Specialist and Supported Housing Needs Assessment

1. The intention of this assessment is to identify the future supported accommodation needs of people with learning disability/autistic people.

2. The assessment of need for housing and supported accommodation draws on a range of evidence, including:

• demographic context: current population and projected population of people with learning disabilities/autistic people
• current provision of housing and supported accommodation
• evidence from people with learning disabilities/autistic people and other local stakeholders
• local policy context
• local commissioner perspectives and intelligence.

Establishing the population baseline

1. In order to identify the population trends in relation to people with a learning disability/autistic people that have social care needs, data provided by Gateshead Council has been used (Gateshead Council: Internally held data on number of individuals with a primary support reason as learning disability support), alongside data from the NHS Short- and Long-term Support (SALT) (NHS Digital: NHS short and long term support return for Gateshead 2021 to 2022 (opens new window); accessed via Adult Social Care Finance Return Data Pack) dataset and Gateshead's Joint Strategic Needs Assessment (JSNA) (Gateshead Joint Strategic Needs Assessment: Information on the number of people with learning disabilities living in their own home or with family).
2. The number of adults aged 18+ with learning disability/autistic people in Gateshead is approximately 550 individuals (2020 to 2021), according to data from Gateshead Council and NHS SALT data. The housing/accommodation status of these 550 individuals is shown below.

Identifying the current housing/accommodation status and characteristics of the baseline population.

1. SALT data has also been used to provide data for the accommodation status for adults that have a learning disability/autistic people.
2. Table 17 shows the housing/accommodation status of the 550 individuals.

Table 17. Housing/accommodation status of baseline population.

Source: SALT 2020 to 2021 and Gateshead Council

1. Data regarding the number of people with mental health needs, people with learning disabilities and other working age adults with care needs living in care homes and in supported living (supported housing) has been provided by Gateshead Council commissioners.

2. This shows that the current supply of supported housing for people with learning disabilities/autistic people (174 housing units in total) is made up of:

• 150 units in 43 shared supported housing properties. 86% of supported housing for people with learning disabilities/autistic people is shared supported housing ranging in size from two people sharing to six people sharing a house.
• 24 units of self-contained supported housing in six schemes, which represents 14% of the supported housing for people with learning disabilities/autistic people. These are typically more recent supported housing developments.

3. 32 people are living on their own with a 1:1 24/7 support package. Some, but not all, of these individuals have high/complex support needs.

Evidence from people with learning disabilities/autistic people and other local stakeholders

The evidence regarding the housing perspectives of people with a learning disability/autistic people has been drawn from focus groups and interviews with:

• A small sample of local people with learning disabilities/autistic people, including some people already living in supported housing.
• Local community organisations such as Your Voice Counts.
• Local providers of supported housing such as Gateshead Council, Home Group, Riverside

1. The evidence from this engagement with local people and other stakeholders is summarised below.
2. Most people with a learning disability/autistic people don't want to live in a care home; care homes are not seen as aspirational or places that enable independence.
3. The majority of people with a learning disability are living with their families, which does suit some people, however some people would like to move on from the family home. This position is not sustainable for some people, for example adults with learning disabilities who are living with older parents/carers or with carers whom have health conditions.
4. There is a need for an increased range of good quality supported accommodation for people with a learning disabilities/autistic people (for example as summarised at paragraph 3.30).
5. The majority of people are seeking self-contained accommodation that enables them to live as independently as possible. For some people this may be a general needs property with an appropriate package of care/support not necessarily supported housing.
6. Some people would prefer to live in shared accommodation; this tends to be younger people where living with friends may be a preference and resembles the housing preference/experience of other young people their age living without a disability.
7. People with a sole diagnosis of autism tend to have sensory needs and social behaviours which make living in shared accommodation challenging. Self-contained accommodation is preferred, and properties may need to be adequately adapted to meet a range of sensory related needs, for example with sound proofing, different types of lighting, careful use of colour schemes. It is also necessary to consider how robust housing materials and fitments may need to be for individuals with complex support needs. Having access to green space will be an important consideration for some people.
8. Some people who are seeking supported accommodation are looking for small-scale supported housing schemes, for example supported housing developments with 8 to 10 self contained dwellings. .
9. Having access to communal space both indoors and outdoors is important for people's health and wellbeing.
10. Location is important. People with a learning disability/autistic people are seeking housing with good access to shops and amenities and where they feel safe.
11. Supported housing should enable tenants to have a sense of community as well as remain part of the local community. This is about linking residents to external social activities, volunteering and employment opportunities and in some cases it may be through the provision of communal space in supported housing schemes.
12. Some examples of best practice within Gateshead include Home Group's recent supported housing scheme and Gateshead Council's supported housing developments including self contained flats and four bungalows. Research participants living at these schemes liked living there.
13. People are seeking support navigating the housing system and accessing supported accommodation. Information needs to be 'learning disability and autism-friendly', for example, people are seeking easy-read tenancy agreements.
14. Evidence from discussions with registered providers and other housing providers indicates:

• There is interest in additional development of self-contained units of supported housing for people with a learning disability.
• There is an increase in people with a learning disability/on the autistic spectrum that also have a mental health diagnosis who may need quite bespoke housing options.

Local policy context and local commissioner perspectives and intelligence

Discussions were held with commissioners and operational managers from Adult Social Care to sense test local evidence and to establish a future housing vision, including the types of housing and supported accommodation required. Existing local plans and policies were reviewed.

The council's Market Position Statement, 2020 to 2022 includes objectives of:

• Improving the housing and support offer for people living semi-independently in the community, working alongside housing, social care and voluntary and community organisations.
• Development of an accommodation pathway for those people who can be supported in the community and continue discussions with partners to facilitate the development of a choice of accommodation for people with a learning disability which adheres to the principles of Transforming Care.

3.The council's Specialist and Supported Housing SPD 2022 (PDF, 1 MB) states:

• "The council is committed to enabling people with short or long-term care or support needs, wherever appropriate, to choose, or be accommodated safely in, suitable mainstream accommodation that will allow them to live in their own home as independently as possible with bespoke and flexible support."
• "There is recognition that extra care accommodation can also meet the needs of some younger adults with long-term conditions including learning disabilities, physical disabilities, dementia."

The council's vision for housing for people with learning disabilities drawing on local evidence of housing needs, stakeholder views and commissioners' insights is set out below. There is a desire to develop a housing pathway which includes a mix of housing and supported accommodation, which offer people different housing choices, from housing options with 24/7 support through to access to mainstream housing with packages of care/support tailored to individuals' needs

1. The council wishes to make less use of residential care as this is not seen as an accommodation option that promotes independence. .
2. There is a need for a small number of specialist supported housing schemes for people with complex care and support needs, including 24/7 support, which for example can also provide 'step down' accommodation for people being discharged from inpatient or care home settings.
3. There is a need for small 'clusters' of self-contained supported housing, both for people who need 24/7 support and for people with lower support needs.
4. There needs to be a mix of types of supported housing which enables people to have housing choices. This will include self-contained accommodation but shared supported housing will be preferred by some people. ..
5. There is a need for fully wheelchair adapted homes for people with learning disabilities who also have significant physical disabilities.
6. There is a need for an increased range of tenure choices, such as home ownership through the Home Ownership for people with Long Term Disabilities (HOLD) scheme.
7. Shared Lives options will be increased as a complementary housing offer alongside supported housing or individuals accessing mainstream housing.
8. People with learning disabilities need to be able to better access mainstream general needs housing within the wider community. This can be a realistic option for people where floating support or individualised care/support packages are provided.

As part of developing these housing options as part of a more extensive housing pathway, the following actions are being taken:

• Some existing shared housing schemes need to be reviewed and their future use considered, particularly where there are voids.
• There is a need for supported housing with lower service charges to enable people to access employment opportunities.

Projecting future adult population with a learning disability/on the autistic spectrum for Gateshead.

Based on evidence in relation to the population of people with learning disability/autistic people and evidence from council officers and their local partners, it is assumed that there will be growth of the adult population of people with a learning disability/autistic people to 2040. The population projection amongst people with learning disabilities/autistic people to 2040 in Gateshead is shown in table 18.

This is based on the following assumptions:

• This includes assumed population growth from:
  • an increasing older population of adults with learning disabilities/autistic people adjusted for estimated mortality
  • young people with learning disabilities/autistic people whom 'transition' to become adults eligible for social care.
  • a net increase of around nine people based on the estimated number of young people 'transitioning' to adult social care each year (estimated to be around17 young people per year based on both DfE data and data from Gateshead Council) and the estimated mortality per year amongst the population cohort (estimated to be eight people per annum based on NHS mortality data). This growth is applied to the number of people with a learning disability/autistic people known to the council in terms of being in receipt of social care services.

Table 18. Estimated population of adults with learning disabilities/autistic people aged 18 to 64 in Gateshead projected to 2040.

Source: NHS SALT (2020 to 2021); NHSE (2021/22); DfE (2021 to 2022)

Assumptions in relation to different housing/supported housing types to estimate housing need of the population of adults with learning disabilities/autistic people to 2040.

This is based on:

• Comparison with England average 'benchmarks' of the use of different types of housing/accommodation for people with learning disability, such as residential care.
• Projections in relation to population growth.
• Assumptions about trends in need for different types of housing and supported housing, drawing on evidence from engagement with people with learning disabilities/autistic people, with local stakeholders and with commissioners

Gateshead's use of residential care is below both the North East average and the England average (table 19). However, in the context of the council's objectives (such as, to reduce the use of residential care), it is assumed that the use of residential care will likely decrease.

Table 19. Adults with learning disabilities (SALT) that are accommodated in residential care (excluding nursing care) in Gateshead compared to North East region and England.

Source: SALT and Gateshead Council. Note. The percentages reflect the number of adults aged 18 to 64 that have a learning disability (SALT) that are in residential care, out of the total number of adults with a learning disability/autistic people (SALT).

The following assumptions have been applied to the projected need for accommodation for adults with a learning disability/autistic people:

• Evidence from commissioners is that there is a need to develop a wider range of supported accommodation, including more self-contained accommodation (as set out in paragraph 3.28).
• An ongoing increase is assumed amongst the population of people with learning disabilities/on the autistic spectrum in Gateshead. This includes assumed population growth from:
  • A growing older population of adults with learning disabilities/autistic people adjusted for mortality.
  • Young people with disabilities 'transitioning' becoming adults eligible for social care.
• The use of residential care is anticipated to decrease by at least around 50% by 2040, including the use of out of borough placements, with a wish to decrease the use of out of borough placements further.
• The need for mainstream housing with a care/support package is expected to increase slightly due to the increase in the overall population of adults with a learning disability/autistic people.
• Living with family/friends/informal carers: based on similar assessments with local authorities elsewhere, it is assumed that the percentage of people living with family carers, particularly older carers will decrease by around 20% by 2040 as a proportion of older carers are no longer in a position to be able to accommodate and support their adult children with learning disabilities. Some recent developments of supported housing in Gateshead have enabled older carers to remain close to their adult children.
• A modest level of growth has been assumed for Shared Lives.
• Supported housing/supported living is expected to increase due to the increasing overall population, a reduction in the use of residential care and a decrease in people living with family carers. However, it is assumed that the need for shared supported housing may decrease due to an increasing preference and need amongst people with learning disabilities/autistic people for self-contained accommodation, voids in existing shared housing schemes and lack of compatibility in terms of people moving into existing shared housing (for example due to the complexity of people's needs). It is assumed that the majority of the growth in need for supported housing will be for self-contained accommodation.
• Evidence from the council's Accommodation and Support Group about housing need amongst people with learning disabilities/autistic people has identified:
  • A need for 17 units of supported housing urgently, 31 units in the next 12/24 months and potentially up to 68 units required beyond that period. Of these people, at least five individuals require wheelchair adapted homes.
  • 21 people who are funded via Continuing Health Care that have a need for supported accommodation.
• Amongst the identified population of people with learning disabilities/autistic people, the council has identified that there are around 18 individuals who are likely to require 'bespoke' housing and support solutions due to the complexity of their needs (for example properties that are highly adapted and/or located in relatively isolated locations) (Bespoke Housing Need for People with Complex Needs (2023)).
• The anticipated need, based on the assumptions above that are used as part of estimating future housing need, are shown in table 20.

Table 20. Estimating future housing/supported accommodation need: housing/ accommodation type assumptions for change in level of need.

Note. Totals may not sum due to rounding

The estimated net need for housing and supported housing for people with learning disabilities/autistic people is shown in detail in table 21 and in summary in table 22. Table 21 shows the number of homes/units currently available to meet need, the number of homes/units required to meet unmet need, this unmet need projected to 2025, 2030, 2035 and 2040. Estimated need for supported accommodation is summarised in table 22.

Table 21. Gateshead: Housing and supported accommodation need for adults with learning disability/autistic people projected to 2040

Source: NHS SALT data 2020/21 and Gateshead Council. Note. Totals my not sum due to rounding

Table 22. Net additional units of supported accommodation required for people with a learning disability/autistic people in Gateshead to 2040

1. In summary, an additional around 90 units of supported accommodation are estimated to be needed by 2030 for people with a learning disability/autistic people and an additional approximately 215 units by 2040.
2. Of these additional around 215 units, approximately 25 units are estimated to be for Shared Lives accommodation and approximately 190 units are estimated to be for supported housing.
3. There is a need to develop a housing and accommodation 'pathway' for people with learning disabilities/autistic people.
4. This pathway of additional housing and supported housing options is required, in part, to reduce reliance on residential care to accommodate people. It is assumed that the number of people living in care home beds will decrease by around 50% by 2040. It is assumed that in future people who may have used residential/nursing care will use supported housing with 24/7 support as an alternative.
5. The estimated need indicates that the following 'components' of this housing pathway are required.
6. Supported housing or people with the most complex support needs. In some instances this may require bespoke individualised housing options, however it is often possible to meet this type of housing need in carefully designed and commissioned supported housing. This will include people identified as having the 'most complex' need and may include some people who are CHC funded. For example, a supported housing scheme in Kirklees, capital funded in part by NHS England, provides an example of this type of bespoke supported housing development Choice support, housing development (opens new window).
7. There is a need for of supported housing consisting of a small number of self contained flats (around six units). This is typically a small 'cluster' of flats with 24/7 support. An example of this type of supported housing scheme is Mulberry Lodge, Basingstoke which has been designed and capital funded by Hampshire County Council.
8. There is a need for additional small 'clusters' of self-contained supported housing that provides supported housing, both for people who no longer need 24/7 supported housing and people who need a supportive environment before moving to independent housing. This the equivalent of the 'concierge' type of supported housing schemes (typically eight to 10 self contained units) that have been developed recently in Gateshead.
9. Some of the need for supported housing can be met through an expansion of provision of Shared Lives.
10. There is a need for some people with learning disabilities/autistic people to have better access to mainstream general needs accommodation and to be supported with floating support to enable people to live within the community.
11. These supported housing requirements to 2030 are summarised below.

2023:

• One additional specialist supported housing development for people with the most complex needs. Five to 6 self-contained units. 24/7 support
• One additional 'cluster' of self-contained supported housing scheme. Six self-contained units. 24/7 support
• One additional 'concierge' type of self-contained supported housing scheme. Eight to 10 self-contained units. Support level to be determined (less than 24/7)

2025

• One additional specialist supported housing development for people with the most complex needs. Five to six self-contained units. 24/7 support
• One additional 'cluster' of self-contained supported housing scheme. Six self-contained units. 24/7 support
• One additional 'concierge' type of self-contained supported housing scheme. Eight to 10 self-contained units. Support level to be determined (less than 24/7)

2030:

• Three additional 'clusters' of self-contained supported housing schemes. Six self-contained units. 24/7 support
• Two additional 'concierge' type of self-contained supported housing schemes. Eight to 10 self-contained units. Support level to be determined (less than 24/7)