Don’t look a gift horse….

Most local authorities know that they are, on average, set to receive an increase of around 80% in their grant allocation click here for disabled facilities grants (DFG) in 2016-17.

Where is the celebration? Positive news announcements? Silence seems to prevail.

Home adaptations have always been the Cinderella subject of the housing world, or, layering on even more metaphors, ‘nobody’s baby’, as they straddled the interests of health, social care and housing. So here we are, at a time of massive funding reductions in local authorities, with a good news story to tell about integration in action, but little is appearing in print.

I have had a couple of emails saying this is great news, but worryingly more rumblings about ‘how are we going to manage this extra work’.

No-one is underestimating the pressure that local authorities and front line staff are facing as revenue funding is squeezed. But ironically, finding ways to say ‘no’ and rationing shrinking budgets can be more expensive to manage than saying yes to greater numbers.

DFG money is now paid through the Better Care Fund. It is not tightly ring-fenced. It can be used in imaginative ways – fast tracked smaller works, block contracts, increased self assessment/ use of Trusted Assessors & HIAs – why not use for Housing Options advisers in hospitals linked to a rapid housing adaptation fund to help people to leave hospital faster etc etc. All could contribute to the BCFs new targets – particularly reducing delayed transfer of care and improving patient/ service user experience.

If someone out there would combine all of the excellent elements of the local pioneers (see our list of ‘Good Practice’ locality notebooks here) we would really see disabled people’s lives transformed – anyone want to step up to the plate?

February 2016

A Stark Reminder

Another week, another set of headlines about the NHS and social care funding in crisis. The CEO of NHS England, Simon Stevens, went as far as saying that the NHS would be ‘unworkable’ without an improved funding offer in the forthcoming Spending Review.

Preventing hospitalisation and reducing need for care services has never been more critical. Yet at a local level housing services which improve older people’s homes e.g. removing falls risks, making older people warmer and safer, are finding it increasingly difficult to keep going.

With a few exceptions, most Care & Repair and similar agencies have faced considerable funding reductions, whilst many of the ‘tools’ available to pay for hazard reduction – affordable loans, small grants, handyperson schemes, falls prevention / safety checks, Warm Front etc. etc. – have all but disappeared.

The Building Research Establishment (BRE) quantifies the cost of poor housing to the NHS was £1.4 billion so it doesn’t take a genius to see the potential NHS savings if we remove hazards in the homes of older people.

What also has to be kept in mind is that there are potentially even greater savings to social care if housing conditions are improved/risks reduced, let alone improved wellbeing and extended independent living – as yet not adequately quantified.

A useful first step would be an obligation on every Health & Well Being Board to include an assessment of health impact of local poor housing conditions in their local strategic plans, combined with commissioning of services that tackle housing hazards and hence reduce risk to health. We can but hope.

 

The Countdown Begins

With just weeks to go before the Government’s Spending Review Announcement on 25th November, it is a nail biting time for anyone involved in public services.

Even though housing is in the news nearly every day, the focus is totally on quantity – stock quality and housing related services never get a mention. In fact if any of us dare to speak up and say that we shouldn’t just be building tiny new ‘starter’ homes but should also take the long view and create healthy, sustainable places to live at all ages and stages of life, we tend to be shot down in flames.

And as for commenting on the policy silence about disrepair of the current housing stock, pointing out that poor housing is costing the NHS at least £1.4bn every year, let alone the importance of adapting mainstream homes for an ageing population – beyond the pale.

So it is welcome news indeed that the head of Public Health England, Duncan Selbie, made a statement at the high profile PHE and Kings Fund conference on health and housing last week about the importance of housing quality to the nation’s health.

Let us hope that Department of Health also has housing on its radar and that we see some good news in the Spending Review about the continuation of help with home adaptations and support for the more visionary health sector partners who also want to address poor housing. [Oct 2015]

 

 

Making home adaptations a health priority

This week has seen yet more negative articles about older people, now labelling those who choose to live in their current home as ‘hogging family homes’. Not only does this negative language drive intergenerational strife, but it also deflects attention from the underlying problems of a dysfunctional housing market.

This emotive promotion of the benefits of moving to retirement housing doesn’t exactly support our efforts to make the case for the continuation of help with home adaptations, the best and often the only housing solution for the majority of older people, particularly those on limited incomes.

This week we have published two more Notebook Cameos describing local agencies that are doing great work helping many hundreds of older people live well at home through home adaptations. These unsung heroes are finding ways to deliver adaptations faster and cheaper, resulting in huge benefits not only in quality of life for individuals, but saving money for health and social care.

Unfortunately as far as media stories goes, pictures of adaptations can’t match the glamorous images of aspirational retirement show homes populated by impossibly elegant 60-somethings.

The unglamorous housing and ageing reality is normal homes with relatively simple changes that enable occupants to use an ordinary looking bathroom and get up and down stairs.

Sue Adams, CEO of Care &Repair England [Sept 15]

Not reinventing the wheel

As times get tougher and the pressure is on to find yet more efficiency savings, it becomes ever more imperative that everyone learns from each other.

Leading bodies in the health field have grave concerns about the scale of savings being demanded of the NHS. Consequently any housing service that can help to reduce demand on hospitals and GPs is going to be of interest.

This is why Care & Repair England has teamed up with Public Health to publish information about how local areas are delivering home adaptations in ways which are innovative and effective.

It is challenging to admit that systems could be improved, and sometimes processes have evolved to some degree to ‘manage’ demand. This is particularly the case where DFG budgets have been reduced.

However, if we are to make the case for inclusion of housing related help in local Better Care Fund and related integration plans, we have to show that home adaptations can be delivered at a speed that chimes with NHS systems. This means thinking in terms of hours and days, not months and years. It means providing better evidence, embedding in processes, and enabling self help to prevent health problems.

We are keen to publish more local examples, so time to stop hiding your light under a bushel and tell the world about your success.

Sue Adams, CEO of C&RE [June 15]

 

Home adaptations – a lifeline

Last night I came across a TV programme ostensibly about DIY but which in fact was about adapting a home for a disabled person. I was struck how little most people appreciate the incredible difference that home adaptations make to people’s lives.

In this particular instance the life of every family member – mum, dad, two younger siblings – was completely transformed by adaptations to their home and which also enabled the family to continue to care for the disabled son.

How often have Care & Repair workers heard older people say that their quality of life is incomparable after sometimes even a relatively minor adaptation?

At a time when saving money has become the measure of everything (and of course we have to keep on making this case too), we do still need to keep in mind the human cost of inadequate, unadapted homes.

NHS mental health services have been in the news lately with various commitments to giving  mental health equal treatment with physical health.

Most of us would make the point that in real life these are so often indivisible, and what better example than the impact of home adaptations on mental health, with their power to enable independence and living with dignity?

Reflections by the CEO of Care & Repair England, Sue Adams [June 2015]

Time for Common Sense?

It was with a heavy heart that I read this section of the government’s recent Budget Statement

[The Government..is exploring the cost-effectiveness of options to integrate spending around some of the most vulnerable groups of people, including:

  • exploring whether improving housing can help people with care needs stay in their homes longer and reduce costs to the NHS. [my emphasis]

When talking to a leading epidemiologist and a consultant specialising in dementia later in the day, their comment was that sometimes there seemed to be a lack of basic common sense. Wasn’t  it obvious that older people’s health and ability to live well at home was made worse by poor housing?

Just days before the Budget the Building Research Establishment (BRE) had published its latest analysis of the health cost benefits of specific home improvements and adaptations, The Cost of Poor Housing to the NHS. This shows that the annual cost to the NHS of poor or hazardous housing is between £1.4 and £2.5 billion – on a par with the cost of smoking.

I was reminded of the excellently titled Finding Ways to Say Yes a report by the leading adaptations researcher, Frances Heywood OBE, which highlighted good ways to provide help with home adaptations.

Increasingly we are faced with is ‘Finding Ways to Say No’ . As public funding is squeezed ever tighter, citing lack of evidence is one way to say no to funding activities which people may have thought were self evidently ‘a good thing’ and so haven’t built up a research evidence base to prove it.

I am a huge supporter of prioritising what works and there are undoubtedly areas of accepted practice across health, social care and housing that are not cost effective. We should root out poor practice, but we do need to balance this with a reality check.

Surely the question for government is not ‘whether‘ improving housing helps people live well at home or reduces NHS costs, but how to spread best practice and deliver ‘what works best’ to gain the greatest cost benefits, improve people’s health and, so importantly, improve their lives.

Reflections by the CEO of Care & Repair England, Sue Adams, [April 2015]

A Blame Culture looks for Scapegoats

There was a flurry of media activity last week in response to headline figures from the latest English Housing Survey which revealed yet another fall in the level of home ownership and rise in private renting amongst younger age groups.

Unfortunately, it was very much a case of adding up 2 and 2 and making 6. A quantified, considered analysis of the shortage of housing stock, the rise of buy to invest/let driving up house prices and making them unaffordable for the majority of younger people (who want to buy a home to live in it), combined with reduced access to affordable mortgages for first time buyers in the wake of the new Mortgage Market Regulations would have been helpful in taking forward a debate about solutions.

Instead we had headline’s along the lines of ‘older people own most of the homes, they ‘under occupy’ and therefore ‘they’ are the ’cause’ of younger people not being able to get onto the housing ladder’. Somehow, this analysis implies, if everyone ‘older’ moved home in some giant rubik cube manoeuvre we would solve the housing crisis.

I am not sure where all of these empty one bedroom (don’t forget anything more than this is under occupied even for a couple), ‘more suitable’ homes for ‘older’ people are located. Nor how many people are queuing up to move into them. And I have come across even fewer older people who are not deeply concerned about the housing prospects for the younger generation. Most are keen to help their children, grandchildren and great grandchildren.

A third of homes are lived in by people over retirement age ie c 9 million properties. The majority of the UK housing stock is made up of two and three bedroom modest dwellings. Most people are happy where they currently live .Most older people make good use of the space they have, many looking after grandchildren who sleep over, not to mention offering places for friends and family to stay both socially and when times get tough. What most want is to be able to look after that home, adapt it if and when they need to and to know that there are specialist housing options should they ever need them.

There is undoubtedly a minority who would like to move and an unmet demand for better designed housing for ageing, particularly for the ‘older old’ and also the more affluent who really do live in large properties. But flawed analysis and overstatement of the need for specialist stock is not helpful, and neither is pitting one generation against another. The housing problem is far more complex and requires a more sophisticated debate with regard to housing tenure, finance, market intervention and possible solutions than anyone at the moment seems willing to contemplate.

Reflections by the CEO of Care & Repair England, Sue Adams, [March 2015]

 

The need to keep stating the obvious

If the mainstream media is to be believed, our hospital systems are close to collapse as people flock into A&E and ambulances are back up outside hospitals with nowhere to unload their charges as vacant beds become as rare as hens teeth.

Against this backdrop it has emerged that the current death rate in England and Wales is running about one-third higher than its normal rate for this time of year, with people over 75 the worst affected. The death rate has risen by 3,700 people a week since early December. Of that more than 3,000 are over-75s.

The failure of the flu vaccine combined with the recent cold weather are identified as key contributors, but the impact of older people living in cold homes which they cannot afford to heat is often a neglected contributor.

Therefore it was a welcome intervention by Dr John Middleton of the Faculty of Public Health this week who, whilst noting that the current predominant flu strain (H3N2) particularly impacts on older people, stated that “The other major causes of winter excess deaths are housing conditions and heating – affordable warmth. What we’ve seen in terms of welfare cuts and the rising cost of heating homes could also be an important factor.”

I could not agree more. This is well documented phenomenon with a quantified evidence base, such as the BRE modelling of the cost to the NHS of poor housing. What we now need is a completely fresh approach to prevention of poor health through systematic, targeted housing improvement, integrated into health and social care systems. With the vast majority of substandard homes in the private sector, the national network of home improvement agencies, including pioneer Care & Repair services, could be at the forefront of such an initiative. Is it so much to ask?

Reflections by the CEO of Care & Repair England, Sue Adams, [February 2015]

 

The thirst for information in an uncertain world

If only I had known….was the title of a Care & Repair England initiative some years ago. It offered housing and care options information and advice to older people in health care settings such as hospitals. That very phrase was one that older people and their families had used so often when talking to an adviser about what to do next with regard to living in the current home, adapting it, moving and/ or finding care and support.

With the Care Act implementation just weeks away, there is an even greater need for clarity about what people might expect of the care system, how much they will have to pay and how, for home owners, their housing equity will be treated.

We welcome the BBC’s ‘cost calculator’ as a useful step in enabling people to understand what the changes might mean for them in cash terms. However, there is still an enormous need for one to one advice to enable people to make fully informed decisions about where they live and their possible options. With 65% of people over 75yrs never having used the internet (ONS Data), and many without family or friends to help, that human conversation, over the phone or in person, is critical.

Which is one reason that we are so pleased to be able to work with EAC FirstStop to support local ‘Housing and care options’ services, utilising another year of invaluable funding from DCLG  In their first 15 months the 15 local pilot projects helped nearly 30,000 older people, whilst the national EAC FirstStop website has millions of hits every year, and their phone line never stops.

Unfortunately, this week we heard there is one part of the country where older people will not have access to the advice and practical help with their housing that they so need.  South Gloucestershire council pressed ahead with its massive cut to the West of England Care & Repair service. Agency of the year in 2014, Care & Repair is a pioneer in its field, bringing enormous benefits both to individuals and to the local economy. Sad news indeed.

Reflections by the CEO of Care & Repair England, Sue Adams, [February 2015]