Below we list recent key policy documents impacting on housing, ageing, care, adaptations and repairs
NHS Long Term Plan – disappointing for housing
The new NHS Long Term Plan (the Plan) published today sets ambitious targets for prevention, including keeping older people out of hospital and delivering more care at home.
Unfortunately, except for Healthy New Towns (Clause 16), the Plan barely mentions the critical role of housing condition, suitability or availability in achieving its aims.
The plan states that ‘…..a comprehensive approach to preventing ill-health also depends on action [by] individuals, companies, communities and national government .. to tackle wider threats to health‘ [Clause 2.3) and ‘Action by the NHS is a complement to, but cannot be a substitute for, the important role for local government.’ (Clause 2.4).
Nevertheless, it is disappointing that the Plan does not make the case for housing action that would reduce NHS demand, given that poor housing costs the NHS £1.4b pa, with cold homes’ impacts and falls risks accounting for the majority of this expenditure.
Pneumonia and Cold Homes
The Plan states that pneumonia places a major burden on the NHS, with acute pneumonia admissions rising by 35% since 2013, disproportionately affecting older people, but it makes no reference to the impact of people living in cold homes or related housing solutions.
Clause 3.87: Community-acquired pneumonia is a leading cause of admission to hospital, despite being avoidable in many cases. Pneumonia also disproportionally affects older people, with incidence doubling for those aged 85-95 compared with 65-69. For every degree drop in temperature below five degrees Celsius, there is a 10.5% increase in primary care respiratory consultations and a 0.8% increase in respiratory admissions.
Falls Prevention at Home
The Plan notes that 30% of people aged 65 and over, and 50% of those aged 80 and over, are likely to fall at least once a year. However, it only cites behaviour based interventions as a solution, even though the falls prevention Return on Investment (ROI) evidence is stronger for home adaptations than exercise initiatives.
Clause 1.17: Falls prevention schemes, including exercise classes and strength and balance training, can significantly reduce the likelihood of falls and are cost effective in reducing admissions to hospital.
During 2019 the Plan says that the NHS will set out specific, measurable goals for narrowing health inequalities, noting that ‘NHS England, working with PHE and our partners in the voluntary and community sector and local government, will develop and publish a ‘menu’ of evidence-based interventions that … would contribute to [reducing health inequalities]’ (Clause 2.26).
It will be important in the coming months to set out the case for housing interventions that would meet this goal. [January 2019]
Housing and Disabled People – Britain’s Hidden Crisis
The Equalities and Human Rights Commission has published its report ‘Housing and Disabled People – Britain’s Hidden Crisis’.
This report reveals the findings of an 18 month-long Inquiry, detailing a wide range of recommendations, and calling on UK governments to take urgent action to make homes adaptable and accessible to everyone.
With regard to home adaptations – the area where Care & Repair England and the Home Adaptations Consortium had the main input – the report is calling on local authorities to tackle delays within adaptations systems and ensure that low-cost, minor adaptations in particular can be installed quickly and easily. It is also recommending improved provision of independent information and advice about housing options, including adaptations.
Sue Adams has written a guest blog for the Commission’s website outlining the critical importance of disabled people having a home that is safe, secure and adapted to maximise independence, dignity and quality of life.
The Commission has also published linked infographics and two related films featuring disabled people describing their experiences of home adaptations and offering their tips on how they manage adaptations in their home. #HiddenHousingCrisis [May 2018]
Select Committee Inquiry into older people’s housing publishes findings
The Communities and Local Government (CLG) Select Committee Inquiry into Older People’s Housing has concluded that a national strategy for older people’s housing is needed to bring together and improve policy in this area.
The CLG Committee’s report on Housing for Older People recommends that the wider availability of housing advice and information should be central to the strategy and the existing FirstStop Advice Service should be re-funded by the Government to provide an expanded national telephone advice service.
The Committee’s recommendations also include:
- Additional funding for Home Improvement Agencies operating services including a handyperson service for older people.
- A range of measures to help older people overcome the barriers to moving home.
- Ensuring that national and local planning policy encourages the building of more of all types of housing for older people – with older people involved in the design process and amending the National Planning Policy Framework.
- Building all new homes to accessible and adaptable standards so that they are ‘age proofed’ and can meet the current and future needs of older people.
In particular the Committee is calling on the Government to recognise the link between homes and health and social care in the forthcoming Adult Social Care Green Paper*
Care & Repair England, who gave written and verbal evidence to the Committee, strongly endorses these conclusions and recommendations and hopes that they will be taken on board by the Government.
* The Communities and Local Government and Health Committees have launched a joint inquiry on the long-term funding and provision of adult social care to feed in to the Government’s forthcoming Green Paper. The deadline for submission of evidence is 7th March 2018. [February 2018]
SUSTAINABILITY AND TRANSFORMATION OF NHS – HOUSING AND AGEING MISSING LINKS
Most plans for the future of the NHS make hardly any reference to population ageing or the role of housing in prevention.
A newly published survey by Care & Repair England reveals that the majority of Sustainability and Transformation Plans (STPs) include very few references to older people, even though they are the majority users of the NHS, nor do they identify housing as a potential contributor to NHS transformation.
STPs are required to address how local partners will meet key national commitments set out in the NHS Five Year Forward View, including greater investment in primary care and focusing more on prevention. NHS services are meant to shift away from hospitals, delivering more health care at or closer to home and reducing lengths of stay when hospital care is essential.
The Briefing argues that small, practical housing interventions can play a critical role in this transformation, particularly with regard to older patients, the vast majority of whom live in mainstream housing. [July 2017]
2017-19 BETTER CARE FUND GUIDANCE PUBLISHED
The official Better Care Fund guidance – Integration and BCF planning requirements for 2017-19 – has now been published.
The document sets out the detailed requirements for BCF plans, based on the 2017-19 Integration and BCF policy framework (publ. 31st March 2017).
NHS England, the Department of Health (DH) and Department for Communities and Local Government (DCLG) have published the guidance (available on the NHS England and GOV.UK websites) amidst considerable controversy.
At the heart of the disagreement is the addition of conditions related to use of the extra £2 billion for local councils’ adult social care, announced in Spring 17 budget, which must now be prioritised for use to reduce delayed discharges from hospital.
The guidance includes more details about use of Disabled Facilities Grant (DFG) – Clauses 30-34, to note in particular:
- All areas are required to set out in their plans how the DFG funding will be used over the two years….
the scope for how DFG funding can be used has been widened ………
- This discretionary use of the funding can help improve delivery and reduce the bureaucracy involved in the DFG application process, helping to speed up the process. For example, LAs could use an alternative means test, increase the maximum grant amount, or offer a service which rapidly deals with inaccessible housing and the need for quick discharge of people from hospital. The Care Act also requires LAs to establish and maintain an information and advice service in their area. The BCF plan should consider the contribution that can be made by the housing authority and local Home Improvement Agency to the provision of information and advice, particularly around housing issues. [July 2017]
WOMEN AND EQUALITIES COMMITTEE REPORT ON DISABILITY AND THE BUILT ENVIRONMENT
The Women and Equalities Committee calls for the Government to lead the charge in improving access and inclusion in the built environment. It’s report published in April 2017 Building for Equality: Disability and the Built Environment.
Strategic leadership: The Government has a range of levers that can be used to achieve more accessible built environments, but is not using them well enough. Greater co-ordination and leadership is needed to make this framework effective, and to make it clear that inclusive design is a statutory requirement, not just a ‘nice to do’.
Designing for equality: The Government should make it easier for local planning authorities to follow this lead through revision and clarification of national planning policy and guidance. Local plans should not be found sound without evidence that they address access for disabled people in terms of housing, public spaces and the wider built environment; to support this, the Equality and Human Rights Commission should investigate the Planning Inspectorate’s compliance with the Equality Act. Planning consent should only be given where there is evidence that a proposal makes sufficient provision for accessibility.
Housing: More ambition is needed in the standards the Government sets for the homes that the country desperately needs. Housing standards need to be future-proofed and to produce meaningful choice in housing, not just to respond to immediate local need. The Government should raise the mandatory minimum to Category 2, the equivalent of the former Lifetime Homes standard, and apply it to all new homes – including the conversion of buildings such as warehouses or former mills into homes.
Public buildings and places: Much more can be done to make the public realm and public buildings more accessible: through building accessible workplaces, and incentivising employers to improve existing ones; by updating the regulations for new buildings and amending the Licensing Act 2003. Greater provision of Changing Places toilets should be a specific priority: such facilities should be required in all large building developments that are open to the public.
Shared Spaces: Shared spaces schemes are a source of concern to many disabled people across the country, particularly features such as the removal of controlled crossings and kerbs and inconsistency in the design of schemes from place to place. The report recommends that the Government halt the use in such schemes pending the urgent replacement of the 2011 guidance on shared spaces, ensure that the new guidance is developed with the involvement of disabled people – and that it is followed in practice [May 2017]
LOCAL COUNCILS’ INCREASED DFG ALLOCATIONS ANNOUNCED
The increased funding allocations specifically for Disabled Facilities Grants (DFG) in 2017-18 have been announced (total £431million compared with £394m in 2016-17 c.10% rise).
The Department for Communities and Local Government (DCLG) has written (click here) to every local authority (County, Unitary, Borough and District) informing them in a DFG Grant Determination letter of the amount of DFG payment to each Better Care Fund and how much is included for every individual local housing authority.
The letter to all LA Chief Executives is strongly worded and highlights that;
‘…the DFG Grant Determination Letter now contains a condition which stipulates upper tier authorities in two tier areas must pass the DFG funding down in full to their lower tiers no later than 30th June 2017.’
The total amount of DFG funding allocated may only not be passed on in full where there is the expressed agreement of the second tier authority that the money may be used for other social care capital projects.
Both letters reiterate the key DFG clauses in the recently published 2017-19 Integration and Better Care Fund Policy Framework, noting that further details about DFG will be provided in a forthcoming Better Care Fund Planning Requirements. [April 2017]
2017-19 BETTER CARE FUND POLICY FRAMEWORK PUBLISHED
The long awaited 2017-19 Integration and Better Care Fund Policy Framework has been published by Dept of Health and DCLG.
This new Framework determines the use of BCF monies for the remaining two years of the Fund (2017-18 and 2018-19).
The Framework includes details about payment of extra money for social care announced in the recent Spring Budget.
National funding for Disabled Facilities Grant (DFG) increases as expected (£431m in 2017-18 & £468m in 2018-19 compared with £394m in 2016-17).
Counties are again being encouraged to pass on the full amount of DFG grant to housing authorities, but there is strong encouragement* to work with health and social care to innovate and integrate adaptations delivery.
Further details about the DFG and BCF are still to be finalised and a Grant Determination letter from DCLG to Local Authorities will be sent out in April.
The associated BCF technical guidance will be published at a later date.
The Framework was published on the same day that the Communities and Local Government Select Committee has published the findings of its Inquiry into Adult Social Care, which is critical of DFG delivery and calls for a fundamental review of provision.
Also on the same day NHS England launched its proposals for health service reforms – Next steps on the NHS Five Year Forward View. Disappointingly, whilst citing the importance of integration, this document does not refer to housing in that mix, only health and care.
*National Condition 1: Plans to be jointly agreed (p28 extracts re DFG)
…….. decisions around the use of the DFG funding will need to be made with the direct involvement of both tiers working jointly to support integration ambitions……………. meet local needs for aids and adaptations, whilst also considering how adaptation delivery systems can help meet wider objectives around integration……….. [March 2017]
HOUSING WHITE PAPER INCLUDES SECTION ABOUT OLDER PEOPLE
The Government launched its Housing White Paper, ‘Fixing our broken housing market’, on 7th February 2017. Whilst primarily focussing on building new homes for new households, it does include a short section specifically about older people (‘Housing for our future population‘, page 63- see note below).
This inclusion is an improvement on the previous Housing Strategy and, whilst it will not go far enough for many people in the housing and ageing fields, it does at least offer the possibility of future action as a result of responses to the consultation.
The White Paper sets out a series of questions, including some concerning housing and ageing.
The deadline for responses to the Consultation is the 2nd May 2017.
Housing White Paper – extracts re Housing & Ageing
Clause 4.42……To ensure that there is more consistent delivery of accessible housing, the Government is introducing a new statutory duty through the Neighbourhood Planning Bill on the Secretary of State to produce guidance for local planning authorities on how their local development documents should meet the housing needs of older and disabled people……. It will also set a clear expectation that all planning authorities should set policies using the Optional Building Regulations to bring forward an adequate supply of accessible housing….
Clause 4.43 comments on the issues around helping older people to move home and in 4.44 says ‘The Government is committed to exploring these issues further and finding sustainable solutions…., including… conversation [to]… generate a range of ideas for incentives and other innovations for the Government to consider: improved information and advice for older people about housing choices, including advice on adaptations; supporting custom build for older people; looking at how community living could work; as well as innovative models of housing with support available. These will sit alongside the Government commitments to fund and develop supported housing, including sheltered, step down and extra care housing……..
With regard to Supported Housing and the application of Local Housing Allowance, Clause 4.48 says ….The detailed arrangements for implementing the new model and approach to short term accommodation will be set out in a subsequent Green Paper which we will publish this Spring. [Feb 2017]
LOCAL GOVERNMENT ASSOCIATION’S HOUSING COMMISSION FINAL REPORT Local Government Association (LGA) has published its Housing Commission’s final report, Building our Homes, Communities and Future, setting out findings, conclusions and recommendations.
The Housing Commission* was tasked with setting out a forward-looking vision for the future of housing and the relationship between councils and communities around four topic headings;
- House building
- Place shaping, community and infrastructure
- Employment, welfare reform and social mobility
- Housing, health and quality of life for an ageing population
With regard to the latter section, it calls for housing to be ‘at the heart of integrated health and care’ and makes seven related recommendations including;
25. Ensure sufficiently funded systems are in place to enable older people to modify their homes to support prevention and positive ageing in ways that generate savings to health and care services.
26. Plan and deliver housing as part of emerging integrated health and social care services, with activities and facilities designed to support older people to age well in their homes and communities for longer.
29. Age Friendly neighbourhood principles should be built into planning policies, integrating All Age Friendly housing as part of healthy, inclusive mixed tenure housing developments.
In 2017 a series of projects will commence to support and spread related innovation across local government.
*Sue Adams, CEO of Care & Repair England, was one of the expert advisers to the Commission on the housing, ageing & health section.
THE CARE ACT 2014, GUIDANCE AND REGULATIONS The Care Act 2014 will radically transform the provision of adult social care. It is ‘wipe clean’ legislation ie previous adult social care law was repealed. The new law comes into force from April 2015. The Care & Support Statutory Guidance and associated Regulations tell local authorities how they have to implement the new law. Weblink to Guidance and Regulations: http://www.gov.uk/government/news/final-care-act-guidance-published. Before & during the passage of the Care Bill, and in subsequent negotiations & consultations about content of the Statutory Guidance, housing organisations including Care & Repair England, made the case for the specific inclusion of housing. A Briefing from Care & Repair England which analyses the references to housing in the Guidance is available here
ADAPTATIONS & DISABLED FACILITIES GRANTS Home Adaptations for Disabled People – A detailed guide to related legislation, guidance and good practice This is the most up to date, comprehensive guide to law and practice and is based on the Dept for Local Government’s revised (but unpublished) revised guidance. It provides local authorities and those charged with service planning and provision with clear and comprehensive information about the legal position concerning home adaptations and specifically Disabled Facilities Grant (DFG) alongside examples and ideas for service delivery. Published by the Home Adaptation Consortium in 2013. Download here
Home Adaptations Consortium blog http://homeadaptationsconsortium.wordpress.com/ includes information on the consortium’s role and membership plus links to reports and websites of interest to people concerned about quality provision of home adaptations for disabled people in England.
KEY PAST EVIDENCE/POLICY DOCUMENTS
Better outcomes, lower costs – Implications for health and social care budgets of investment in housing adaptations, improvements and equipment: a review of the evidence. Click here for report.
Lifetime Homes, Lifetime Neighbourhoods – A National Strategy for Housing in an Ageing Society. Click here for report.