Grasping an Opportunity

Blog by Sue Adams, CEO of Care & Repair England



Cutting services has sadly become the ‘norm’ for local councils, and so receiving more money for specific provision requires a shift in mindset.

This is particularly so when that money is for a ‘Cinderella service’ that crosses the boundaries of housing, care and health, as is the case for home adaptations grants for disabled people.

In the grand scheme of things this year’s national government budget of £505 million towards Disabled Facilities Grants (DFG) isn’t large e.g. compared with the additional £10 billion for the Help to Buy scheme, announced in the Autumn 18 Budget or the £25 billion spent on social care.

Nevertheless, this DFG funding can help to transform the lives of around 60,000 disabled people, c.60% of whom will be older people, enabled to live more independently, safely and well in their own homes.

As the recent letter to local councils setting out the DFG Allocation for each individual authority shows, there are very wide variations which aren’t all related to population size. Neither is the national government funding intended to be the only source of money for DFG (in the past there was a mandatory requirement to match fund from local sources).

However, as the research into good practice in providing help with home adaptations clearly shows, it isn’t only about money. Fast tracking systems, outreach and innovative approaches to collaboration between health, care and housing can all result in greatly improved use of the home adaptations funding that is available.

The recent review of the future provision of DFG, highlights a range of potential changes that could be adopted sooner rather than later (others will require legislative change/ regulations).

So let’s not overlook good news when it comes along. This year’s DFG funding provides an opportunity to change lives and do things differently, as well as contributing to achieving the NHS Plan’s stated intentions of preventing health decline and delivering more care at or closer to home.

[April 2019]

Why is it so hard?

Blog by Sue Adams, CEO of Care & Repair England





Talk to Joe (or Joan) Public about whether your home affects your health and most would say it was ‘blindingly obvious’ that having a safe, warm, secure place to live is good for you.

So why is there virtually no mention of housing conditions in the new NHS Long Term Plan, despite its emphasis on prevention, not to mention delivering more healthcare in people’s own homes?

The omission was doubly disappointing given previously encouraging remarks by Minister Matt Hancock and the government’s vision statement about prevention.

In the light of the recent publication of the World Health Organisation’s excellent Housing and Health Guidelines it can be hard to not despair of ever joining up health, care and housing policy, let alone practice, in England.

With yet more cuts to local authorities’ expenditure on the horizon we are seeing signs of further contraction (or closure) of the invaluable preventative housing services offered by holistic home improvement agencies. These include Handyperson, Hospital to Home, Housing Options information and advice, help with essential home repairs, tackling cold homes, hoarding – the list goes on.

Whilst it is perfectly reasonable that the NHS Long Term Plan states that it cannot fund every aspect of provision that impacts on population health (Clauses 2.3, 2.4), the Plan could have gone so much further to pave the way for concerted joint action to tackle the housing conditions that affect health, not solely fund action on homelessness (important and welcome as this is).

Failing to mention home modifications in the context of falls reduction (despite the stronger evidence base for these compared with exercise programmes), let alone cold homes and the large increase in pneumonia amongst the older population, was doubly disappointing.

So, back we must all go to building the evidence of impacts, promoting successful models and trying to embed housing in the forthcoming Prevention Green Paper.

It is good news that the ‘What Works’ UK Centre for Housing Evidence (CaCHE) has added health, care and housing connections to its new list of research priorities – never has fresh evidence and impetus for change been more critical [January 2019]

The art of the possible

Blog by Sue Adams, CEO of Care & Repair England



I’m sure we all sometimes wonder why, when it can be so obvious what works best, why doesn’t everyone do it?

When we came to consider what works well in terms of help with home adaptations from the perspective of older people, the Older People’s Housing Champions were very clear about this, coming with this list:

  • Suitable need impartial/ independent information and advice about what adaptations would best suit me
  • Transparent -easy to find out about the help available, open and clear process, clear pricing, good communication etc
  • Simpleto get help and professionals listen to what I want/ my priorities
  • Speedyso I get what I need when I need it; adaptation delivery/ installation is fast/ efficient
  • Trustworthy, good valuea good job, done well by a reputable contractor at a reasonable price

At the risk of stating the obvious, if you need a home adaptation the sooner you get it the better. If you can’t get in and out of the bath and are reduced to having to strip wash, why on earth would you want to wait for a year or more for a shower to be installed? If you had the money, knew what was possible and had the wherewithal to organise a builder, you would just get on and sort it, wouldn’t you?

So why do some local areas provide help with home adaptations so well, other, quite frankly, very badly?

Thanks to the Centre for Ageing Better, who commissioned Care & Repair England to undertake an open ‘Call for Practice’ with regard to home adaptations provision, we have been able to document a wide range of local examples of good practice and innovation.

Martin Hodges, our Catch 22 project lead, has trekked all over England, meeting people in local authorities, home improvement agencies and social housing who are going the extra mile to improve people’s lives.

The end result is a new report published, Adapting for Ageing: Good practice and innovation in home adaptations, alongside a set of linked stand-alone profiles describing the 24 local ‘exemplar’ sites (all are hyperlinked from the main report).

The really big challenge is how to get everyone to take up these ideas. The extra £240m social care winter pressures money would be well spent on adaptations and replicating some of these good examples. [October 2018]

Off to a good start

Blog by Sue Adams, CEO of Care & Repair England



Off to a good start

With the Summer heat wave becoming a distant memory and the chill of Autumn in the air, it is good to start the ‘Autumn Term’ with some positive news.

Care & Repair England has been working with the Dunhill Medical Trust for many months now developing ideas and plans for a research call on the subject of home adaptations and older people.

It is therefore brilliant to see this come to fruition and for September to start off with the announcement of £200,000 for new research in this field.

As a leading research funder Dunhill Medical Trust seeks to fill evidence gaps and link research with ‘real world’ policy and practice. Their recognition of population ageing as a pressing social issue, and our shared interest in the link between housing and healthy later life made this an ideal collaboration.

What we need now is some brilliant research proposals from leading academics in the field.

With the 2020 spending review not far away, and austerity not over yet, we are all going to have to work harder than ever to make the case for investment in housing adaptations and repairs for older people.

So I would encourage anyone with an interest in this field to look at the Dunhill call and pass it on to friends and colleagues. 

[September 2018]


Handyperson – new evidence of cost benefits

Sue Adams, CEO of Care & Repair England




Handyperson services: New evidence of cost benefits

One of the highlights of my past year was undoubtedly visiting and talking to older people who have used the Preston Care & Repair handyperson service.

I carried out these interviews in connection with writing our latest report Small but Significant: The impact and cost benefits of handyperson services.

Over and again, I was struck by the psychological impact of the very existence of the local (independent, not for profit) Care and Repair service. Knowing that there was someone to turn to who was trustworthy, would do a good job at an affordable rate when something went wrong with their home was incredibly important, particularly to older single women.

I’m very happy in my little flat and I don’t want to move. Before [Preston] Care and Repair, when there was something that needed doing [to the flat] I would wake up every morning and lie there thinking ‘How can I get this done’. I don’t want to go down the road of my home declining, I want to get repairs sorted – knowing Care and Repair is there to call on makes all the difference.”   Mrs Y, 84yrs

In the service user feedback survey 96% of older people said that the Preston Care & Repair handyperson service made them less worried about their home and 100% said that they would recommend the service to others.

The extent to which ‘older old’ people, especially women living alone, were turning to Preston Care and Repair was also an outstanding feature. Nearly half of the service users are over 80yrs (46%), 77% are older women, and 72% are older people living alone.

Increasingly we have to make the case for service continuation based on cost benefits, particularly to the NHS. These groups of older people are higher risk in terms of NHS use and so here again, we see that handyperson services provide an exceptionally high rate of return on investment for health and care services.

By analysing just the falls prevention impact on a small number of higher risk cases, applying robust national evidence from Public Health England, we found that for every £1 spent on the handyperson service the saving to health and care is £4.28. In addition there are many other fiscal and social gains e.g. improved wellbeing, reduced anxiety, hospital discharge etc.

However, it is the effect on the quality of life of individuals through reduced worry and peace of mind that for me, emerged the most significant benefit. This has been a consistent finding in successive evaluations, going right back to the very first Care & Repair England report in 1993, and including the major national government commissioned handyperson services evaluation published in 2012.

Mrs X, 75yrs, so clearly sums it up “….. It makes me feel that I can manage. It is such a relief when you have never had to do these things and you don’t know where to turn to.”

Link to short summary brochure here

[July 2018]

Ideas in action

Sue Adams, CEO of Care & Repair England




Ideas in action – older people shaping policy and practice in housing

  • “I need services that will enable me to stay in my home to the end of my life”
  • “When your health declines you need help with your housing”
  • “When I get to the stage where I need support I need to know where to go”

Just three quotes from older people in a survey carried out in Leeds and which we often hear from older people across the country.

To respond to these, and other concerns from older people about their housing, local older people’s groups and organisations have been getting together to influence housing strategies and deliver housing support for their peers – and the Older People’s Housing Champion’s group have captured some examples in our new Ideas in Action guides, click here

With support from the Esmѐe Fairburn Charitable Trust we have produced four guides looking at how in London, Leeds and Manchester older people have come together to influence housing strategies and plans and in Hackney how older people are supporting their peers to make sense of the options available, making use of IT and supporting digital inclusion in the process.

Alongside this, and again via the Esmѐe Fairburn funding initiative, Elders Council of Newcastle, with Skimstone Arts and Northumbria University have produced Housing Voices – with a film resource pack and report – which can be used by others to engage people in conversations about their housing in later life.

Offering support to each other, providing ways to ensure that peers have the right information and advice and ensuring all older people are not ignored in local housing policies and plans has been a hallmark of local older people’s groups and networks over the years.

The Older People’s Housing Champions hope these examples help to stimulate local action and would love to hear from you if you are taking any local action on housing and ageing.


If only……

Blog by Sue Adams, CEO of Care & Repair England




If only……

I was so pleased to read of the £6 million allocation to Care & Repair in Wales. This is fantastic recognition of the value of investing in local Care & Repair services to help older people in Wales live independently and well in their own homes at a time of funding constraints.

The fact that £2m of this funding is for the Rapid Response Adaptations Programme (RRAP), which provides minor adaptations that help prevent hospital admissions and / or speed up hospital discharge to home, shows how the Welsh Government is not only taking the links between health and housing seriously, but it is spending on prevention.

Care & Repair Cymru estimates that for every pound invested in the RRAP programme there is a £7.50 saving to health and social services.

This is not far off the recently published new evidence from Public Health England which shows the social and cost benefits of falls prevention. Home modifications came top of the list, cutting hospital admissions by 23%, with a Social Return on Investment of £7.23 for every £1 spent and a Financial Return on Investment of £3.17 for every £1 spent.

What gave me pause for thought with regard to Care & Repair in Wales, is the 100% coverage of the country, and the continuation of Care and Repair services that are independently run. Similarly in Scotland, out of 33 Care and Repair services, 5 are independent not-for-profit bodies, 20 are managed by RSLs, 3 by other organisations and their new Good Practice Guide cites the official position of the Scottish Government which is that ‘…where practicable, all Care and Repair services (should) become self-governing, operating as either a standalone project or as a subsidiary of an RSL’.

In England voluntary organisations, particularly the older people’s sector, are under enormous strain, with an alarming rate of service closures and at best service contractions. The small remaining cluster of independent HIAs remain sector pioneers, at the forefront of innovation and cross sector working. Despite the current hostile climate, we can but hope that they remain that they are able to continue and thrive, and that their enormous value gets the recognition that it deserves.

[June 2018]

Urgent action needed

Blog by Sue Adams, CEO of Care & Repair England




Urgent action needed on housing for disabled people

This was featured as a guest blog by the Equalities and Human Rights Commission in May 2018 – link here

[Care and Repair England] advocates for the importance of safe, secure and adapted homes for disabled people, to maximise independence, dignity and quality of life. So we were very pleased to hear that the Equality and Human Rights Commission were planning an inquiry into housing for disabled people.

With the publication of the resulting report we certainly welcome the findings and recommendations.

However, I can’t help wondering how many more reports are needed before the message gets through to decision makers that building all new homes to be accessible and adaptable is absolutely fundamental to creating an inclusive society and that this will not happen without national regulations to set minimum standards.

The impact on the lives of disabled people condemned to living in unsuitable homes seems to be hard to grasp for anyone who has never faced such problems. So many things that are simply taken for granted – like using the bathroom, being able to go to bed in a bedroom, even just getting through the front door – are made impossible for far too many disabled people by inadequate housing.

Very often lives can be transformed by a relatively small adaptation – a level shower, a ramp, a hoist, wider doorways, level thresholds.

The reports of the misery caused by long delays in adapting homes are additionally frustrating when contrasted with places where home adaptations help is being delivered really well. Many pioneer areas are now fast tracking more straight forward adaptations, involving disabled people in decision making, simplifying the grants processes, as well as contracting quality builders and supervising work to ensure high standards.

Unfortunately, what we currently have is a postcode lottery when it comes to disabled people being able to get their homes adapted.

The growing problem of adaptations in the private rented sector is rightly highlighted in the report. There are very fundamental problems with short term tenancies and home adaptation grants that will need to be tackled head on, if we are to improve the lives of young people who so often rely on privately rented accommodation.

The government commissioned a review of the Disabled Facilities Grants provision which is currently underway and would do well to consider the issues and recommendations highlighted by the Commission’s report.

[May 2018]

Safe and comfortable at home

Blog by Sue Adams, CEO of Care & Repair England




Care & Repair England’s contribution to the Government’s Implementation Plan on dementia

Care & Repair England believes that all older people should have decent living conditions and be able to live in a home of their own choosing. Poor or unsuitable housing has a profound effect on older people’s health and well-being. We welcome one of the key commitments in the Government’s Implementation Plan on dementia which focuses on health and care to enable ‘people to live well in their own homes for longer.’

Here is some of the work we do to help make this happen.

Information for older people and their carers

Last year we produced a series of guides for older people and their carers on making their homes a better place to live with a range of long term health conditions including dementia. Each guide advises on what people can do to their home to make living at home more manageable and life easier so that people can continue to live independently and do the things they want to do. The guides also describe the range of alternative housing options and offer suggestions about where to find more detailed advice.

More recently, and with Carers UK, we are developing a guide specifically for carers who care for older people, including people with dementia, on the housing options available aimed at enabling people to think ahead and know what to consider together. This will be published shortly.

Promotion of responsive services for older people and their carers

As well as guidance for older people and carers we work with local partners to support the development of practical housing solutions, particularly for older people living in mainstream private housing. We also promote great local practice.

A fantastic example of this practical help – and a service we would like to see everywhere – is Homewise Memory Matters based in Lancashire. This project supports people with memory loss and dementia to stay at home continuing to live independently keeping them safe and out of hospital and residential care. It also works with their carers to ensure that they are aware of local services including respite care and have a network of support available to them. Simple innovations in the home can make all the difference whilst advice on care, support and benefits ensures continued independence, good health and wellbeing

Sharing ideas and practice

Care & Repair England believes in sharing ideas and practice and is a committed member of the Dementia and Housing Working Group where we focus on the issues for older people with dementia who live in mainstream housing. We want to see a situation where all older people with dementia can choose to remain safely and with comfort at home for as long as possible

[April 2018]


Drowning in words and numbers?

Blog by Sue Adams, CEO of Care & Repair England




Drowning in words and numbers?

The sheer volume of information that we are all expected to process every day really can feel overwhelming. The lists of publications, reports, blogs and comments that we haven’t had time to read grows ever longer so no wonder many people just give up and stop even trying to keep up.

For those of us involved in the field of housing and ageing, constantly trying to reflect the diverse reality of older people’s everyday lives, hopes and experiences, challenging the stream of negative, reductive headlines is increasingly challenging.

But we have to persevere and keep on analysing the reliable sources of information, because without rigorous analysis of solid data and application of evidence we will fail to develop workable solutions to the many housing issues faced by people of all ages.

Pitting the generations against each other, stoking a blame culture with a simplistic ‘the old caused all of the problems faced by the young‘ is profoundly damaging to our society. With regard to housing, the misleading narrative that says if only old people would move out of their homes young people wouldn’t have a housing problem, is not only clearly illogical, but it also fails to analyse the multiple root causes of current housing problems.

Nor is it a simple numbers game, building ‘units’ of accommodation rather than creating decent, affordable, accessible and sustainable homes for the long term good of society.

The reasons why older people are home owners whilst younger people increasingly face seemingly insurmountable obstacles to living in a secure, affordable home, let alone buy one, are multifaceted.

Policies which have supported buy to let or invest, declining numbers of social rented homes, land-banking, rising inequalities, lower incomes & insecure employment resulting in limited access to mortgages compared with the 80s and 90s [when home ownership suddenly opened up for a whole generation of working people], not to mention welfare reform are just some of the many reasons that we are in a housing crisis.

So easily lost in all of this maelstrom is the situation of the million or more lower income older home owners living in non-decent homes, who face day to day worry about repairing, adapting – even insuring or heating – their homes. Those with families don’t want to be a ‘burden’, many see the difficulties faced by their grandchildren and want to help, often by passing on even limited equity in their homes. A small amount of practical help can go a long way to reducing not only the health risks that result from living in a cold home, or one with falls hazards, but also the grinding worry.

This is why handyperson, home improvement agency and the associated practical services that they offer are so important and we just have to keep on making the case.

[March 2018]