On September 14, 2021, the ASD received from the municipality the draft Regiovisie doordecentralisatie beschermd wonen with the request to advise the regional council on its content. On October 6, together with the other 14 advisory councils, we were updated via a video link by the regional Care Landscape Working Group. The draft Regional Vision was discussed at the ASD meeting on October 7. Based on available information and discussions, the ASD formulated an opinion. The advice will be sent to the regional working group with a copy to the Nuenen college. This working group will prepare a draft for the regional board, also based on the advice from the 15 municipalities.

Summary

The Regional Vision is a brave and good attempt as 15 municipalities to manage the transition from a central solution from Eindhoven, to a decentralized solution for each individual municipality in the field of protected living. The ambitions are set high. There is great attention for the psychologically vulnerable residents. It is proposed to work from an inclusive idea in which mentally vulnerable residents remain part of society as much as possible.

The arrangements sound logical and are humane and balanced.
Yet the ASD sees risks to effectively implementing the intentions. In our view, there are two major risks:

• Insufficient budget, people and available housing to actually implement the intentions.
• Insufficient incentives for municipalities to want to jointly solve the problems.

The ASD therefore provides comments and suggestions to make the arrangements even clearer and more effective.

Advice, suggestions and questions

Expectation Management

In recent years, system changes in the social domain have often been accompanied by budget cuts. These were then argued with statements such as better Health through better coordination, close to the client and efficiency improvements. While the cuts were real, the other assumptions were often wrong.

Advice: Communicate that the decentralization is not a cut, but an even further decentralization. The effects for clients are neutral or possibly slightly positive due to the shorter distance client and help.

Ambitions

Ambitions are set high. Great attention is paid to mentally vulnerable residents. Their needs are central, such as quick availability of housing and sufficient adequate guidance and assistance. However, for other residents it has for years failed to organize everything properly and on time. Why should this succeed for this target group now?

Suggestion: Maintain ambitions, but a little more realism can limit unrealistic expectations and thus avoid disappointment.

Housing

The availability of suitable housing is an essential component in implementing the ambitious plans. Without suitable housing, there is no outflow and procedures stall. There is a great and probably increasing scarcity of these housing units. Clients must compete with other categories, such as divorced parents with children and status holders. The prioritization of this choice is outside of this regional vision, but it is essential for its successful implementation.

Question: How can the Regiovision anticipate this? In other words, what actions can be proposed in this Regiovision to achieve the desired ambitions more effectively?

Worn common arrangements

The regulations should protect clients and prevent municipalities from throwing their problems across municipal borders.
Recommendation: Therefore, formulate clear rules for the following topics, among others:

• Which municipality is responsible for which clients?

• Does the funding run parallel to the expenses incurred?
• Are there incentives and opportunities for municipalities to jointly save costs through collaboration?
• Are there incentives for municipalities to actually pursue the stated ambitions?
• Can clients also move between municipalities, e.g. because a Protected Living home happens to be available/established elsewhere? Is there free establishment of Protected Living houses?

Avoid grinding clients in bureaucratic procedures between municipalities, encourage desirable, cooperative behavior between municipalities, and discourage "throwing problem across municipal borders." Therefore, the following sections of text, among others, are relevant:

• p.8: Definitions Congregation of registration and origin
• p10: We work from the national access protocol protected living. We encourage the resident to live near a helping social network and where there is the greatest chance of recovery.
• p11: A resident flows out to the origin community unless there are factors there that impede recovery or there are factors elsewhere that better contribute to recovery.

Opinion: It should not be rewarding for a municipality to do too little, leaving other municipalities to solve the problems.

Distribution model

There is strong reliance on an objective distribution model. This is justified. But ultimately the distribution model chosen is a political choice from several models based in part on objective data. This important choice has not yet been worked out in the draft. But that choice is very important for the acceptance of the Regiovision.

Recommendation: Elaborate sufficiently on the proposed objective distribution model(s) to make it clearer what is being decided on.

Protected Living

This term has two conflicting meanings in this paper:

• One of three forms: Protected Living, Protected Home and Assisted Independent Living
• As an umbrella term for these three.

This is confusing for everyone, because now you have to keep checking which interpretation the word has.
Advice: Try to reduce this confusion for everyone, by using different words/concepts, e.g. Protected living24/7 for the subcategory Protected living.

Duration of transition

The proposed scheme runs for four years (2023-2026). Full decentralization takes about 10 years. Stopping along the way is not an option. An unclear future after 2026 significantly limits progress and risk-taking before 2026. It does not seem convenient to make an arrangement limited to the first four years (2023-2026) if the entire transition is going to take about 10 years.

Recommendation: Be clearer that the proposed arrangements will continue beyond four years, possibly modified based on a review after three or four years.

Both inflow and outflow cannot be fully controlled. Therefore, the stated 10 years is not exactly met.

Q: What happens if the tipping point is reached earlier or later?

Miscellaneous

p17-18: We divide the costs of the customized provision of Protected Living fairly and efficiently among the 15 municipalities in relation to its use with our residents1⁾. For the period 2023-2026, based on a forecast, a regional budget will be formed from which the regionally organized products will be financed. The municipalities contribute to this regional budget based on the proportions in the objective distribution model Protected Living2⁾.

Q: Two methods, ¹⁾ and ²⁾, are mentioned to calculate costs for the municipalities. These do not appear to be the same. Why is there a difference?

p10: We use the same access criteria for the Protected Housing, Protected Home and Assisted Independent Home products so that these products form a fluid chain of support.

Note: But with different numbers, otherwise there is no distinction between the three forms.