Research aims and methodology
Housing adaptations play a key role in allowing disabled and older people to live safely and independently, yet there are three main issues of concern relating to their provision across Wales currently.
- Grants and other aspects of housing adaptations have long been subject to a 'postcode lottery'.
- The complex funding regime, with different funding routes available depending on tenure.
- The range of different organisations providing access to adaptations further complicating the system.
Opinion Research Services (ORS) was commissioned by Welsh Government to undertake research into the allocation of grants and how they are accessed/spent on Housing Adaptations in Wales via the following strands of research.
- A review of relevant literature to underpin the results of the study.
- Scoping interviews with six key organisations to understand the current situation.
- A data analysis exercise to assess the current levels of spend of each housing adaptation funding program and identify how each programme supports the delivery of housing adaptations in Wales. The analysis is based on monitoring returns from Care & Repair agencies, housing associations, including Large Scale Voluntary Transfer housing associations, and local authorities from the financial? year 2018/19.
- In-depth telephone interviews with 18 recipients of housing aids and adaptations to gather views on the process of accessing them and how it might be improved.
- Two stakeholder workshops with 22 participants to explore the key research themes.
Essentially, the project was designed to understand the allocation of funding and how it reflects population need, particularly whether it is based around factors such as tenure and area/organisation rather than need. Alongside this general aim, the research aimed to inform the provision of a geographic and socially equitable system for people who require adaptations to their home.
A note on the data
Several issues were present with missing data, notably with none being returned by Bridgend, Merthyr Tydfil and Wrexham councils. It was possible to include Bridgend local authority area in the analysis because of data from Care & Repair and housing associations being available for Bridgend, but Merthyr Tydfil and Wrexham are omitted completely. Consequently, this is a limitation of the analysis by local authority area and by funding stream; it will particularly affect any analysis that involves data on Local Authority (Mandatory DFG) and local authority (Other) funding streams.
Other issues were that:
- the 2018/19 data set does not include a field for the location of the adapted properties
- there is no suitable measure of disability that can be compared to Census statistics for long term health problem or disability, which prevents a fully comparable analysis of spending by local authority area, using standardised disability rates
- no data on ethnicity is available; nor is there any identification of urban and rural areas to allow a comparative analysis of spending by population in rural and urban areas; this prevents the identification of inequality of access or delivery of adaptations between rural and urban areas and different ethnic groups
A note on coronavirus (COVID-19)
The impact of the COVID-19 pandemic on some aspects of this research has been considerable. In particular, recruitment for the service user interviews was impossible for several months during the first national lockdown as the gateway agencies on which ORS was relying to source participants were unable to assist due to resource pressures; and several events at which the project was due to be promoted were cancelled. Furthermore, while recruitment resumed in late summer, the agencies were understandably still unable to offer as much assistance as they would ordinarily, and the specific service user quotas ORS was aiming for (in terms of adaptation type, funding stream, age and geographic location) proved unachievable. Nonetheless, a good mix of service users were able to take part.
How are the individual funding streams for housing adaptations allocated and spent across Wales and to what extent is this allocation based on need?
Stakeholders were of the view (corroborated by the literature) that the allocation and spend of funding on housing adaptations is not only determined by need, but also by geography and, especially, tenure. The main perception was that Registered Social Landlord (RSL) tenants particularly benefit from not only being generally more aware of adaptations as an option, but also from being able to quickly and easily access the “less bureaucratic” Physical Adaptions Grant (PAG) system.
The perception that tenure drives inequality in funding adaptations is supported by the data: the average cost of an adaptation in social housing is £2,369; considerably more than the average cost in the private sector (£818) for example. On the other hand, the data appears to contradict the perception that RSL tenants enjoy shorter waiting times; the median time from the need for an adaptation being identified until the adaptation is ready for use is 119 days for PAG, which funds 65% of RSL adaptations, compared to 99 days for Disabled Facilities Grants (DFGs), which are chiefly used by local authorities.
Comparisons of spend purely on adaptations across Wales must be cautious. As spending on allocation differs across local authorities, this must be contextualised by external factors. For example, the existence of health and community services can increase or decrease the demand for adaptations by providing support that avoids the need for adaptations or by proactively promoting adaptations.
Bearing this in mind, it is clear that there are different levels of spend between local authority areas, with three particular groupings identified in the age standardised cost figures.
- Group 1: over £15,000 per 1,000 persons (Cardiff and Vale of Glamorgan, Rhondda Cynon Taf and Carmarthenshire).
- Group 2: £5,000 to £15,000 per 1,000 persons (Newport, Ceredigion and Pembrokeshire, Gwynedd and Isle of Anglesey, Conwy and Denbighshire, Monmouthshire and Torfaen, and Neath Port Talbot and Swansea). The highest cost among these authorities is Newport at £10,133 per 1,000 persons. All others are below £10,000 per 1,000 persons.
- Group 3: under £5,000 (Blaenau Gwent and Caerphilly, Bridgend, Flintshire and Powys). However, data is missing from some local authorities which can lead to them showing lower cost than in reality, especially Bridgend and Flintshire.
Also in terms of geography, a particular issue appears to be the way in which different sized adaptations are defined, meaning two people receiving the same adaptation but in different areas can be subject to different processes. It was, though, recognised that the ‘small’, ‘medium’ and ‘large’ definitions in the Welsh Government Service Standards may be particularly helpful in ensuring service users receive a uniform service regardless of their location in future.
The issue of means testing was raised in relation to ways of overcoming inequity, and there were differing views on the potential impact of abolishing the test for housing adaptations. Some stakeholders were in favour of doing so to improve access and remove ‘red tape’, whereas others were concerned about opening a ‘floodgate’ of applications (two viewpoints also noted in the literature reviewed)., The general perception was that allowing small and some medium adaptations to take place without means testing would be fairly low risk, providing Occupational Therapist (OT) Assessments are robust enough to ensure that only those in real need receive them.
What stakeholders did agree on, however, is that the £36,000 DFG threshold is too low in many cases and that another marker of disparity in the system is that some local authorities will ‘top-up’ the spending cap and others will not. In order to improve access and address inequity, one consideration for Welsh Government (as suggested at one of the stakeholder workshops) is the provision of a central ‘pot’ of discretionary funding whereby applications could be made for funding over and above the £36,000 in appropriate circumstances.
What are the main strengths of the current housing adaptations process?
Overall, the data shows that adaptations are delivered without excessive delay; six out of eight funding streams have a median time of less than three weeks from identification of the need until the adaptation is ready for use. The two exceptions to this are PAG and DFG (119 and 99 days respectively), which involve more of the ‘large’ category works that can involve complicated building work and difficulties arranging the work with the household involved.
There also appear to be some pockets of process-related good practice, most notably in the integration of teams and the use of properly recruited, trained and supervised trusted assessors for minor adaptations; which has resulted in quicker, more aligned and streamlined processes. Improvements have also been seen through:
- procuring via lists of trusted contractors or framework agreements
- having well-developed adapted property registers
- using private OTs as opposed to those employed by local authorities
The dissemination of good practice activity is important in terms of increasing knowledge and ensuring, where possible and appropriate, that it is adopted more widely across Wales.
What are the main barriers to accessing housing adaptations currently?
Findings from the literature review and primary research suggest that the quality of information and advice offered to service users and potential service users about adaptations, funding and how to navigate the system is relatively poor. While this is less of an issue for those who proceed ‘into the system’ (as they are typically assisted through the process), many people will require adaptations following a sudden change of circumstance and so need to know what is available to them and how to access it. For these people, it would be desirable to consider a consistent, single point of entry to the system.
One further barrier is the inconsistent availability and accuracy of accessible housing registers across Wales, the improvement of which is key in ensuring properties are allocated quickly and according to need. A recent Tai Pawb good practice guide was said to be a good starting point, as well as a recent piece of research on accessible properties in Gwent: wider knowledge and dissemination of these documents would be beneficial.
What support do service users receive/require to access housing adaptations?
Service user participants were generally positive about the support they had received through the application and assessment process. Indeed, in the stakeholder workshop it was stressed that while the current system for accessing funding for adaptations is complex and somewhat inequitable, the inequity is mainly in how the system is accessed. This is a concern for those delivering and overseeing the process rather than the end service user, who will typically provide very positive feedback about both process and outcomes.
Support and communication appear to be lacking in some cases in fully engaging service users in the design and implementation of adaptations (especially ‘large’ ones), which can result in installations that are not fit for purpose and do not achieve the desired outcomes. Given the small number of interviews on which these findings are based, more research/analysis is needed to determine whether this is a systemic issue or not.
What are the key characteristics of a good housing adaptations service?
During the course of this research, service users identified four key characteristics that a good housing adaptations service in Wales should exhibit.
- Consistency across all areas and tenures: ensuring all service users receive similar levels of service.
- Communication with and involvement of service users at every step of the process, from the initial conversation to establish need, desired outcomes and feasibility of the various options, through full involvement in the design and implementation of the adaptation itself.
- An integrated and collaborative multi-disciplinary approach to assessing designing and installing adaptations, involving the housing, health and social care sectors.
- Achievement of desired outcomes: the first main predicted outcome of the adaptations service is preventing falls among older people; the second is increased independence in daily living across all age groups.
How is the housing adaptations service best evaluated and monitored?
Constant monitoring and evaluation of provision to establish what it is being done well and where improvements can be made appears to be key. The literature and stakeholder views, along with gaps in the data, point to data collection and reporting being historically poor but improving – and further improvements will be required understand variances in provision and ensure consistency.
Most service users reported that checks had been done to assess the quality of their adaptation on completion. However, it is important not to overly rely on customer satisfaction surveys, as both the literature and stakeholders are clear that the results they generate can be misleading: because adaptations typically result in positive outcomes, recipients will tend forgive any negative aspects of the process, which then have to be inferred through key performance indicator (KPI) data. Essentially, performance indicators and survey data must be considered ‘in the round’ to gather the full picture around housing adaptation provision in Wales.
On a related note, there is concern among stakeholders that the current publicly available data is too ‘hard’ and could be supplemented with ‘softer’ outcome-based measures. This would necessitate more and better collection of data around impacts and benefits in addition to the mechanics of delivering adaptations. Indeed, several stakeholder workshop participants said they had been involved in the process of developing a consistent questionnaire that is distributed to service users across Wales post-adaptation – and while they were satisfied with the type of data the questionnaire produces, they would support work to adapt it to enable the collection of some qualitative data on outcomes.
To monitor and manage the grant funding, the data needs to be complete. There should be no geographical gaps; at present there is no data at all for some local authorities. All the relevant attributes should be included; at present there is no data collected on disability or ethnicity.
The literature and the stakeholders both report a need for a wider range of publicly reported KPIs to cover not only DFGs, but also PAG and RRAP to ensure a far more complete picture of the whole adaptations system. Encouragingly though, improvements are beginning to be seen via the Welsh Government ENABLE review (introduced in January 2017).
In terms of specific suggestions, there was support in one of the stakeholder workshops for the Welsh Government Service Standards breaking expected timeframes down by adaptation size, and then breaking down the timeframes for medium and large adaptations by the time it should take to see an OT and completion time thereafter (although some cautioned against taking such timescales at face value, as some areas suffer from more acute OT shortages than others).
Similarly, in terms of measuring wider timescales, the need to consider the context of individual adaptations was stressed. Looking specifically at DFGs, means testing adds time to the process - and this is compounded in the case of larger and more complex, adaptations by the fact they are often awarded to younger people with multiple needs, complicated family structures and a reticence to share personal information as a result. All of this can extend the time it takes to apply for funding and complete an adaptation, which must be considered when comparing timescales across different funding streams. The cost and time figures from the funding stream data analysis supports this approach.
Finally, while performance indicators are considered important for public bodies to manage performance and identify areas of good practice and improvement, there was also a view amongst stakeholders that they can act as a constraining factor on positive outcomes as organisations will operate to meet them rather than to achieve the best outcomes for service users. For this reason, it would be prudent to keep their use to a reasonable minimum.
 It should be noted that Welsh Government currently reports this as part of its annual high-level analysis.
Authors: Lock, K., Baker, T., Davies, A
Views expressed in this report are those of the researchers and not necessarily those of the Welsh Government.
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Social research number: 48/2021
Digital ISBN: 978-1-80195-561-4