Challenging a culture of blame

In a week which saw an Institute for Fiscal Studies report highlighting the growing disparity of wealth/ poverty between young and old, we also saw tabloid headlines about ‘Millions of older people failing to adapt their homes’ in response to ILC-UK’s latest report.

Why did I publicly object to this latter headline? Does such language actually matter?

I strongly believe that it does matter as it contributes to a growing culture of blame and intolerance.

The more that the narrative around ‘older people’ is a portrayal of the negative (houseblockers, bedblockers, failing to save for/ plan for retirement) the greater the risk of simplistic and crude attribution of fault to individuals for complex and difficult social issues. We risk pitting ‘young’ against ‘old’ when the reality is so much more nuanced.

For starters, just as at all other stages of life, there is great diversity of the experience of older age, including significant inequalities – of wealth and income, quality of home and neighbourhood, healthy vs unhealthy life expectancy and so on.

Add to this the reality that the current built environment, and housing in particular, is not well designed for an ageing population. Whereas the Disability Discrimination Act has brought about a revolution in accessible public space (no-one thinks twice now about dropped curbs, level thresholds and automatic doors into and out of shops) this is not the case with regard to the housing stock. The perspective of the disability movement of the 80s and 90s was clear – people are disabled by the world around them and so the built environment should be changed to be more accessible. So why don’t we apply the same ideas to accommodate population ageing?

The reasons why most people ‘fail’ to adapt their own homes in advance of possible physical decline in later life are many and various.

For most of us, there is the hope that loss of physical function may never happen – and indeed for many it doesn’t, with only half of those over 65yrs reporting mobility problems (albeit that this increases significantly after 75yrs and 85yrs).

Even for people who are finding day to day living harder (most commonly, difficulty with stairs/ steps/ getting in and out of the bath) there are emotional and financial barriers to installing adaptations.

In a culture where youth and fitness is all, with ‘stay young forever’ the popular culture backdrop, no-one wants to admit that they are getting old and that infirmity is setting in.

Even when people do want to adapt their homes, many home modifications are expensive and unaffordable to lower income people. Even for those with money, faced with a high level of intensive marketing it can be hard to choose the most appropriate adaptation – it is not easy to find impartial, independent information and advice.

For those who can’t afford to pay (both tenants and home owners) there are considerable barriers-  few people have even heard of Disabled Facilities Grants, let alone have any idea how to get this help.

Hence my annoyance at a headline which says older people are failing to adapt their homes.

A revolution is needed both in the design of all new homes and also in the design and mainstreaming of accessible design features in general housing (think fashionable wet-room vs ‘adapted’ bathroom). The ‘public image’ of home adaptations needs a make over. These have to become less of an outward manifestation of losing mobility [and by implication, control] and be seen as a positive way of creating a good place to live that enables independence. We can but try. [July 2016]

[this Blog has also been published by ILCUK, click here]

A Glimmer of Hope?

One of the consequences of the recent tumultuous events is a sense that everything else in the political and policy arena is on hold.

This includes housing policy, where the focus is on speculation about a possible market crash.

However, life does move on, people need homes and the issue of decent housing for an ageing population still needs a radical policy response.

This week saw two long awaited reports of relevance to this subject published. The first to come along was the preliminary report of the Local Government Association’s Housing Commission, ‘Building our Homes, Communities and Future.’

At this point I declare an interest as I have been acting as one of the two ‘ageing and health section’ expert advisers to the Commission and our detailed input has been into the sub-section on ageing. However, we have tried to make the case that consideration of population ageing and building homes that support healthy living and well-being across the life course, need to woven in throughout the Commission’s report. I hope that others will support this bigger picture vision for design of an accessible, inclusive built environment.

The second report is the culmination of many years of important research, debate and deliberation about the necessary policy response to demographic change and an ageing society. This is the Government Office for Science’s summary report of its ‘Foresight’ Project into ageing, ‘Future of an Ageing Population’.

This report has an extensive section about housing and notes that building suitable new homes and supporting the adaptation of the existing housing stock will be critical as the population ages. The section also reflects how interconnected housing is to all of the other considerations – wealth/ assets/ health/ work/ transport/ neighbourhoods and technology.

We can only hope that in the latter case the evidence, conclusions and recommendations will be taken up whoever eventually takes up the reins of government.


8th July 2016

Blame culture back with a vengeance

As the crises in hospitals escalate, blame culture is rife. Whether it is older people living too long, migrants and ‘health tourists’ – all are in the firing line. The implication is that the more ‘deserving’ are not getting the NHS treatment that they require because ‘less of deserving’ people blocking their way.

More balanced views are out there. The major funding reductions in social care are increasingly being recognised as one reason why many older people are in hospital for longer than is clinically necessary.

The recent National Audit Office report, Discharging older patients from hospital, concludes that current official data significantly underestimate the scale of the problem, and that …‘health and social care systems’ management of discharging older patients from hospital does not represent value for money‘.

The search is on for solutions. Cue the rising interest in use of the extra funds for disabled facilities grants (DFG) paid into all local Better Care Funds (BCR) this year. One of the additional conditions attached to the BCF is to reduce delayed transfers of care. There are a few emerging beacons of innovation where fast track home adaptations and housing related services are being included in discharge processes, but they remain a small minority, with more preventative provision facing cut backs rather than increases.

Care & Repair England keeps on repeating its message about the housing, health & care links, encouraging the take up of fresh approaches and good practice, Last week saw the publication of our latest Integration Briefing 3 supported by Public Health England. This week our event, ‘Health at Home – The Right Prescription’ takes place in Manchester,  shining a spotlight on the ways in which integrated housing interventions can reduce delayed discharge and increasing independence at home for older people. Yet we do also recognise the massive challenges that those trying to balance the books face, challenged on all sides to do more for less and less.

Nevertheless, without more visionary planning and commissioning of preventative services that fundamentally address the state of the homes and neighbourhoods that people live in as they get older, those queues in A&E are just going to keep on getting longer.  [June 2016]

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]