Specialised housing: A gap in the safety net
In the second part of his exclusive investigation into specialised housing, FIRE Correspondent Tony Prosser reports on the increasing difficulties of responding to fires in properties for vulnerable people
An early morning fire in Chingford, North London, on April 20, 2018, demonstrated some of the difficulties in managing the welfare of some of the most vulnerable members of the community when a fire occurs. The fire in Connington Court broke out at 0214 and severely damaged two semi-detached care homes (the other being Connington House) necessitating the mobilisation of ten pumps plus special appliances, including an aerial ladder platform (ALP) and over 70 firefighters.
Both homes provided supported living services for adults with learning disabilities and secondary diagnosis, including autism, mental health conditions and some challenging behaviours. Twelve people were evacuated from the three storey building which was severely damaged on all floors and destroyed the roof. Unfortunately, one resident – a young woman with learning difficulties who was living in a supported living flat – was pronounced dead at the scene.
With a growing population and likely increasing numbers of the elderly and those requiring a range of key interventions, supported living is likely to gain in popularity as it means that individuals retain their independence and have a better quality of life than will be the case if they lived within an institution. The increase in numbers, however, means that there is a potential for a greater risk for those individuals as safety within this specialised housing sector is not necessarily as well managed as it could be, with current evidence suggesting that the number of fire-related incidents in these premises is increasing.
“As with many residents receiving care or some form of support in their own homes, there are some fire safety issues which can be particular to that community”
Care in the Community
Ever since the 1950s, governments of various shades of red and blue have been trying to reconcile the problem of helping people with mental health problems, and other disabilities, reducing dependence upon the many crumbling Victorian and Edwardian institutions that virtually incarcerated many patients. ‘Care in the community’, originally mooted in the 1950s (but never implemented due to both political and practical reasons) and the policy of denationalisation of this care, often attributed to Margaret Thatcher, was also viewed as a cost-effective method of supporting individuals.
Following publication of the 1989 White Paper Caring for People, it was felt that the state provision of care was overly bureaucratic and inefficient and in the ‘new world’, the state would be an enabler rather than a provider of services. It also provided for the division of budgets and budgetary controls down to lower levels of government, which should mean that care could be more focused at a local level. As a result, a wide range of care facilities was created, resulting in a plethora of types of premises, ranging from shared homes, sheltered housing and, less prominently, high-intensity nursing homes.
Today, an estimated three-quarter million residents live in specialised housing, having a higher level of medical care (including nursing services or sometimes just the administration of medicines), safety and security while maintaining an independent lifestyle.
Specialised housing encompasses a wide range of types of premises and can generally be categorised into three groups:
Sheltered housing is designed for residents to live independently in self-contained accommodation often in blocks of flats similar to general needs; that is properties in those buildings used by the general population. These can usually be occupied by retired people or those with a vulnerability and may include communal facilities and staffed with a warden, based at the block or located off site.
Extra Care Housing
Extra care housing includes assisted-living schemes which have on-site care support services for those who need them and possibly include 24-hour staffing and those schemes which have independent living but with 24-hour on site care provision.
Supported housing provides a level of care for one or more residents who may have common characteristics such as learning disabilities or sensory deprivation. Many have their own bedroom or studio flat, but more often share facilities including kitchens and lounges. Sometimes the house is occupied as a single family dwelling and these dwellings are the permanent home for the residents. Care and support (sometimes called domiciliary care and can include administration of medicines and physical assistance including feeding, toileting, washing and dressing, often several times a day) is provided to enable them to live as long as possible in an independent way in a high quality domestic setting.
At the less invasive end of care provision, specialised housing, such as that provided in Connington Court, is becoming more common, so much so that it has been identified by fire and rescue services as a potential problem due not so much to a slightly elevated risk of an outbreak of fire but more to the hybridised nature of some property types which may result in a gap existing in the safety net provided by enforcing agencies.
The National Fire Chiefs Council’s (NFCC) Higher Risk Accommodation Task Group produced Fire Safety in Specialised Housing, with the intention of ensuring adequate fire safety in these homes. Properties used for supported housing can be as simple as a converted residential dwelling or can be more specialised and purpose-built. Fire precautions in these converted properties will be similar to those within houses in multiple occupancy (HMO) and the similarity with HMOs can create confusion in the application of inspection and enforcement procedures. A comprehensive automatic fire detection phone, emergency lighting (but not necessarily fire exit signs) are generally required. In the event of fire, these premises require a full or simultaneous evacuation of the premises, although in larger blocks it may be necessary to have levels of compartmentation that allow a “stay put” policy to be used.
“Emollient creams have been identified as been responsible for contributing to the deaths by fire of several people as some are composed of oil-based materials which can ignite relatively easily”
For supported housing, the law covering specialised housing is complicated by the fact that at least three agencies have primary legislation for which they may be responsible for enforcing through licensing and/or inspection. There is an added layer of complexity as under the Health and Social Care Act 2008 and its associated regulations, the Care Quality Commission (CQC) registers the provider of care in these premises, but not the accommodation itself. This means that where the housing provider is different from a care provider, a degree of cooperation, collaboration and coordination is required to ensure a seamless provision of safety within a building.
A new trend has been provision of accommodation by private organisations and individuals outside the more traditional providers in the local authority and charity sectors. Whether this trend gains further traction is a moot point given that, as is the case in the sector providing residential care and nursing home accommodation, funding is problematic and may not be an attractive proposition for those seeking a sustainable return on investment in the long-term.
The Housing Act (2004) is the principal legislation covering the accommodation side of supported and other forms of specialised housing. A resident’s accommodation within supported housing as well as the common parts are subject to requirements made under the Housing Act and local housing authorities are charged with the assessment of individual dwellings.
An assessment of individual units is carried out through the Housing Health and Safety Rating System (HHSRS) which identifies and assesses 29 types of hazard including that of fire. The practicalities of carrying out such assessments are enormous and housing authorities are unlikely to be able to resource the demands on its services without compromises elsewhere, and inspections are often undertaken only as a result of a complaint. Some supported housing can be considered to be a house in multiple occupancy and may require licensing if it has five or more unrelated people living there or has two or more separate households in residence. The laws around this are complex and very often need determination by specialists within the local authority.
The Regulatory Reform (Fire Safety) Order 2005 does apply to common areas, workstations and staff accommodation where these exist and FRSs are expected to enforce fire safety within those areas. The FSO does not, as is the case in HMOs, or blocks of flats, apply to the individual residential property unless some aspect, for example an automatic fire alarm system, is relevant to the overall building safety strategy. It is not normally the case that the FSO will be used to enforce these measures as there is no power of entry for inspection by Fire and Rescue Service staff, but the Housing Act will permit such access, although this could be viewed as being heavy handed and insensitive from the resident’s perspective.
Specific Fire Safety Risks
As with many residents receiving care or some form of support in their own homes, there are some fire safety issues which can be particular to that community. Extensive use of oxygen for some types of illness, particularly those involving cardiovascular or pulmonary diseases, can create an elevated rate of burning during a fire or become a key factor in the cause or rapid spread of fires when smoking materials are used or are in close proximity. More recently, emollient creams have been identified as responsible for contributing to the deaths by fire of several people as some creams are composed of oil-based materials which can ignite relatively easily. It is also possible that due to age-related infirmity and immobility, or as a result of mental health problems, some residents in supported housing may have a propensity to hoard materials which may increase the risk of ignition, spread and create access issues for rescuers, including members of staff and carers.
One of the answers to the problem of addressing the needs of thousands of individuals is the use of a person-centred fire risk assessment; not necessarily a new concept but one that is key to avoiding an institutionalising ‘one size fits all’ approach. In supported housing, particularly where the number of residents is relatively small, an individual assessment may be carried out on each person. Assessments should be carried out by appropriately qualified care provider or specialist who regularly engages with the individual resident. Where necessary, Fire and Rescue Service advisers will be able to provide specific fire protection advice and possibly identify specific solutions to the needs of individuals. Where vulnerabilities cannot be addressed by relatively routine measures, it may be necessary to have a referral made to local authority adult social care specialists.
Risk Reduction Measures
Measures to reduce the risk to individuals living in specialised and supported housing includes ensuring that ignition resistant materials comply with British Standards BS 7175 and BS 7176 for bedding, mattresses and nightwear are the only materials used in the premises. As it is unlikely Fire and Rescue Service resources are to be such that that inspections of every premises of this type is possible, so alternative strategies for providing advice and protection for the residents are likely to be required. As they will be familiar with the building, and seeing residents on a regular basis, care staff and managers are ideally placed to provide fire safety advice and evacuation procedures of the premises in case of fires on a repeated basis. For this to be effective, advice should be consistent and staff should be in a position to recognise difficulties when they arise. This could include recognition of deterioration of the mental abilities of a resident to recognise the significance of a fire alarm actuating, an increase in hoarding or other unsafe practices that may contribute ignition or spread of fire.
There is also a need to identify behaviours that may signify the presence of a potential arsonist. The existence of a positive relationship between carer and resident should increase the likelihood that information about fire prevention and protection is retained and should be reinforced regularly. More physical safety measures which can be used to prevent fires starting include automated cooking equipment isolation switches. These activate if a fire alarm is set off, managing portable heating systems, reducing the incidence of smoking related fires through smoking cessation programmes and safer ashtrays.
To address more serious risks, additional fire detection systems including telecare monitoring capabilities may be installed, and in the most serious cases automatic suppression systems and/or personal protection water-mist systems can be provided. It may be necessary in some supported housing that a default full evacuation systems is rehearsed. Once again, where this is not sufficient then referral to social services may be necessary to avoid serious repercussions through lack of control of fire risk.
Of course, there may still be gaps even where a full person-centred fire risk assessment has been undertaken. In one case, one supported housing premises had five fires in one week with one resident setting fire to different parts of the building deliberately. Upon investigation of these incidents, the FRS found that the individual had only recently moved into the residence from a different borough and subsequent enquiries found out that he had been setting fires in his previous home. Despite the fact the boroughs were within a few miles of each other, the transfer of information did not occur and the new landlord knew nothing about his incendiary activities.
“Once again, it appears that there is an emerging trend of fires in a class of premises that has the potential to grow significantly in the next decade”
The number of agencies, both jurisdictional and geographical, that are potentially involved in licensing, inspection and enforcement of supported housing can be so many it may be possible that many higher-risk premises have the potential to inadvertently fall unnoticed through the net. Local authorities do not have the resources to inspect premises very often; the Care Quality Commission may not necessarily have a remit to inspect premises, in that they may superficially appear (and considered by all agencies) to be a typical house in multiple occupancy, rather than providing the level of care necessary for a higher standard of protection, required as care providers.
The NFCC guide on specialist housing, despite being published in 2017, still has not gained sufficient awareness across the specialised housing sector including its inspectors and enforcers, local authorities and even fire and rescue services themselves. Agencies themselves are hamstrung by the fact that data about the number and location of these premises may be limited and that there is no national database on sheltered homes or other forms of specialised housing. It is also the case that local authority owned or run premises may not be within its own boundary and they may own specialised housing in areas many miles away from its own borough, which creates yet another layer of potential complication of jurisdiction and enforcement.
Raising Awareness of Residential Risk
Once again, it appears that there is an emerging trend of fires in a class of premises that has the potential to grow significantly in the next decade. With the distractions of Brexit and the financial anchors of the 2008 financial crash both still with us, it is easy to see why the fire risk in specialised housing is lost amongst the turmoil of today’s problems within the care and social services sector. Raising awareness of the potential problem of the fire risk within specialised housing and supported housing in particular, is only half the battle; much has already been done to identify the problems and define a suitable strategy for managing risk.
A greater appreciation of the problem and a more focussed approach to addressing the issues is now needed to ensure that society is not faced with an unnecessary rising tide issue in the future so that some of our most vulnerable, but often unrecognised communities, are allowed a dignified and safe existence in their own homes.
Thanks to Chris Callow, London Fire Brigade, in preparing this article. The NFCC Guide to Fire Safety in Specialised Housing can be accessed at:
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