Agenda item

This report provides the Community and Wellbeing Scrutiny Committee an update on New Accommodation for Independent Living (NAIL).

Gill Vickers (Operational Director Adult Social Care, Brent Council) introduced the report, noting that New Accommodation for Independent Living (NAIL) was a good example of the choice residents had on offer and was seen as good practice. She highlighted that NAIL was a good model for supporting people with a range of different needs from complex to lower level needs to ensure they have the best possibility to live independently. The Committee heard that COVID-19 had slowed down the Council’s ability to move people but the positive was that people were beginning to recognise living in residential care was not necessarily what they wanted and would be seeking something that would allow them to be more independent while still having a level of support going forward.

Andrew Davies (Head of Commissioning, Contracting and Market Management; Adult Social Care, Brent Council) explained that the NAIL programme had been running in Brent within Adult Social Care since 2014 as its accommodation and support programme. He advised that the Council had a whole host of supported living and extra care services for people with disabilities which gave a real choice and control over care and support. The way the programme delivered savings to the Council was that those who lived in NAIL accommodation were tenants and therefore the housing part of their care package was paid for through housing benefits. Those principals were set out in the report and in section 4 which detailed the savings made year on year. The Committee heard that when the COVID-19 pandemic hit in March 2020, and throughout the course of 3 lockdowns, the Council had been unable to move anyone into NAIL due to safety and ensuring risk management, and a number of NAIL schemes had not been able to open as planned because the staff were not in place to help people move in at the time. Andrew Davies highlighted that despite the difficulty during the pandemic, during the periods that adult social care were able to operate as normal they had managed to increase NAIL occupancy by 9% across the year. In addition, during the pandemic while nobody was able to move in to NAIL schemes, those schemes that had not been mobilised or opened were used as COVID-19 step down services for people coming out of hospital but not yet able to return home. In terms of moving forward for the next year, Andrew Davies highlighted table 2 of the report showing the schemes delivered in 2020-2021 which the Council were committed to delivering. There would also be a need to look again at the demand moving forward. Areas of focus were detailed in table 5.6 of the report and the extra care model of care was being reviewed as in earlier stages of NAIL the threshold for care had been set relatively high to be eligible for an extra care housing scheme, which was now being reduced to improve and broaden the number of people eligible for those schemes to create more mixed communities. This would also pre-empt the need to move someone later in their life as their care needs increased rather than moving them at a point of crisis.

In relation to the shortfall of savings, Gill Vickers advised that the scheme was not just about savings, but a key issue for people was to have their own home and with support coming in it was the second best option for independent living compared to being looked after in their own home. Committee members asked whether there was a conflict of balancing the expectation of needs against savings. Gill Vickers replied that it was less about cost and more about getting the right support for a person’s needs and receiving personalised care, which was more difficult to do in residential care compared to independent living. NAIL and extra care were just one option available at the point of a personalised assessment of many options including staying in their own home, with family, staying in a care home or nursing home, or going into NAIL. Phil Porter (Strategic Director Community Wellbeing, Brent Council) added that the Council had started a very ambition programme ahead of other local authorities and hoped the Committee could see from the strong pipeline coming through that the Council would eventually make those savings in the longer term. The scheme had provided a big learning process and he advised it had taken 3-4 years to get to a model with a really strong design working with the housing supply team. The timeline to catch up with the savings target was end of 2023-24.

Continuing to discuss the shortfall of savings, the Committee highlighted that the table showed some projects fell short pre-covid and queried why that was. Andrew Davies believed this was due to Visram House which had been delayed a few years from its scheduled open in 2017 until April 2019. There had also been a need to conduct significant renovation post Grenfell to ensure the building was safe.

Andrew Davies also spoke about developing the market to tailor to specific needs. He advised that for each NAIL scheme detailed in the report a care provider had been appointed to deliver services to people living in those schemes, building their services around the cohort of people in the schemes. The Council then worked with the care market to put together a service specification and would encourage service providers to bid to deliver those services and design care packages around those individuals in NAIL schemes. The individuals in the schemes, which were staffed 24/7, still had a choice on how their care was delivered as providers were appointed to provide core services for a certain number of hours per week, meaning the individuals who moved into those NAIL schemes could mix and match their care package and tailor it to best suit their needs in a way that was not possible with residential or nursing care.

Responding to further queries about client choice, Gill Vickers confirmed that clients did have a choice which NAIL they would live at and the Council would never enforce where people lived.

In relation to whether there was consideration of how neighbours may perceive those people with more challenging mental health needs, such as those with a diagnosis of schizophrenia, Gill Vickers advised that there may be other people who did not understand and may see those exhibiting behaviours associated with schizophrenia as challenging or frightening, but for Brent Council it was really important those people were part of the community and contributing to it and being supported by it. She advised there was a constant balance of ensuring Brent had mixed communities offering that kind of supported living and also the sensitivity to disruption to people’s lives.

The Committee highlighted the details on the proposed number of schemes over the next few years and asked whether that was based on demand and projections of what the demographics would be in a post-COVID environment. The Committee heard that originally the proposals were based on demand determined through the Joint Strategic Needs Assessment but COVID-19 had changed things so there would be a review. She advised this review would focus on where the schemes would go, how big they would be, and whether they would be mixed communities. Andrew Davies added that with a programme this large running over 10 years reviewing progress and plans for the future irrespective of COVID-19 would be sensible, and some of the demand projects within the report to Committee was very much based on issues being seen now. For example services for people with learning disabilities, autism and complex needs was something the Council had identified there was a need for therefore was determined to progress with. Extra care services demand figures would be reviewed from time to time using a combination of Brent Adult Social Care data and broader population projections, working with colleagues in corporate, GIS planning and mapping to get rich data to bring together an accurate picture of demand.

The Committee heard in response to queries about the role service users and their families would play in service delivery that their appetite for NAIL would be assessed and they would be informed of their options and the benefits of their options. With NAIL adult social care were trying to put together cohorts of similar need and ages to plan services around them and give a better experience through NAIL. James Pearce (Head of Service for Complex and Direct Services, Brent Council) added that a huge percentage of Brent residents had been significantly affected by COVID-19 over the past year which may have resulted in a change of need, meaning the interventions the Council made now would be pivotal and having a menu of services to offer would be helpful.

As there were no further questions, the Chair thanked Committee and invited recommendations, with the following recommendations RESOLVED:

i)              To note the contents of the report.