• It was noted that people are initially likely to see this proposal very negatively, but where there has been an overprescription  of this type of care, we need to correct this. As a consequence, people may be able to gain more independence in the longer term, which would have positive impacts on outcomes for individuals.
•  A fairer distribution of housing-based support, right-sized according to need will free up capacity to address unmet need in the longer term.

Older people; Disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems); young people (particularly those in transition from children’s to adults services)

• Younger adults and those in middle years may see more of an impact than older people as older people are more likely to receive higher volumes of personal care and lower volumes of housing support, with the opposite applying to younger adults.
• The potential impacts of a reduction in housing support will depend on the kind of tasks being provided. Where support is focused more in emotional and wellbeing support, there may be risk of increased social isolation however we would seek to mitigate this by connecting people into local community resources and alternatives. This in turn could lead to increased pressure on these services.
• Potential increased risk of people struggling to maintain a tenancy, it will be important to ensure that any follow up reviews seek to ensure people are accessing universal supports and also accessing any benefits they may be entitled to.
• There may be an increased risk of hoarding, although the proposed approach would identify those at particular risk of this and ensure appropriate mitigation is in place (which may include removing them from the scope of any proposed reductions).
• Where housing support is focused on helping people to develop skills, there may be a risk that this will be compromised because the time available to devote to this will be limited. This may have a particular impact on older people or those with a learning disability.
• It is possible that those with mental health issues  may become more unstable.
• There is a risk of knock-on impacts or increased demand for other services such as hospital admissions due to the changes proposed.
• We will need to consider how these changes are communicated to particular groups, for example, those with learning disability or non-English speaker. A clear communication plan will be needed, including consideration of information in accessible formats. This includes communications for families and carers as well as for those who are directly receiving a service. This challenge also includes family or carers.
• There may be particular impacts on minority ethnic staff, as a significant proportion of the provider workforce is made up of international staff.
• Some risk to people with different religion or beliefs if the housing support service is partly based on supporting them to attend places of worship, although this may be mitigated by the fact that those within religious communities may be more likely to have access to informal support from their community.  
• There may be an increased impact on those who have less family support around them to help where formal support is reduced, which may include those who are unmarried or childless. These people may also be at greater risk of social isolation as a result.
• Potential for greater impact on unpaid carers, who may have to absorb additional responsibilities as a result of any reduction.  Greater risk into carers crisis and break down in care arrangements. Decisions may be made without considering carers input and it will be important to be aware of any carer vulnerability, including where a carer support plan is in place.
• Complaints might increase and we need to ensure we support staff to deal with them. We need to ensure they have skills to do that and that they are being supported by their managers. There might be a need to do realignment of work.

All negative impacts can be mitigated to a large extent by the implementation approach set out – cases will be considered by a senior assessor before any decision to reduce service is taken. An individual assessment of risk and need (desktop assessment) will be applied to each case.

Older people; Disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems); young people (particularly those in transition from children’s to adults services)

Minority ethnic people (includes Gypsy/Travellers, migrant workers, non-English speakers); AND Refugees and asylum seekers

People with different religions or beliefs 

People who are unmarried, married or in a civil partnership 

Carers

Staff

No specific impacts were identified.

No specific impacts were identified.

• There could be significant impacts on some providers of commissioned housing-based support services. Reductions in commissioned hours will reduce the income these providers receive and this could lead to viability risks for their business. Some providers may not be able to continue to operate, leading to a loss of capacity within the market. We are aware of a small number of providers who have focused primarily on housing-based support rather than personal care, and the impacts for these businesses will be greater.
• There are risks for the staff who work for affected providers. If providers do not have sufficient income, they may be unable to continue to pay their staff and jobs may be at risk as a result.
• Staff who work via the Home Office visa scheme may be particularly at risk. There is a risk that even a temporary reduction in hours could lead to the loss of staff, which would make it difficult to recruit up to the required numbers again once the need for service increases.
• Communication with providers throughout this period is very important.