Rumbling on

Back in February 16 I reflected on the lack of publicity about the 80% increase in the DFG budget, made all the more remarkable in the context of most other local government budgets decreasing.

The big question is how much of that extra money will actually be used for increase DFG delivery and, hopefully, system improvements?

At the moment the answer appears to be ‘who knows?’

Local responses to the DFG increase range from a few ‘That’s great, let’s get on and deliver more and in better ways‘ to the cynical ‘It isn’t really more money because ‘they’ (DH) took away our Social Care Capital Grant so we are not going to increase the DFG budget at all’.

To the latter we can only make the plea – ‘use it or lose it’.

As the Spending Review announcement in 2015 made only too clear, DH are rightly looking for a return on their DFG investment. There are expectations about DFG outcomes including delayed admission to residential care, lower care costs and, as the 2016 Better Care Fund Policy Framework states, in reducing delayed transfers of care.

If the local response to extra DFG money is to not use it for the purpose intended then DH will be well within their rights to review payment and delivery systems in future years.

We urgently need to get organised with regard to evidence of resulting benefits from adaptations. Care & Repair England is working with the Centre for Ageing Better with regard to the commissioning of an evidence review. It is also doing its utmost to support plans for ‘proper’ academic research in the field. However, this will take years, rather than months. Local ‘snapshot’ evaluations will be critical in the short term and we are keen to do whatever we can to help to develop methods and share ideas in this area. [May 2016]

Looking back, looking forward

Care & Repair England is 30 years old.

Little did most of us back in the 1980s think that three decades on we would still be championing the importance of home repairs and adaptations to a decent older age.

One of the visionaries without whom none of the work of home improvement agencies would have happened is Mike Wright, who died recently just short of his 90th birthday.

Mike was an extraordinary character, an army colonel who, on retirement from the army in 1960, set up HACT, alongside a sister charity, Help the Aged Charitable Trust. It was Mike’s tireless fundraising and innovation that underpinned the development of many housing associations during the 60s and 70s, and that same passion which resulted in the creation of Care & Repair England (initially England and Wales).

Jane Minter, now our Head of Programmes, has written a detailed obituary about Mike’s work which is a great reminder of what a difference one person can make.

Reflection on the past is a useful starting point for looking to the future. There remains a great deal to be done to reach the point where all older people are well housed in homes that are healthy and accessible. Mike will be an inspiration to us all in planning future action to achieve that ultimate aim.  [March 2016]

Off the radar?

Even though building new homes is high on the housing policy agenda, the condition of the housing that already exists hardly gets a mention.

It seems self evident to many of us that a warm, safe, decent home is a necessity for good health, particularly in later life when we spend more time in that home. So why so little attention?

It almost seems as if some sort of roof over your head is ‘good enough’ – to ask for that home to be a healthy, good place to live is expecting too much.

The NHS is facing unprecedented demands. Older people are more likely to live with the chronic health conditions which can be exacerbated by poor housing. So again, isn’t it obvious that better housing could reduce health service pressures?

We even have a cost savings figure. A report by the BRE The cost of poor housing to the NHS (Nicol et al (2014)) estimates that poor housing in England costs the NHS in excess of £1.4 billion a year.

Care & Repair England’s latest report Off the Radar: Housing disrepair & health impact in later life uses new data analysis (thanks to data supplied by the BRE) of the incidence of poor housing, alongside the age, health and tenure of the occupant.

There is a compelling case for action to reduce health hazards in ordinary, private housing, given that 79% of older people who live in non-decent homes are owner occupiers.

Definitely an opportune moment for Health and Well Being Boards to take a lead on this issue at a local level, as well as time to put housing stock condition back ‘On the Radar’ of national government policy. [March 2016]


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 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]