Council agreed to host the pilot.

To bring about radical change, partners agreed that only those steps that were of value to the customer would be included in a new system design for the pilot project. This significantly reduced the steps required in the process.

For the reasons outlined above, it was agreed to remove the service from a social care/ Fairer Access to Care context whilst retaining the ability to provide a holistic assessment of need. In addition, the different agencies and officers who had traditionally contributed to the process agreed to work collaboratively as one service. A specific, bespoke assessment tool has been developed for officers to use, as part of the experiment, to capture the circumstances and needs of the customer to ensure the most appropriate solution is found for them. 

As Nuneaton HIA provides assistance for North Warwickshire customers in the current system, their Housing service has contributed a member of staff to the pilot team. The county council, which provides both occupational therapists and occupational therapist assistants as part of the service has also been integral to the pilot project. The pilot has been based on three key steps:

Step 1 – Customer contact and assessment

Occupational therapist assistant / caseworker / technical officer: integration and cross-training by sitting together to trial the benefit of offering a ‘housing & health assessment’ as one officer role.

Step 2 – Design and adapt 

Specification of adaptation allowing for customer choice.

Step 3 – Deliver

All agencies including contractors working as partners (entire supply chain) to deliver a seamless service from end-to-end. This is already highlighting substantial cost-saving opportunities.

The trial period to test the new way of working was set at three months. The team has had to overcome difficulties to create a radical change in how the service is provided. This included integrating a number of partners with staff from different disciplines to find a way of working holistically and share skills and knowledge. However, with a team of committed staff much has been achieved in a short space of time. The principles which were agreed should underpin the system and used to deliver the service have been proven to be sound. 

The pilot is at a very early stage however there are indications that the changes are radical and the achievement remarkable. The customer gets a quicker service with no compromise on quality: 

•             The assessment stage has been reduced from an average of 270 days to an average of 8 days.

•             The design and grant phase has reduced from an average of 103 days to an average of 22 days.

•             Start of works following approval has been reduced from an average of 56 days to an average of 18 days.

Next Steps                                                                   

The pilot has shown the way to improve services to provide adaptations. However more work needs to be done to ensure sound systems of work are in place and there are clear measures to understand the impact of those new systems. It is proposed that the pilot be extended for until April 2012. 

During that time the pilot team and project board will work together to make proposals for mainstreaming the new systems of work both in Nuneaton and North Warwickshire and more widely across the county. These proposals are likely to be firmed up between February and April and will require approval by each council involved. 

Delivering the service in a radically different way in a short space of time means that work remains to be done to fine tune systems and make further improvements. These practical issues include (not exhaustively):

•             Identifying how savings and benefits will accrue to each individual council with the aim of each council being able to understand clearly ‘what is in it for them’.

•             Identify and detail model structures for consideration by unions and members

•             Identify and detail models of governance for consideration by members

•             Undertake a risk analysis for each option so these can be addressed or mitigated. This will include coverage of possible arrangements for existing staff, such as TUPE or redundancy, and the likely costs of these.

•             Recommended governance arrangements

•             A proposed timetable for introduction and project plan for doing so

The project board is meeting senior officers of the county on 31 January for ‘decision day’ at which the experiment’s outcomes will be reviewed in conjunction with cost information, and a favoured delivery vehicle for the new service will be identified for practical development and consideration by each organisation at senior member and political level. 

The ‘Larger Prize’                                                           

The project experiment stage has focused on bringing three authorities together (Warwickshire County Council, Nuneaton and Bedworth Borough Council and North Warwickshire Borough Council) to test the validity of the fundamental changes to how services for disabled adaptations are provided. There are other services provided as part of the Home Improvement Agency. Following proposals for the adaptations service in the private sector consideration will be given to involving those in the public sector and then for other Home Improvement Agency services. 

Other aspects of Home Improvement Agency services will be considered as part of the overall project during 2015. 

Academic support has been sought in the shape of an application, through Professor Justin Waring at Warwick Business School, for funding a collaborative studentship entitled: “Creating the currency of institutional change: developing shared value in the strategic integration of home improvement services”.

This part of the project aims to understand how to create a 'single currency' principally between the agencies of health, adult social care and housing in the arena of independent living across Warwickshire. As part of this, the project will clarify and strengthen the evidence to demonstrate to all interested observers whether the project, initially focused on adaptations, is meeting its aims. It will also aim to embed a culture of continuous improvement into the services' eventual providers, ideally in terms of the lean systems approach that we are using to drive change.

The anticipated term of collaborative working would be three years. Funding of £15,000 per year will be provided by the university should this application be successful and should this funding be matched by £5,000 per year from the partnership.

Resourcing the change                                               

The project has benefited from significant contributions in kind from partners.

All councils are contributing time in steering and evaluating the project. RBC and Nuneaton and Bedworth Borough Council have provided management time, office space and equipment as well as PCs and internet access for the check stage and now the experiment stage. All partners mentioned on p1 have contributed staff to the check stage of the review, which was full-time for more than two months. 

Improvement and Efficiency West Midlands has provided funding to carry out a review of services across the county, provide a consultant with lean systems skills to support the check and experiment stages of the review and fund items that support the review. 

Governance and project management                 

The project will continue to be monitored at the monthly Warwickshire Housing Heads of Service meeting. Each district or borough provides a representative, as does the county council 

The representatives will also report on project progress to the Warwickshire Housing Support Partnership (ex- Supporting People Commissioning Body).