Disabled Facilities Grant and other adaptations: external review
An independent review of the Disabled Facilities Grant in England, commissioned by DHSC and MHCLG and written by the University of the West of England, Foundations, the Building Research Establishment and Ferret Information System was published this morning.
Housing important in Government Survey of Older People
After health and finance, older people identify housing as the third most pressing issue to address with regard to population ageing.
In a large scale survey of older people carried out for the government by Saga, 52% of respondents said that designing housing and communities to meet the needs of multiple generations was one of the main societal issues that arise from people living longer (the third most important issue after health and finance).
Home repairs expenditure was reported as the main use of disposable income after holidays.
The survey was undertaken in connection with the Ageing Society Grand Challenge. [November 2018]
Planning ahead: Influencing local planning on housing ageing
The Older People’s Housing Champions Group, working in partnership with Care & Repair England has published Planning ahead: Influencing local planning on housing and ageing,
This new guide provides an overview of the planning system and potential opportunities to influence the homes and neighbourhoods being planned and built, particularly regarding making good inclusive places to live as people get older. It also contains a practical example of how High Peak Access Group influenced the Local Plan
It is aimed at local older people’s groups and forums and draws on the experience of members of the older people’s housing champions network and on a session held earlier this year with Katy Lock, projects and policy manager, from the Town and Country Planning Association. [November 2018]
Autumn 18 Budget includes extra £55 million for adaptations
In the Autumn Budget the Chancellor announced an extra £55 million (Clause 5.17) for local authorities to spend on home adaptations in this financial year (18-19).
This is addition to the £468 million already paid to LAs for Disabled Facilities Grants (DFG) in 2018-19.
The mechanism for paying the extra capital grant to individual councils is still to be announced*.
This boost to local adaptation budgets comes soon after Dept of Health and Social Care announced an extra £240 million for adult social care to help ease pressure on the NHS this winter, specifically mentioning help with home adaptations as one of three potential areas for use of the additional funding.
For ideas on how to innovate and make best use of the extra money, see this recent report, from the Centre for Ageing Better, Adapting for ageing: Good practice and innovation in home adaptations.
* The November 2017 Budget included an additional £42 million for DFG. This was subsequently paid directly to all housing authorities (i.e. not via the BCF, which in two tier areas requires distribution by Counties to Districts). [October 2018]
Extra social care winter funds – but Committee calls for 10 year plan
The individual council allocations from the £240m additional winter funding for adult social care have been announced, ranging from over £6m (Kent) to £12,662 (Isles of Scilly).
Once again, the Government announcement highlights home adaptations as one of the three areas for potential use of the additional funds (the others being home care and reablement).
Two days after the allocations were announced, the Public Accounts Committee published a critical report about integration of health and care, citing the squeeze on council funding as a block to progress on health and care integration.
It concludes that ‘the Government still lacks an effective overall strategy or plan to achieve its… aim to integrate sectors‘ and calls for a ‘costed 10-year plan for social care to go with its 10-year plan for the NHS‘. [October 2018]
The hidden costs of poor housing in the North
Poor housing occupied by people with long term health problems or disability, particularly older home-owners, is a major and growing problem in the North of England and requires urgent government action.
This is the headline conclusion of a new report, The hidden costs of poor quality housing in the North published by the Northern Housing Consortium https://www.northern-consortium.org.uk/
In the North there are nearly 1 million owner-occupied homes and 354,000 private rented homes which now fail to meet the decent homes standard, and the problem of disrepair is a particularly urgent concern for many older homeowners.
Nearly half of all non-decent homes in the North have at least one occupant with a long term illness or disability – well above the England average.
The report calls for a new Decent Private Homes grants programme, arguing that there is strong evidence that intervention costs would be offset against reduced care and health expenditure. [October 2018]
Home Adaptations: New report reveals local innovation and good practice
Adapting for Ageing, published by the Centre for Ageing Better, highlights local innovation and good practice in delivery of home adaptations for older people by pioneers across England.
The report, researched and written by Care & Repair England, describes a range of innovative approaches to enable councils, commissioners, home improvement agencies and social housing providers to learn from the good practice it has uncovered. This ranges from proactively raising awareness of adaptations and fast track initiatives to linking adaptation installation with vital home repairs and handyperson help.
It describes what a ‘good’ service looks like from the perspective of older people, providing a breakdown of key factors against which local areas can review their own services.
By delivering home adaptations in the best ways possible councils can enable older people to keep living safely and well in their own homes for longer, reducing pressure on health and care services, as well as improving older people’s lives. [October 2018]
Dunhill Medical Trust – £200k for adaptations research
The Dunhill Medical Trust have opened a call for research proposals that examine the impact of adaptations to older people’s homes, particularly in terms of health and return on investment.
The Centre for Ageing Better’s international evidence review concerning home adaptations and healthy later life identified a lack of rigorous academic studies in this field.
The Dunhill Medical Trust actively seeks to fund important but underfunded topics and so has made £200,000 available to help to fill this adaptations evidence gap.
Full details about how to apply are available here
Deadline for applications is 17.00 on Friday 9th November 2018. [September 2018]
Developing the Long Term Plan for the NHS
NHS England is asking for comments, ideas and insights on developing the NHS plan and has produced a discussion guide, click here
In the light of the new health Minister’s view that prevention is one of the top three priorities for the NHS you might wish to comment on the important role of housing, particularly issues of house condition and adaptation
You can submit your response to this web portal here
The deadline for submissions is 30th September 2018 [September 2018]
Housing action by older people’s groups in Hull and the Wirral
We are pleased to draw your attention to the work being undertaken in the Wirral and Hull by older people’s networks on housing issues.*
These two reports sit alongside the work of the Older People’s Housing Champions Group on developing their Ideas for Action* guides working with local older people’s groups and organisations across England.
These guides offer practical ideas for older people’s groups, forums and organisations who want to influence local housing policy, plans and action. In Hull and Wirral older people have come together to influence housing policy and plans locally and have been written up to share ideas with others.
All the reports and guides can be accessed here.
These reports also highlight pioneering ways to engage with older people whose voices are less often heard.
If you are taking any local action on housing and ageing, we would love to hear from you. [August 2018]
* We are very grateful to the Esmèe Fairbairn Foundation for making this work possible
Handyperson services: New evidence of cost benefits
A new report from Care & Repair England concludes that handyperson services offer a high rate of return on investment, as well as wider social benefits, and are highly prized by older people, particularly ‘older old’ single women living alone.
Small but Significant: The impact and cost benefits of handyperson services – clearly shows how these low cost schemes, which carry out small repairs and minor adaptations for older people (primarily delivered by not for profit Care and Repair and other home improvement agencies), result in fiscal and social gains to the NHS and Social Care.
The report includes a detailed evaluation of the Preston Care and Repair Handyperson Service, identifying a high level of use of the service by ‘older old’ (80yrs+) people and more vulnerable groups, particularly the rising number of older single women living alone, often with chronic long term health conditions, reduced mobility and sight loss.
Handyperson services provide older people with great relief from worry about their home, resulting in them feeling more independent and in control:
- 96% of older people said that the Preston Care & Repair handyperson service made them less worried about their home
- 100% would recommend the service to others
Relevant to policy makers, service planners, commissioners and providers, Small but Significant shows how handyperson services can play a critical role in the integration and prevention agendas.
A short summary brochure is also available here. [July 2018]
Ideas for action guides: practical ideas to influence local housing policy, plans and action
The Older People’s Housing Champions Group, in partnership with Care & Repair England and local organisations from different parts of England, has published a series of Ideas for Action guides.
These Ideas for Action guides, plus a linked ‘Housing Voices‘ film, resource pack and report from the Elders Council of Newcastle working with Skimstone Arts and Northumbria University, offer practical ideas for older people’s groups, forums and organisations who want to influence local housing policy, plans and action.
They highlight pioneering ways to engage with older people whose voices are less often heard.
We are very grateful to the Esmèe Fairbairn Foundation for making this work possible.
The guides, film and resources can all be accessed here [July 2018]
£6m funding for Welsh Care & Repair agencies
The Welsh Government has announced £6m grant funding for Care & Repair agencies to support vulnerable older people to live independently at home.
There are 13 Care & Repair agencies in Wales covering every local authority area.
Last year Welsh Care & Repair agencies helped more than 40,000 older people, carried out over £11.5m of repairs, 17,000 small adaptations, and helped more than 22,000 with safety and falls-prevention work.
Care & Repair Cymru was also in the news on 31st May as part of an extended feature about pensioner poverty on Radio 4’s Today programme [June 2018]
Thinking Ahead: housing and related care options in later life – a new guide for carers
Working in partnership with Carers UK and our Silverlinks project we have published a guide for carers on the housing and related care options for older people in later life.
The guide covers:
- Help with making appropriate housing choices together
- What help is available if you decide it is best for the person you care for to stay at home including:
- What can help to support people to live independently
- How to make the home safe and healthy
- Living at home with a long-term condition
- What help is available if a move is the option agreed
- What to think about in moving in together
- Where to get the further help and advice you need
Carers UK is the national membership charity for the 6.5m carers in the UK. It provides expert advice and information, campaigns for greater recognition for carers and helps other organisations do more for carers.
You can find further information and advice on the financial and practical matters related to caring here [May 2018]
Half a £billion for DFGs paid to all Local Authorities
On 16th May 2018, the Ministry of Housing, Communities and Local Government wrote to all local authorities informing them of the payment of their DFG Capital Grant amount click here.
The total payment from national government to local authorities for DFG in 2018-19 is £468,000,000.
In the strongly worded Annex top tier authorities are told to pass on the specified amount of DFG money to lower tier housing authorities by the end of June. [May 2018]
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]
Half of all poor households are home owners – JRF new report
This report examines the relationship between home-ownership and poverty for all age groups. One of its conclusions is that ‘the poor housing conditions among home-owners in poverty, particularly older outright owners, need greater attention. Fixing homes that are cold, dangerous or in poor repair should enable older people to stay in their homes for longer, and avoid homes becoming a potential cause of ill-health’. [April 2018]
Delivering Healthy Housing
This new report from the University of Birmingham, written by The Academic- Practitioner Partnership, makes the case that too little emphasis is placed on poor standards of housing and failures to make best use of the existing stock. Delivering Healthy Housing examines what can be done to improve conditions for people living in unsatisfactory housing that damages their health, wellbeing and life chances. It notes that:
‘Significant numbers of owner occupiers live in older properties that present risks to their health and wellbeing. Some older owners in these properties do not have the financial or other resources to address problems and they need support. Increased funding for home improvement agencies and other policies targeted on this group would represent effective use of resources to address health as well as housing issues’. [April 2018]
Government and national organisations sign up to improving health and care through the home
Over 25 stakeholders have signed up to a renewed commitment to taking joint action to improving health through the home.
A revised version of the document ‘Improving Health and Care through the Home: A National Memorandum of Understanding’ (MoU) has been published.
A wide range of Departments and organisations operating across the health, social care and housing sectors have signed up to the MoU. These include the Department of Health and Social Care, the Ministry of Housing, Communities and Local Government, NHS England, the Local Government Associaton, ADASS, Public Health England and more than 20 other national housing, health and care organisations, including Care & Repair England.
The MoU sets out:
- A shared commitment to joint action across government, health, social care and housing sectors in England
- Principles for joint working for better health and wellbeing outcomes, and to reduce health inequalities
- A framework for national and local cross-sector partnerships to provide healthy homes, communities and neighbourhoods
- Conditions for developing integrated and effective services to meet the needs of individuals, carers and families with a range of local stakeholders
- A view of what shared success might look like [March 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]
New English Housing Survey reveals rise in non-decent owner occupied homes
For the first time in more than a decade the number of non-decent homes in the owner occupied sector has increased, rising from 2,694,000 in 2015 to 2,912,000 in 2016 – 19.7% of sector stock.
The latest English Housing Survey Headline report (2016-17) highlights the higher percentage of non-decent homes in the private rented sector (26.8%), even though the actual numbers are much lower than the owner occupied sector and are continuing to decrease (1,301,000 private rented non-decent homes in 2016, down from 1,350,000 in 2015).
Social rented homes are still by far the least likely to be non-decent in both percentage and actual numbers (12.6% of sector stock, 511,000 in 2016 vs 525,000 in 2015).
This finding about the owner occupied sector is not mentioned in the headline report, and is only evident if you search the tables, specifically Annex Table 2.2: Non-decent homes by tenure 2006-2016.
The survey table 1.4 shows that 78% of older households (65 or over) are owner occupied (16% social rental, 6% private rental).
As our previous report demonstrated (Off the Radar), the majority of those living in non-decent owner occupied homes are older people. [January 2018]
Future funding of Adult Social Care – Parliamentary Inquiry Launched
The Communities and Local Government and Health Select 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 Government has confirmed its intention to present a Green Paper containing proposals to reform care and support for older people before the summer recess.
The inquiry seeks to identify funding reforms that will command broad consensus to allow progress in ensuring the long-term sustainability of both the health and care systems.
There is significant interest within government about the role of housing, and home adaptations in particular, in the context of adult social care reform.
The deadline for written submissions is 7th March 2018 [January 2018]
Extra £42m for DFG paid out to Local Authorities
The additional £42m capital grant for home adaptations (announced in the 2017 Autumn Statement) has now been paid out *directly to Local Housing Authorities.
Yesterday the Ministry of Housing, Communities and Local Government published a statement to this effect, noting that the council receiving the biggest share is Birmingham, paid £1,007,785.
At the time of the original announcement some local authorities expressed concern about their capacity to complete works and spend the capital in the current financial year.
However, many areas have been working to streamline systems, including creating fast track arrangements, or reviewing the scope for carrying forward other funds into 2018-2019 and using this additional money first.
*DFG main funding is paid via the Better Care Fund [January 2018]
Department of Health commission review of Disabled Facilities Grant
On 13th December 2017 the Department of Health announced that it is commissioning a review of the Disabled Facilities Grant.
The review will:
(i) provide an assessment of how the DFG is currently being used, and
(ii) make evidence-based recommendations on how the DFG could function in the future
The review will cover specific details, such as the means test, maximum grant limit, how the DFG might need to adjust to the changing aids and adaptations market eg. adoption of new innovations and technology.
The broader findings of the review will also feed into discussions about the role of housing in health and social care.
Bids are invited for up to £50,000 (excl. VAT)
Closing date for bids is 10th January 2018. Notification of the successful bid is expected in late January 2018, with the aim of the work completing in April 2018.
Further details can be found at: here [December 2017]
[In order to view the full information, you will need to be registered on Bravo.]
Healthy Independent Ageing – the Pivotal Role of the Home
At a high profile event held at the House of Lords on 12th December, Care & Repair England launched its new brochure, ‘Homes fit for ageing’ This document succinctly sets out the case as to why ageing well at home is key to health, housing and care policies (paper copies are available).
The reception was addressed by Professor Chris Whitty, the government’s (interim) Chief Scientific Adviser, who provided a fresh, data and evidence based perspective on the subject.
A snapshot of the event in pictures
Older people preparing their homes for staying put
Older people are the most satisfied with their current home, are the age group least likely to want to move, and the most likely to have adapted their home, according to a recent survey.
The survey, carried out by BMG Research click here with Care & Repair England, found that 82% of those 55yrs and over said that they were satisfied or very satisfied with their current home and 78% wanted to continue to live there as they got older.
Just under a quarter (23%) of those aged 55+ have already had adaptations made to their homes and a further 23% said that they expected to have to carry out adaptations at some stage. The likelihood of already having an adaptation increases with age: 17% of those aged 55 to 64yrs have had a home adaptation rising to 32% of those aged 75yrs+.
43% of over 55s say that they cannot afford home adaptations, and 23% don’t adapt because they don’t know what adaptations might be possible or best for them.
When they need information about home adaptations, a fifth (20%) of older people would go to the council first. Asking friends/ family is the least likely route, with just 8% of respondents saying this would be their first step.
The full results of the survey are available online with interactive graphics. click here [December 2017]
Home adaptations – search for local innovation and good practice
Care & Repair England is looking for local areas which are delivering home adaptations and organising services in the most innovative and effective ways for older people.
This ‘call for practice’ is being undertaken in partnership with the Centre for Ageing Better as a follow on from the publication of their international evidence review click here.
The aim to identify high quality and innovative practice in the provision of home adaptations, specifically focussing on what works well from the perspective of older people.
It will gather and share practical evidence and examples of how local areas can organise services most effectively for older people, drawing on the findings of the evidence review about factors that are important (eg. speed of delivery, tailored adaptations based on what the person prioritises etc).
The resulting report will focus on the elements of ‘what good looks like’ with short illustrative local examples. It will complement other areas of work which describe systems and whole delivery models.
To tell us about your local adaptations good news story click here [November 2017]
Extra £42m for home adaptations announced
The November 2017 Budget includes an additional £42 million for Disabled Facilities Grants in 2017-18, increasing the total budget for this year to £473 million.
Home adaptations play a key role in enabling older and disabled people of all ages to live independently and safely their own homes. As well as their positive impact on people’s quality of life, adaptations can also save money for the NHS and social care, helping to prevent accidents such as falls and reducing risk of injury to carers.
The majority of Disabled Facilities Grants are £5,000 or under, with adaptations that enable people to use their bathroom the most commonly grant aided works, followed by stairlifts. [November 2017]
New case studies that integrate health, care and housing to support older people at home
With support from the Quality of Life Charitable Trust, Care & Repair England has published case studies identifying work that prevents hospital admission and delayed transfers of care, reduces the risk of admission to residential care and extends independent living and wellbeing for older people at home and their carers.
The case studies are:
- Age UK Nottingham & Nottinghamshire Silverlink’s housing options information and advice service in GP services and hospitals
- Age UK Warwickshire Housing Advice and Information Service, working with local GPs
- Homewise Memory Matters support for people with dementia at home
- West of England Care & Repair reducing delayed transfer of care through housing interventions
Further case studies are in development.
See our health and housing pages for further information [October 2017]
Housing our ageing population – learning from councils meeting the housing need for our ageing population: a new report from the Local Government Association (LGA)
This report identifies the urgent need to better provide a range of housing options to meet the wide variety of housing circumstances, aspirations and needs of our ageing population.
It follows from the report from the LGA Housing Commission published in Dec 2016 (Sue Adams our Chief Exec was one of the two experts on housing, health and ageing on this Commission.)
The report sets out a series of case studies which demonstrates how councils are innovating to support older people to live in their own homes for longer, shaping change from building new homes to supporting people to stay in their own homes for longer.
The case studies include developing long term housing and age friendly strategies encompassing the whole range of housing options (Newcastle) to supporting home improvement services (across North Somerset, Bristol, Bath and NE Somerset) to offer a range of services for older people in mainstream homes.
It also makes the case for new housing options with new models being developed (Essex, Birmingham and Central Beds and Worcestershire) and focuses on solidifying links between housing and health (Mansfield).
It concludes with a series of themes and lessons from the case studies. [September 2017]
New self-help guides on Making your home a better place to live with a long-term condition
Care & Repair England, working with Silverlinks, has just updated its range of self-help guides for older people with long term conditions and their carers on making their home a better place to live.
There are six guides covering respiratory, macular and heart disease, dementia, stroke and arthritis; and a general online guide for people with long term conditions.
Each guide advises on what people can do to their home to make living with long term conditions more manageable. They look at areas such as: –
- design and layout
- lighting and heating
- safety, security and technology
- gadgets and equipment
- going out and about
The aim is to make 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 information, advice and help.
You can access the guides on Silverlink’s Information for Older People page. [September 2017]
A chance to respond to the APPG Green Paper on healthy homes and buildings
The All Party Parliamentary group on Healthy homes and Buildings has produced its Green Paper on Building our Future: Laying the Foundations for Healthy Homes and Buildings and asks for views on its recommendations by 30 September 17. Click here
The report highlights the health and cost benefits of delivering homes and buildings that are healthy, comfortable and energy efficient too, setting down a number of areas where changes could be made to deliver healthy homes and buildings.
In conclusion it identifies a number of tangible actions which the APPG can focus on to begin with:
- Work with Government to establish a cross departmental committee for health and buildings to champion change in the sector, recognising the interaction between buildings, health, education and the economy
- Begin building the research and evidence, starting with a focus on housing and schools, to develop a clear case for further government action on standards for new buildings
- Make housing (including renovation) an infrastructure priority and develop plans for retrofitting the current housing stock that take a holistic approach to maximising health and wellbeing
For those concerned with policies to improve homes and buildings, including the development of a much greater evidence base on the impact of housing on health and wellbeing do send a response to: firstname.lastname@example.org [September 2017]
Improving Health through the Home
Public Health England has produced a range of resources which consider the impact of the home environment on people’s health and wellbeing. This includes new infographics intended for use locally to inform conversations between sectors and professionals about the scale and nature of the home and health relationship.
PHE identify the risks to an individual’s physical and mental health associated with living in:
- a cold, damp, or otherwise hazardous home (an unhealthy home)
- a home that doesn’t meet the household’s needs due to risks such as being overcrowded or inaccessible to a disabled or older person (an unsuitable home)
- a home that does not provide a sense of safety and security including precarious living circumstances and/or homelessness (an unstable home).
The resources include:
- Details of the Memorandum of Understanding, first published in 2014, which sets out the shared commitment to joint action across government, and the health, social care and housing sectors on improving health through the home
- A checklist for reviewing local plans to make sure they consider home and housing circumstances, and their effect on health
- Sources of intelligence and evidence, alongside guidance to support the use of this in planning and decision making and
- New infographics covering:
- a home in which to start and develop well
- a home in which to live and work well
- a home in which to age well
Given the need to influence health plans on the importance of housing, including Sustainability and Transformation Plans (STPs) which our research shows make hardly any reference to the role of housing in prevention, these resources are timely and welcome. [August 2017]
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]
Small but Significant – Innovation, Impact and Evidence: Practical housing interventions to improve older people’s health and wellbeing
In July 2017 Care & Repair England with the support of the British Society of Gerontology (BSG) and the University of Manchester’s Institute for Collaborative Research on Ageing (MICRA), held a national conference in Manchester that examined the evidence, cutting edge practice and related policy in the field of increasing safe independence at home for older people through practical housing interventions, such as handyperson services.
The day highlighted innovation and opportunities in the gathering of evidence and the provision of practical housing services for older people.
The links between prevention of health and care need and housing interventions was explored, particularly reducing hospital admissions and extending safe independent living at home, alongside the key role of evidence and the emerging policy landscape.
There was a fantastic line up of contributors, including Department of Health, Centre for Ageing Better, The British Society of Gerontology, Manchester Institute for Collaborative Research on Ageing and University of the West of England, alongside innovative commissioners, local authorities and service providers.
- Poverty and disadvantage in later life – Professor Debora Price, Manchester Institute for Collaborative Research on Ageing & President of the British Society of Gerontology.
- What the health sector wants from handyperson services – Tom Luckraft, NHS England
- The importance of practical housing help in later life– Dr Rachael Docking, Centre for Ageing Better
- The impact of housing modifications – emerging findings from the evidence review – Sheila Mackintosh, University of West of England
- Small but Significant – evaluating Preston Care & Repair’s handyperson services – Sue Adams, Care & Repair England and Laura Holmes, Preston Care & Repair
- Innovation in handyperson provision:
- Faster hospital discharge: West of England Care & Repair’s Dolphin scheme – Robin Means & Sheila Mackintosh
- St Helens Hospital Admission Avoidance Car Project – Lee Norman & Helen Williams, St Helens Council
- Integrated prevention: Lightbulb in Leicestershire – Quin Quinney, Blaby District Council
- The impact on older people of excess heat in the home – evidence and opportunity – Dr Alan Lewis, University of Manchester [July 2017]
£80m Life Chances Fund – Older People’s Services Call for Proposals
The Life Chances Fund (LCF) is an £80 million central government fund ‘to provide payment-by-results contracts for locally developed projects by socially minded investors’. Contracts must be locally commissioned and aim to tackle complex social problems.
The LCF has six themes and it has now issued a call on the last theme – Older people’s services.
The priority is for proposals that help maintain independent living, focusing on outcomes that support hospital discharge and reduce or delay long-term admissions to care homes.
The call says that they would ideally like to see proposals that put older people in the lead of designing the services they receive.
Housing adaptations, assistive technology and Telecare are specifically mentioned as examples of interventions that can enable older people to live more independently and stay in their own home, delaying admission to residential care.
Reducing injuries from falls are cited as an opportunity for Social Investment Bonds to be applied.
Living in poor housing conditions is included in the list of factors that can put older people at risk of developing a health condition or injuries.
Full details, including how to apply, are on this page.
The deadline for Expressions of Interest is 14th September 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 the Spring 2017 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]
Integration in Action: Evaluation of Age UK Warwickshire’s Housing Options Service
This evaluation report about provision of impartial information and advice about housing, care and related finance in later life, provides analysis of the benefits, including the cost benefits, of the service delivered to older people by Age UK Warwickshire.
The initiative is of particular relevance due to its activity at the interface of health, housing and care and the ways that the service operated as part of a pro-active GP Care Navigators initiative. This Care Navigators scheme, funded by CCGs, pro-actively contacted and visited all people over 75 yrs, particularly focussing on those with multiple long term health conditions / with indicators of high health need.
The housing options additional service was made possible through the EAC FirstStop national programme and the evaluation demonstrates the critical importance of including housing help as part of a holistic response, noting in particular the £8 payback for every £1 spent.
Full report available here [May 2017]
Ageing Well: A Housing Manifesto
The Older People’s Housing Champion’s network has produced its Housing Manifesto which includes ten recommendations that it considers are important for all working in housing, health and care to ensure that all older people have access to a decent home in later life. They are:
- Home adaptations assistance should be mandatory, delivered quickly, efficiently and be a core part of future integrated health, social care and housing systems.
- There should be nationwide provision of practical, affordable housing repair and adaptation services – including home improvement agencies and handyperson services for older people in all housing sectors.
- Small “healthy at home” grants or low cost loans for essential repairs and improvements (including heating systems) should be made available for disadvantaged older people, resulting in benefits both for individuals and society.
- Local authority house condition audits should be re-introduced alongside private sector housing renewal programmes to tackle disrepair and prevent existing housing stock decline.
- Build all ordinary housing for all ages – all new homes should be built to accessible standards and be suitable for further adaptation.
- Build more innovative mainstream housing of a design and size that is particularly suitable for later life.
- Build a wider range of specialist and supported housing for those with later life care and support needs.
- A national source of independent, specialist, housing, care and finance information, combined with impartial local one-to-one advice and support, is urgently needed for older people, their carers and professionals.
- A register of accessible, adaptable housing would help people locate suitable homes quickly when their needs change.
- Older people – experts through experience – need to be engaged and involved in developing and delivering housing strategies and solutions for later life at all levels locally and nationally.
See the manifesto at https://housingactionblog.files.wordpress.com/2017/05/housing-champions-housing-manifesto-final-20172.pdf and link to their blog at https://housingactionblog.wordpress.com/
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]
The March 2017 Budget in context of housing and ageing?
Against a backdrop of a £12b underspend in government finances, the budget was notable for the tax rises (particularly for self employed) and just a few areas of increased expenditure. Commentators from the local government, NHS and social care sectors had hoped for more, and with regard to housing, health and ageing, there was not a lot to write home about.
Social Care and the NHS
The headline news story about older people is the announcement that £2b will be made available for adult social care (ASC) – £1.2b in 2017-18, £800m in 2018-19 and £400m in 2019-20. The amount falls short of the funding that the LGA & ADASS have called for but this is a welcome move.
The additional funding is to enable ‘…councils [to] take immediate action to fund care packages for more people, support social care providers, and relieve pressure on the NHS locally’, and councils will be expected to work with the NHS to agree expenditure plans. ASC funds also meet the care costs of disabled adults (around a third of budgets are spent on younger people with learning disabilities) so this is not all money for older people’s services.
A green paper on the future of social care is promised [no publication date set].
There is to be new capital investment in the NHS (for A&E plus Sustainability and Transformation Plans) but there was no announcement of additional revenue funding for the NHS. Department of Health DR Budget to 2020 is 2016-17 £116.1b: 2017-18 £117.6b: 2018-19 £120.3b: 2019-20 £123.2b [Table 1.6].
There were no headline announcements about housing.
Local voluntary organisations who receive funding from local government should note the ongoing decrease in funding for local authorities from DCLG. Table 1.6 shows DR Budget of 2016-17 £8.2b: 2017-18 £6.5b: 2018-19 £5.5b: 2019-20 £5.4b. Whilst the financial situation becomes more complex (e.g. allowing LAs to increase council tax to raise funds specifically for social care, changes around business rates, changes to funding for education etc) this fall does not bode well for provision of any non-statutory functions (or even some statutory ones).
The government has confirmed that it is pressing ahead with existing plans for welfare reform – so no sign of any reversal of the planned changes that could impact on supported housing, or in the light of emerging evidence of the negative impacts of some reforms. Budget states that there are no plans to introduce further welfare savings in this Parliament beyond those already announced.
Pensions in the future
There is to be a statutory review of State Pension age. Government will publish results of the review in May 2017.
Further national government expenditure reductions
The government will deliver £3.5 billion of resource savings in 2019-20, supported by the Efficiency Review. The Chief Secretary to the Treasury, supported by the Minister for the Cabinet Office, is leading the Review, and has commissioned relevant Whitehall departments to consider options for reducing departmental spend in 2019-20. The government will report on progress on the Efficiency Review in Autumn 2017.
Full budget document is available here
Health & Housing – Connections being made?
There has been a (small) flurry of blogs and tweets about housing, health and ageing linked to DH, NHSE and the Kings Fund.
Along with other commentators, David Buck of the Kings Fund notes that the recent housing White Paper didn’t mention the critical connection of health and housing (with the exception of a reference to Healthy New Towns). He also highlights the absence of housing as a core theme in virtually every Sustainability and Transformation Plan (Nottingham and Nottinghamshire being the exception).
In an NHS England guest blog, Sam Haskell of Dept of Health, gives five reasons why health care staff should care about housing and health. He argues for a change of perspective so that rather than seeing housing and health as ‘ships that pass in the night’, they are considered as ‘boats in the same fleet’ and recommends use of the NHSE Health and Housing Quick Guide.
All welcome words indeed – and we hope they will prompt those making the funding and commissioning decisions to start to think differently when it comes to co- funding practical housing help. [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. [February 2017]
National Falls and Fracture Consensus Statement Published
The Falls and fracture consensus statement: Supporting commissioning for prevention has been published (25/1/17) setting out the recommended approach to falls & fracture prevention.
Produced by Public Health England with the National Falls Prevention Coordination Group* (NFPBG) member organisations, this important document outlines interventions and approaches that the group recommends to local commissioners and strategic leads with a remit for falls, bone health and healthy ageing in England.
Care & Repair England is an active member of the NFPBG and has contributed information and evidence with regard to the role of the home environment and falls prevention. There are sections on healthy homes and references to the role of housing in the document.
The document includes useful data and extensive references to evidence / key reports to underpin its recommendations.
Following publication, the NFPBG* intend to initiate a programme of work to support local commissioning activity which will be underpinned by the commitments outlined in the Consensus Statement and to support a ‘whole system’ approach.
*The National Falls Prevention Coordination Group is made up of organisations involved in the prevention of falls, care for falls-related injuries and the promotion of healthy ageing. It was formed with the aim of coordinating and supporting falls prevention activity in England. The 17 group members include NHS England, the Royal College of Physicians, Royal College of GPs and other key health, care & ageing sector organisations. [January 2017]
LGA launches Housing Commission’s 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.