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
£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 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. 6th 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
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………..
31st 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. [Feb 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.
Free Download of TCPA/PHE Journal: Healthy Planning – Securing Outcomes from United Action
The Town and Country Planning Association and Public Health England has published a special joint edition of the TCPA Journal – Healthy Planning – Securing Outcomes from United Action. This can be downloaded here free of charge.
It includes my article on the subject of housing and ageing – pages 480-482. Because PHE supported this edition of the normally paid-for journal it is being made freely downloadable so please do pass on to anyone to whom this subject is of interest. [Dec 2016]
A new briefing from Care and Repair England ‘Disabled Facilities Grant – a system of help with home adaptations for disabled people in England – an overview’
Written by Sue Adams, this practical briefing provides an overview of the Disabled Facilities Grant system in England. It covers what it is, who it helps, who decides, who funds, evidence of its benefit and looks at issues for the future.
It concludes that home adaptations have a critical role in supporting independent living, efficient delivery of health and care closer to home, reduction in delayed transfers of care, better management of long term conditions and the prevention of falls. [Nov 2016]
Centre for Ageing Better Commission Home Adaptations Evidence Review
The Centre for Ageing Better (CfAB) has announced the winner of the contract to undertake a systematic evidence review into how home adaptations can contribute to a good later life. Click here for announcement.
The review will be carried out by a team from the University of the West of England (UWE) in Bristol and the Building Research Establishment (BRE).
The new review will provide evidence on the most effective home adaptations which will be useful for policy makers, commissioners and professionals, as well as for older people and industry.
Care & Repair England, as part of its Catch22 initiative, has worked closely with CfAB on shaping the plans for the review and is a member of the project’s advisory group.
The last evidence review, Better Outcomes, Lower Costs, was published in 2007; since then more information has become available which UWE and BRE will review, including both relevant UK and international research.
The review is due to be completed by July 2017. [Nov 2016]
Quick Guide published by NHS England – Health and Housing
This new Quick Guide, published by NHS England, encourages joint working across health, housing and social care to prevent hospital admissions, help people to be discharged from hospital safely and effectively and support people to live independently at home.
Aimed at Clinical Commissioning Groups it offers practical examples and resources on how housing and health can work together and marks the start of a national CCG engagement programme which includes a series of webinars and a dedicated webpage
Care and Repair England is delighted to be one of the partners with NHS England and others in the housing sector to drive change to support greater links between health and housing.
We will continue to identify good practice and evidence on the impact of housing interventions particularly in repairs, adaptations and handyperson services and in promoting housing advice and information services in health settings to enable people to stay or return to their home.
If you have any local good practice to share please do let us know.
Bathing Adaptations Innovative research – Protocol published in British Medical Journal
The BATH-OUT Trial is an innovative research project, led by University of Nottingham, to undertake a feasibility randomised controlled trial concerning the effects of bathing adaptations on the health, well-being and functional ability for older adults and their carers.
The protocol, which describes the initiative in detail, has now been published in the British Medical Journal.
Care & Repair England’s CEO, Sue Adams, is chair of the project advisory and we will bring you updates as the work progresses, but you can also receive updates about the study directly – please email firstname.lastname@example.org and request to go onto the study mailing list. Alternatively you can follow the study on twitter @bath_out
Further information can be found on the project webpage: www.nottingham.ac.uk/go/bath-out
NHS hospital discharge guide mentions housing
NHS England has today published a new Quick Guide on Discharge to Assess.
The Quick Guide includes an overview of the benefits of discharging patients to assess them in a familiar environment. It includes tips and resources to help localities initiate or improve similar systems.
Care & Repair England made the case for incorporation of housing/adaptation/HIAs/ info & advice into hospital discharge systems and some local examples have been included.
The headline local models [Medway, Sheffield and South Warks] had to be backed by detailed evaluation.
Open day events, targeted at those responsible for hospital discharge systems, are available to find out more about some of the local examples described in the Quick Guide
If you have other local examples of inclusion of housing, particularly if these have been evaluated, please let us know as we are keen to add to these examples.
Street Design for Age Friendly Neighbourhoods
A practical report on street design produced as a result of work with the Manchester Age Friendly Design Group [Sept 2016]
New report highlights role for Disabled Facilities Grants (DFGs) in linking up housing, health and social care to enable people to live independent lives
Written by Sheila Mackintosh and Philip Leather for Foundations and with input from Care and Repair England, the report concludes that there is real potential for using DFGs help to reduce hospital admissions, cut care costs, delay the move into residential care and speed up hospital discharge.
The report identifies that awareness of DFGs is still low, provision is fragmented and too often older and disabled people are left to search out solutions themselves.
However with DFGs becoming part of the Better Care Fund and with increased funds from Government the authors identify key ways to increase their potential and identify local good practice at the cutting edge of provision where services have been joined up to great effect.
The authors conclude that
“The accessibility of the home is finally being recognised as important for successful hospital discharge, to enable care to take place at home, and to allow people to live independent lives… it is possible to join up the previous disjointed pathways and link the DFG to other related health and care services in a way that will make much more sense to customers. Rather than standing alone as a single solution it can be part of a more holistic range of interventions to help older and disabled people remain independent at home.”
Good Housing: Better Health
This new report from a collaborative involving academics and practitioners, calls for a rebalancing of housing policy so that unhealthy housing is tackled alongside strategies for increasing new housing supply.
It notes that the UK has the oldest housing stock and highest medical costs associated with inadequate housing of any of the European countries and highlights the need for housing policies and strategies which go beyond building new homes and also address inadequate housing, including disrepair and cold homes; unsuitable housing, including overcrowding and the needs of older people; unaffordable housing, including high maintenance and running costs; and insecure housing, including fear of eviction and loss of homes,
The Collaborative HIA
Foundations, the national co-ordinating body for HIAs, has published its vision for the sector’s future, ‘The Collaborative HIA’ setting out a vision, analysis of the operating environment and possible actions [July 2016]
English Housing Survey – Special subject reports published
A new government report about Housing and Ageing, based on in depth analysis of the national English Housing Survey, notes the finding that the vast majority (94%) of older households were satisfied with their accommodation compared to 86% of younger households, and for those older people classified as ‘under-occupying’ this satisfaction rises to 97%.
Given that ‘older age’ commonly now lasts for 30 or even 40 years, there is some helpful analysis of the situations of different age groups within the ‘older age’ category.
For example, this reveals a marked difference for those aged 85 years, who are more likely to live in a non-decent home than other any other age groups and live on lower incomes.
- Some 29% of households where the oldest member was 85 or over lived in a non-decent home. This compares to 17% for households aged 55-64 years and 20% for households where the oldest person was under 55.
The report includes analysis of a range of factors & trends, including home moves, income levels, dwelling characteristics, and is invaluable to anyone interested in this field.
The report is just one of the 9 detailed subject analyses of 14-15 English Housing Survey published yesterday. Others are:
- Adaptations and Accessibility of Homes
- Housing and well-being
- Housing stock
- Private rented sector
- Social rented sector
- First time buyers
- Smoke alarms [July 2016]
Housing & Ageing News
The announcement of the appointment of Croydon MP Gavin Barwell as Minister of State for Housing & Planning (as well as Minister for London) came just days after a number of key reports which again highlight the critical importance of population ageing in debates about homes and communities.
Our headline message, that housing, health, social care, finance and ageing are inextricably linked, is reflected in the comprehensive report from Chief Scientific Adviser, Sir Mark Walport, Future of an Ageing Population *.
New figures from DCLG reveal that 74% of household growth (to 2039) will be older households (65yrs+), with a large increase (33%) in single person households.
The Local Government Association’s Housing Commission’s preliminary findings also make the connection between health, ageing and future housing requirements.
News is awaited about who will replace Alistair Burt, Minister of State for Community and Social Care at DH.
It is to be hoped that Mr Barwell will meet his new DH counterpart as soon as possible, alongside DWP, as decisions by each of them will have a profound impact on the homes and lives of older people in the coming months and years. [July 2016]
Future of an Ageing Population – Major new government report
This final summary report from the Government Office for Science is the culmination of 3 years work analysing and bringing together evidence about today’s older population, alongside future trends and projections, to identify the most critical implications for government policy.
One of the key points included in the housing section notes the importance of the quality of the existing housing stock:
• Ensuring there is appropriate housing. Demand for housing that meets the needs of older people will increase as the population ages. Adapting existing housing stock to meet this demand is critical as even by 2050 the majority of housing will have been built before 2000. Ensuring new housing can adapt to people’s changing needs as they age will also be important, reducing demand on health and care services and enabling people to work flexibly and for longer [July 2016]
LGA launches Housing Commission preliminary findings
At its national conference the Local Government Association (LGA) launched the report, Building our Homes, Communities and Future detailing the preliminary findings and emerging recommendations from its Housing Commission. Click here for article on the LGA website.
The Housing Commission* was tasked with setting out a forward-looking vision for the future of housing and the relationship between councils and communities. There was a call for evidence earlier in the year around four topic headings;
- Place shaping, community and infrastructure
- Employment, welfare reform and social mobility
- Housing, health and quality of life for an ageing population
The headline call in the report is for a “national renaissance” in council housebuilding to solve the chronic housing shortage, and to deliver the mix of different homes that meet the growing and changing needs of communities.
With regard to the health and ageing section, the new report notes that most people as they age live in mainstream housing. It states that housing should be central to emerging models of integrated health and social care services and highlights the key role that councils are already playing in providing information, advice and support with property repair and adaptation.
It also calls for a development of a new market of all-age homes, as well as noting the importance of specialist housing, and of information, advice and help to enable people to plan ahead for their later life housing.
*Sue Adams, CEO of Care & Repair England, is one of the expert advisers to the Commission on the housing, ageing & health section. [July 2016]
UPDATE: Centre for Ageing Better Home Adaptations Evidence Review
The Centre for Ageing Better (CfAB) has launched an Invitation to Tender (ITT) for a systematic evidence review on how adaptations to people’s homes can help improve later life. To see the full ITT document, please click here, and note that the deadline for tender submissions is 12:00 noon on 21st July 2016. If you have any questions about the ITT or the tender process please contact email@example.com
Care & Repair England has, through its Catch 22 Project, highlighted the importance of improving the evidence base with regard to provision of home adaptations and has collaborated with CfAB on this initiative. The ITT has incorporated many of the comments received from the consultation on the original scope and content of this systematic review.
CfAB is inviting academics with an interest in home adaptations, particularly in the context of ageing, to respond to the ITT. [July 2016]
Our new Integration Briefing, Innovation in home adaptations – a fresh chance, considers how the substantial increase in national funding for home adaptations offers opportunities to improve integration and meet performance targets, particularly reducing delayed transfers of care.
Backed by Public Health England, Integration Briefing 3 explains the connections between Disabled Facilities Grant finance, this year’s new Better Care Fund Policy Framework and the interests of Public Health & the NHS.
The Briefing will be particularly useful for anyone involved in related service planning including Directors of Public Health; Members of Health and Wellbeing Boards; Local Councillors; Patient and Service User Representatives; and all those involved in the field of home adaptations. [June 2016]
The cost benefit to the NHS from preventative housing interventions – new BRE report
Poor housing costs the NHS at least £1.4billion each year.
This new report from the Building Research Establishment (BRE), the organisation at the forefront of quantifying the cost to the NHS of poor housing, models the potential scale of NHS cost benefits of pro-active interventions to remove specific housing risk factors in the 3 million homes of people with long-term illness and/ or disability.
In their analysis the BRE uses data about the incidence of particular housing hazards (cold homes/ falls risk etc) in the homes of at risk groups alongside the resulting costs to the NHS that arise from specific housing defects. Using the average costs of the interventions necessary to remove such hazards, the model creates indicative payback periods for large scale, preventative works to make homes safer and warmer.
BRE note that there is further work to be done to also quantify the potential further fiscal gains of such prevention to social care.
This important initiative was prompted by the BRE’s involvement in Care & Repair England’s Catch 22 project event back in 2014 – the ‘Bletchley Day’ – which brought together academics, practitioners and other stakeholders with an interest in this field.
Much has been written about ‘prevention’ in the context of NHS costs, and the NHS Five year forward view called for expansion of evidence based preventative action. This report is a welcome and timely contribution which will be of interest to those working in the fields of health and housing.
The report, The cost-benefit to the NHS arising from preventative housing interventions’ can be purchased from BRE either as a download or in paper format. [May 2016]
Developing integrated, impartial information and advice about housing and related care and finance – A guide for commissioners
Care & Repair England and EAC have recently published a guide about commissioning information and advice services on housing and care options and related financial advice. The guide is based on the experience of EAC FirstStop working with local FirstStop partners. It offers commissioners model clauses which can be used in specifications describing services providing housing and related care and finance advice for people in later life. It includes a number of options to enable commissioners to make use of clauses and/or sections which are relevant to local circumstances [May 2016]
Centre for Ageing Better to fund a Home Adaptations Evidence Review
Care & Repair England has, through its Catch 22 project, highlighted the importance of improving the evidence base with regard to provision of home adaptations and has collaborated with CfAB on this initiative.
CfAB is inviting everyone with an interest in home adaptations, particularly in the context of ageing, to give feedback on the proposal and they will then refine the scope before issuing a full Invitation to Tender to conduct the systematic review.
Home adaptations: The Care Act 2014 and related provision across the UK
The College of Occupational Therapists have published a new Briefing, written by legal expert Michael Mandelstam, about the effect of the Care Act 2014 on the provision of home adaptations for adults in England. It also outlines broadly the comparable position, under different legislation, for adults in Wales, Scotland and Northern Ireland. Likewise for children in all four countries of the United Kingdom.
Publication date: 31/03/2016
Helping people to age well in place
The Centre for Ageing Better held a recent round table to look at how to help older people ‘age well in place.’
Most people want to stay within their home environment for as long as possible. In a major report with Ipsos MORI – Later Life in 2015 – the Centre for Ageing Better found that having strong social connections helps some people to overcome disadvantages such as poor health or a lack of financial security. They also found that people felt maintaining strong local social networks depended, in part, on how long they had lived in their local area. Many had been in their home for a number of years so had strong networks and were, understandably, reluctant to move out of their home, which were full of memories and often the place where they had raised their family. Ways to support older people to age well were considered including access to good and reliable independent information, and also more desirable products, which are attractive and meet lifetime standards. http://www.ageing-better.org.uk/news/can-help-people-age-well-place/ [March 2016]
Quick Guide to support patients’ choices to avoid long hospital stays
This multi-agency Quick Guide aims to provide better support to patients and families in making their choices and to support health and care systems to reduce delayed transfers of care.
It contains tips, examples and links to useful documents:
- A checklist for local areas to use to identify areas for improvement;
- Information on existing solutions to common problems, including tools to support choice and environments to support choice (e.g. intermediary placements).
- A template policy and template patient letters which can be adopted locally.
The Guide makes reference to the role of housing setting out examples of Home Improvement agencies working with hospitals to support effective discharge. It also references First Stop and Silverlinks [March 2016]
Local Government Ombudsman report urges action to improve home adaptations delivery
People with disabilities are being left for too long in unsuitable homes because of problems with councils’ Disabled Facilities Grants (DFG) processes is the conclusion of the Local Government Ombudsman (LGO).
In a new report, Making a house a home: Local Authorities and disabled adaptations: Focus report: learning lessons from complaints http://www.lgo.org.uk/information-centre/reports/focus-reports the LGO highlights some of the DFG complaints it has received and notes the significant impact that delivery shortcomings can have on disabled people’s lives.
The report includes good practice guidance to local authorities and also offers elected members questions they can ask to scrutinise local grants processes. [March 2016]
- 1.2 million of households 65 years or over live in a non-decent home – 79% are owner occupiers
- Poor housing costs the NHS £1.4 billion pa
These are just two new figures taken from our latest report [free to download] Off the Radar: Housing disrepair & health impact in later life . You can also download the Off the Radar flyer here.
The report was officially launched at the Care & Repair England 30th Anniversary Reception in the House of Lords on 3rd March.
The report sets out the national picture with regard to the scale of poor housing conditions amongst older people, the concentration of poor housing in the owner occupied sector and the resulting impact on the health and wellbeing of an ageing population.
The Building Research Establishment Trust very generously carried out extensive data analysis for us and some of the figures about ageing, disrepair and tenure are not currently available elsewhere. [March 2016]
Care & Repair England Celebrates 30th Anniversary at Reception in House of Lords
The Rt Hon Alistair Burt MP, Minister of State for Community and Social Care at the Department of Health gave the keynote address at the event, which was hosted by Care & Repair England’s patron, The Baroness Greengross OBE.
The topic of the presentations was ‘The Critical Connection: Housing, Health, Social Care & Ageing’ and other presentations were given by Anna Dixon, CEO of the Centre for Ageing Better plus Paul Tennant OBE, CEO of Orbit Group who sponsored the event.
Click here for a selection of photographs of the event.
Click here for the Care & Repair England 30th Anniversary Brochure. [March 2016]
Lords Built Environment Committee calls for better health connection
The House of Lords Select Committee on National Policy for the Built Environment has published the report summarising its findings, Building Better Places
One of the Committee’s conclusions is that ‘ the link between people and place is lost in decision-making concerning the built environment. ……..and exert a long-term negative impact upon health and wellbeing’.
It goes on to recommend ‘…. a number of strategies for improvement to streets, highways and the public realm, combined with additional measures intended to promote greater joint working between health and planning professionals and better local monitoring of health impacts resulting from the built environment.’
Other recommendations include appointment of a Chief Built Environment Adviser to integrate policy across Government & champion change. [February 2016]
NICE guidelines: Upcoming events
NICE (the National Institute of Care Excellence) has recently produced three social care guidelines relevant to the care and support of older people
Care & Repair England has commented on the last two asking that where people live and their housing options are considered alongside their need for care and support.[February 2016]
Local Allocations for DFG funds announced
The increased local allocations to each Better Care Fund and to every local housing authority has now been published click here
The average increase is around 80%.
SEE ITEM BELOW FOR MORE DETAIL [February 2016]
Big rise in national money for home adaptations in 2016-17
The national allocation of funding for Disabled Facilities Grants (DFG) is set to almost double, increasing from £220m in 2015-16 to £394m in 2016-17.
These figures were revealed in the recent publication of the Better Care Fund Policy Statement 2016/17 by DH & DCLG.
Whilst an increase by 2020 was announced in the 2015 Autumn Statement, the level of DFG allocations in the intervening years was not specified.
The new BCF Policy Statement again states that DFG monies are payable to local housing authorities to enable them to carry out their statutory duties with regard to DFG provision, but it should be noted that two new national conditions for the Better Care Fund have been introduced.
These require local areas to fund NHS commissioned out-of-hospital services and to develop a clear, focused action plan for managing delayed transfers of care (DTOC), including locally agreed targets. It would be surprising if the use of the extra DFG money was not in some way linked to DTOC.
Details of individual local authority DFG allocations are yet to be announced
LGA Commission on housing – call for evidence
The Local Government Association (LGA) has launched a Housing Commission to develop a new vision for the future of housing and the relationship between councils and communities. It has called for evidence from councils, partners, organisations and individuals welcoming details of the issues, evidence, examples of effective housing and ideas to the Commission’s Advisory Panel, made up of LGA Board members, experts and academics.
Sue Adams has been appointed to the Commission as their expert adviser on housing and ageing.
The 4 themes for the Commission are:
- Housebuilding – in particular looking at new ways that councils can enable investment in new homes
- Place shaping, community and infrastructure – in particular looking at the role of councils in shaping homes within prosperous places and communities
- Employment, welfare reform and social mobility – in particular looking at the role of housing in supporting tenants to find and progress in sustained employment
- Health and quality of life for an ageing population – in particular looking at the role of housing in preventing onward costs onto health and social care services
Contributions are requested before 26 February 2016. Submissions of no more than 3,000 words should be sent to: LGAhousingcommission@local.gov.uk.
This is a great opportunity to influence. For more information click here [February 2016]
Poor housing for older people costs NHS at least £634m every year
Two million older people live in homes that fail to meet the Decent Homes Standard, with 1.3m in a home with a serious hazard, resulting in high costs to the NHS, particularly due to cold related health problems and falls.
These are some of the headline figures from a new report from the Building Research Establishment (BRE), Homes and Ageing in England
The BRE estimates that for older households (55yrs or more) the cost of poor housing to the NHS (just for first year treatment costs) is £624 million.
The report also highlights the lack of properties amongst the existing stock which meets the needs of an ageing population, with just 4% of homes having basic accessibility features (level access/ flush threshold, ground floor WC, wide doors/ circulation space).
The report was commissioned by Public Health England and is a useful source of data for anyone involved with or interested the field of housing and ageing. [Dec 2015]
Towards Accessible Housing – a toolkit for planning policy
Habinteg and the Town and Country Planning Association (TCPA) have launched an on line toolkit to help make accessible housing a national planning priority click here
The toolkit pulls together resources to help local councils implement the new Housing Standards (in response to the Building Regulations October 2015) setting out how to support accessible housing through guidance aimed at increasing the supply of accessible homes.
It includes the case for accessible housing, viability testing, data resources for plan making and links to other useful resources, helping local councils to ensure the building of accessible homes to meet demographic realities.
The online resource and will be updated regularly. [Dec 2015]
‘Practical and valuable’ FirstStop housing and care options advice services support well-being and deliver value for money
Making the Case sets out how local integrated FirstStop housing and care information and advice services help to deliver on care and health outcomes, improve the well – being of older people and make savings to the public purse.
The report is the result of an independent evaluation using data from DCLG (Department of Communities and Local Government) funded local housing and care options advice services and interviews in four local areas with service users, key local stakeholders and staff.
It identified a saving of £11.5 million to health and care services from an investment of less than £500,000 by DCLG to 16 local FirstStop services in 2015 – 16. This was due to the avoidance of falls, preventing unplanned hospital admissions and GP appointments. Local FirstStop services also identify and secure aids, adaptations and improved heating and, where appropriate, alternative housing options to support successful hospital discharge for people with complex health conditions.
Summary report can be viewed here
Adaptations help for older and disabled people to continue
The Chancellor’s Autumn Statement included some good news for older and disabled people, with the announcement that Department of Health will continue to fund Disabled Facilities Grants for the next five years. [Dec 2015]
‘The government will also continue to improve care for older and disabled people and support for their carers. The Care Act reforms introduced in April focus on wellbeing, prevention and delaying the need for social care. In support of these principles, the Spending Review includes over £500 million* by 2019-20 for the Disabled Facilities Grant, which will fund around 85,000 home adaptations that year. This is expected to prevent 8,500 people from needing to go into a care home in 2019-20.’
What this will mean for DFG allocations in the years running up to 2019-20 is as yet unknown. Hopefully the further comment in the statement about increasing the Better Care Fund by £1.5 billion (DFG is included in this fund) might indicate a staged rise.
Watch this space for further details.
Click here for the Home Adaptations Consortium 2015 Spending Review Submission re DFG value, Home Adaptations for Disabled People – Integration in Action
* The DH budget for DFG in 15-16 is £220m. Budgets are set locally with the expectation that contributions to the DFG budget will also be made by housing, social care and health (in the past there was a legal obligation to mach fund on 60:40 basis)
Search Engine Failure: Housing and Care Advice in the North West
The Housing Group of Future North West, the regional forum on ageing have kept a watchful eye on the integration of housing, care and financial advice offered to older people and their carers by local authorities in the wake of the introduction of the Care Act 2014. They conducted a survey in September and have shared their recommendations in a report titled, ‘Search Engine Failure: Housing and Care Advice in the North West’.
Information and advice is key to decision making but the Care Act duty on local authorities to provide information and advice is harder to find than we hoped for and in some cases, non-existent. The Housing Group came up with a number of recommendations including:
- Government should offer additional guidance to councils on explaining the Care Act, the use of website links, and the importance of directly linking housing services and providers into Care Act provisions, particularly those relating to prevention.
- Councils should engage with their local older people’s forum or, where they don’t exist, a similar body to review their website and information.
- Information and Advice needs to be more person-centred and capable of responding to questions that do not fit existing service patterns. This would assist greatly in fulfilling the remit of preventing early use of care services.
- The full report is available here [October 2015]
Agenda for Later Life
Age UK’s annual audit of how public policy is meeting the needs of our ageing population, Agenda for Later Life 2015 highlights the challenges and opportunities facing older people today.
It says that too many older people, who are finding it hard to cope at home, are being left to fend for themselves. This is because the public services that are supposed to support them are disappearing due to Government cuts. Of particular concern is the lack of funding in health and social care.
Covering money, feeling well, health and care, being safe at home and active in communities the report assesses the situation for older people and sets an agenda for priority action.
On housing the report calls for
- all homes built to lifetime standards,
- more retirement housing
- enable older people to access adaptations and equipment quickly to reduce demands on health and care
- bring homes up to a minimum energy standard.
It also calls for preventative services such as Home Improvement Agencies and handyperson schemes. There is recognition that investing in housing can help to reduce health and care spending and improve the lives of older people. We must continue to press for this investment for all older people living in poor and unsuitable housing.
Housing solutions in a new NHS guide to improve hospital discharge and reduce unnecessary hospital admissions
NHS England has published a series of quick guides to support local health and care systems. The guides provide practical tips, case studies and links to useful documents, which can be used to implement solutions to commonly experienced issues such as delayed discharges and unnecessary hospital admissions.
Care and Repair England supported the development of one of the guides on Better Use of Care at Home. Produced by United Kingdom Home Care Association, it looks at how to improve the relationships, processes and use of home care and housing support to help people home from hospital and avoid admission. This guide includes examples of Home Improvement Agency and First Stop housing, care and finance advice agencies’ partnerships with hospitals and GPs.
All the guides are available from here
The guide to Better use of care at home can be accessed here
Some of the case studies we identified are available here
Housing goes up the public health agenda
Directors of Public Health now play a pivotal role in decisions that affect planning and commissioning services across housing, health and social care, primarily through Health & Well-Being Boards.
- A health & housing evidence, case example and guide from CIEH
- Health and housing training resources from SITRA
- Good evidence standards and guidance for the housing sector from HACT
Care & Repair England’s Integration Briefings about Disabled Facilities Grants (DFG) and the Better Care Fund plus Home Adaptations, Integration and the Care Act, as well as our DFG local good practice notebooks.
We have also launched short ‘cameos’ that describe local delivery of housing related help in hospitals and with GPs. Please let us know if you have a local initiative that could be added as we are keen to expand this resource for health professionals. Contact mailto:firstname.lastname@example.org [Oct 2015]
Case Studies of Health and Housing Links
Please click here to view four new case studies from local agencies working with health (GPs and hospitals) to enable people to stay well at home or return quickly and comfortably from hospital as well as an article on Manchester Care & Repair’s Home from Hospital service. [Oct 2015]
2015 Annual Review – Happy at Home?
With so much negative publicity recently about older people and housing we thought that it was timely to highlight how important ‘home’ is in later life. This is why we have called our latest Annual Review – ‘Happy at Home’ [Sept 2015]
Care & Repair England New Patrons
Care & Repair England is pleased to announce that two new patrons have joined longstanding Patron Baroness Greengross OBE in support of the work of the housing charity.
“We are absolutely delighted at this news,’ said Peter Archer, Chair of Care & Repair England. “Ho indicate a staged rise.
al issue. Care & Repair England reflects the aspiration of the vast majority of older people who live in ordinary housing and just need a bit of help to stay safe and well at home. This endorsement of our approach is extremely helpful.” [Sept 2015]
Integration and innovation in home adaptations delivery
A new Briefing: Home adaptations, integration and the Care Act has been launched Care & Repair England alongside two additional new ‘cameos’ of local adaptations provision good practice https://homeadaptationsconsortium.wordpress.com/good-practice/
Promotion of wellbeing and independence, prevention and integration with health are central to the vision of the Care Act. Adapting people’s homes plays a pivotal role in meeting new obligations. The Briefings and the good practice information are backed by Public Health England and endorsed by the national Home Adaptations Consortium.
These resources and the earlier Cameos https://homeadaptationsconsortium.wordpress.com/good-practice/, Integration Briefing about DFG and the Better Care Fund https://homeadaptationsconsortium.wordpress.com/briefings-and-reports/,will be particularly useful for anyone new to provision of help with home adaptations such as Directors of Public Health; Members of Health and Wellbeing Boards; Local Councillors: Patient and Service User Representatives.
Those involved in the provision of home adaptations will also find the newly updated in depth guide Home Adaptations for Disabled People: A detailed guide to related legislation, guidance and good practice useful. This statement of law and guidance has just been updated to incorporate the implications of the Care Act 2014 and related Guidance and Regulations. [Sept 15]
CIH has provided briefing papers on the Care Act, and the statutory care and support guidance, to highlight the importance of housing, and the potential new opportunities for partnerships, and available by following the links [Sept 15]
Resources linking housing and health
Housing organisations have long argued the importance of good housing to better health and wellbeing. Yet there is still a long way to go in seeing housing as an essential part of health and care planning. Resources have been developed recently that aim to put housing rightly on the health and care agenda.
The Housing Lin has developed its health Intel resources that aim to help people understand the health and housing landscape
The Kings Fund with the National Housing Federation has developed a Learning network on integrating housing care and health
The NHS Alliance has produced its housing for health resource for GPs
The Memorandum of Understanding produced by NHS England, Public Health England and a range of social care, health, housing and local government organisations in Dec 2014 shows that the right home environment can:
- Delay and reduce the need for primary care and social care interventions, including admission to residential or nursing homes
- Prevent hospital admission
- Enable timely discharge from hospital and prevent re-admissions
- Enable rapid recovery from ill-health or planned admissions.
More recently we have also seen an initiative from NHS England and Public Health England to fund a number of projects to ‘design and develop new town partnerships that put innovative health and social care practice at the very heart of urban planning to create healthier places to live from the outset’.
Let’s hope that through these resources and initiatives housing is not only identified but is also solidified as a key ingredient to good health and care. [July 2015]
Ageing: the silver lining: The opportunities and challenges of an ageing society for local government
This report, published in June, by the Local Government Association (LGA) Task and Finish Group on Ageing, sets out the increasing contribution to society and the economy older people can make through empowered local government and challenges the commonly-held belief that an ageing population is a burden.
It recommends that Government develop an ‘Ageing Well’ strategy and assert a positive vision of ageing, tackle discrimination and offering sustainable funding and devolution of power to local government to meet the opportunities and challenges.
The report, through identifying good practice from local councils, also considers economic activity and civil engagement, housing and neighbourhoods, outdoor spaces and public buildings, transport, information and advice, social participation and inclusion and health and wellbeing.
In housing such practice includes developing a housing strategy jointly with health and social care including the development of specialist housing, funding practical services such as care and repair (home improvement agencies) and assessing age friendly neighbourhoods.
Whilst arguing for adequate funding for social care and health the report sees real benefit in funding to transform the delivery of services with older people at the heart.
The LGA has said that it will be considering the findings of the report in the development of its priorities, policy positioning and work plan recommendations that will be put forward to the LGA’s Community Wellbeing Board in September 2015. Ageing – the Silver Lining [July 2015]
Integration in action – innovation in home adaptations delivery
A set of new ‘Cameos’ describing inspiring local examples of cutting edge delivery of home adaptations has today been launched by Care & Repair England, backed by Public Health England and endorsed by the national Home Adaptations Consortium. The six cameo’s can be downloaded here from: West of England Care & Repair; Walsall Independent Living Centre; Sunderland Care & Repair; Suffolk Orbit Care & Repair; Middlesbrough Staying Put; Knowsley Centre for Independent Living
Promotion of wellbeinlife. This is why we have calledprevention, are critical to the vision of the Care Act. Adapting people’s homes plays a pivotal role in meeting these obligations. There are pioneers around England who are ahead of the curve on finding new and better ways to offer home adaptations advice, practical help and financial assistance, including innovations in use of Disabled Facilities Grant (DFG). These new ‘cameos’ describe activities in an initial six localities. Care & Repair England has also published a Briefing which explains the changes, clarifies responsibilities and highlights opportunities for integration now that the DFG funding is paid to local councils through the Better Care Fund. These resources will be particularly useful for anyone new to provision of help with home adaptations such as Directors of Public Health; Members of Health and Wellbeing Boards; Local Councillors: Patient and Service User Representatives, as well as anyone involved in the field of home adaptations. [June 2015]
Housing & Ageing Summit Report
This summit report from the Housing and Ageing Alliance click here has been sent to the Housing Minister, Shadow Minister, MPs and other policy makers following the general election. The result of a summit in the Spring, it sets out what leading figures from the housing and ageing sectors agreed were the actions required to address the critical issue of housing for an ageing population. It is hoped the report will influence thinking as policies unfold. [May 2015]
Care & support cuts impact on NHS
The latest Association of Directors of Social Services (ADASS) annual spending survey shows further deep cuts of £1.1b are being made in care and support for older and disabled people in 2015-16. The ADASS report is launched in the week that a survey by the NHS Confederation revealed that 99% of health staff believe that cuts to social care are causing extra pressure on the health service. What has not yet been analysed is the impact on the NHS of reduced funding for housing related support. Practical housing interventions, including provision of the critical home adaptations, equipment and repairs that can make or break a person’s ability to live safely and well at home, still go largely unrecognised, even though analysis by the Building Research Establishment (The Cost of Poor Housing to the NHS click here) recently revealed that such shortcomings cost the NHS at least £1.4 billion each year. [June 2015]
Disabled Facilities Grant Funding via Better Care Funds – An Opportunity to Improve Outcomes?
This month heralds a significant change in the way that national funding for disabled facilities grants is paid. The Better Care Fund will receive the money and the allocation then needs to be passed on to the relevant Housing Authority (in two tier areas) or Department (in unitary authorities). Care & Repair England has published a Briefing which explains the changes, clarifies responsibilities and highlights opportunities for integration. It will be particularly useful for anyone new to provision of help with home adaptations such as Directors of Public Health; Members of Health and Wellbeing Boards; Patient and Service User Representatives. Earlier this week local authorities were informed of the amount of funding that they were due from national government to support provision of DFGs – Here is the link to the table which sets out the amount for each locality. [April 2015]
Disabled People Facing Long Delays for Home Adaptations
Research by the Leonard Cheshire Foundation has revealed that two thirds of councils are missing legal deadlines when it comes to provision of disabled facilities grants (DFGs) to meet the costs of essential home adaptations for disabled people. ‘The Long Wait for a Home’ reveals that almost half (44%) of councils had examples of disabled people waiting more than two years for DFG payment. Eight councils reported waits of over four years. Councils are struggling to meet the increase in demand. DFG applications have risen by 6% since 2011/12 but the amount of adaptations funded in the same period has risen by only half that (3%). Health and social care policies are committed to independent living at home for more disabled and older people. Home adaptations play a vital role in enabling this to happen but so far most local budgets have not been set at levels which are adequate to achieve this aspiration. [April 2015]
Opportunity to improve housing & ageing evidence base
There is an opportunity to put the case for improving the evidence base re housing interventions and ageing. The Centre for Better Ageing is consulting on which areas it should prioritise in its initial work programme. One of the options is ‘Sustaining Independence in the Home’ (TOPIC 4) which would consider ‘what works best’ with regard to physical improvements to the homes of older people. Only three or four Topics out of a possible list of eight will be selected. It is important that anyone with a view about this issue responds to the Consultation The Work of CfAB_Consultation Paper_March 2015. The deadline is 20th May. It is a very detailed consultation – Care & Repair England will aim to publish its own response by the end of April and will make this widely available. [March 2015]
Making the case – for integrated, impartial information and advice about housing, care and related finance for older people
The delivery of independent information and advice for older people which brings together housing and care options and related financial advice is the focus of Making the Case, a new report published this week by the leading national organisations concerned with the provision of such services. The report sets out how integrated housing and care information and advice services enable local authorities to meet their new duties under the Care Act and includes model clauses to assist with service commissioning. Endorsed by ADASS (the Association of Directors of Adult Social Services), it will be particularly useful for the planners, commissioners and providers of care, health or housing services for older people. Making the Case also shows how integrated information and advice provision meets specific NHS, Public Health and Social Care Outcomes Framework measures. It highlights not only the cost benefits but as importantly, the benefits to older people themselves. The report can be downloaded here. The brochure is a joint publication from Age UK, C&RE, EAC, Foundations and Independent Age, and has been endorsed by the ADASS Housing Policy Network. [March 2015]
Poor housing costs the NHS £1.4 billion every year
In last week’s Budget the government said it would be looking at whether improving housing for vulnerable people can reduce costs to the NHS (see item below). Today it has an answer. In a new report using up to date figures the Building Research Establishment has calculated that the annual cost of poor housing to the NHS is at least £1.4bn. This is more than double the £600m estimate in their 2010 report. The improved analysis indicates that the health impact of poor quality housing is on a par with smoking. The hazards of cold homes and falls are identified as those which have the most impact on NHS costs, whilst reducing falls hazards has the fastest payback because of the relatively low remedial cost. This Briefing Paper, The Cost of Poor Housing to the NHS click here provides a strong case for achieving significant public health gains through focusing on the most cost-effective improvements to the homes of the most vulnerable people. [March 2015]
Unexpected hint about future housing help in March 15 Budget Statement
In the Spring budget announced on the 18th March, there was a notable reference to the future provision of housing help. In the section of the ‘Red Book’ https://www.gov.uk/government/publications/budget-2015-documents headed Integrating services to improve outcomes and reduce costs it is stated that …. (Clause 1.87) Further savings will also be achieved……….the Budget announces that the government is exploring the cost-effectiveness of options to integrate spending around some of the most vulnerable groups of people, including:
- exploring whether improving housing can help people with care needs stay in their homes longer and reduce costs to the NHS. <%pting people’s homes plays a p0A
There was a possible hint that the Better Care Fund might not continue beyond 15-16 with the commitment that the government would be:
- taking the next steps on from the Better Care Fund to continue to join up services for people with health and social care needs, and learning from Greater Manchester’s experience following their recent landmark agreement to bring together commissioning of around £6 billion of local health and social care budgets.
The very specific focus on saving NHS costs only for people who already have care needs does risk missing the important role of housing adaptations and improvements in preventing care needs arising in the first place. One to watch. [March 2015]
Two recent reports addressing cold homes
NICE (the National Institute of Clinical Excellence) on 3 March published its guidance on Excess winter deaths and morbidity and the health risks associated with cold homes click here With 24,000 excess winter deaths each year the guidance urges health and social care professionals and those working in the heating, plumbing and electrical industries to signpost people to a ‘single point of contact system’ (a housing and health referral system) which it says, Health and Well Being Boards should ensure is commissioned . NICE propose that people should be identified and referred to the right agencies to receive help with such matters as loft insulation, heating improvement and energy efficiency programmes (including those provided by Home Improvement Agencies.) However, it does not address the fact that the agencies needed to deliver the solutions to cold, poor homes may not be there. We had asked that Health and Well Being Boards be tasked to commission these services not just a referral system. The guidance could also have better reflected the fact that cold homes are due to more than just poor insulation and inadequate heating but encompass issues as rotting windows, defective doors and damp due to roof problems. Cutting the cost of keeping Warm – the Government’s Fuel Poverty Strategy for England click here This sets out a new fuel poverty target to ensure that ‘as many fuel poor homes as is reasonably practicable achieve a minimum energy efficiency rating of Band C, by 2030.’ DECC is also making up to £3 million of funding available for new fuel poverty pilots to encourage innovation particularly with regard to the health costs of poor homes. National Energy Action considers that the current activity in England is insufficient in scale. To put an end to cold homes and excess winter deaths needs ‘adequate resources as well as joining up action’ and they want the next Government to end the cost and suffering of cold homes more quickly. [March 2015]
New Housing & Care Options “teach yourself” resources
The Silverlinks project has developed a downloadable workbook and walk-though of our workshops on Housing, Care & Related Finance in later life. You can also read our guidance on the new Care Act and what it could mean in terms of paying for care. There are also links to other useful sites and resources for finding out further information on housing & care options. [February 2015]
You can read more and download the resources by clicking here
New report from Leonard Cheshire reveals costs to health of lack of adapted housing
In their latest report, the national charity Leonard Cheshire Disability, highlight the pressures on health and social care that result from a lack of disabled friendly homes. In ‘‘The real cost of the lack of disabled-friendly homes’ the key findings are:
- The lack of disabled-friendly homes is placing huge pressures on health and care services
- Over the past month at least 15,000 hours of GP time have been taken up with disabled or older people who had suffered injuries, illness or other health problems because of an inaccessible home;
- Some GPs (22 from our survey) had more than 20 appointments for health problems caused by inaccessible homes in the last month;
Earlier reports are
- No place like home
- The hidden housing crisis
All are freely downloadable from this webpage [March 2015]
Importance of Housing in Integration gets another official stamp of approval
A joint Memorandum of Understanding to support joint action on improving health through the home’ has been signed by twenty organisations, including Government Departments and public bodies (including Dept ofHealth, DCLG, NHS England, Public Health England) plus national statutory and voluntary organisations, including Care & Repair England. Click here The MoU states that ‘The right home environment is essential to health and wellbeing, throughout life. We will work together, across government, housing, health and social care sectors to enable this. There is an associated action plan to drive forward the agenda and local organisations are encouraged to make use of this in local profile raising efforts to connect housing, health and care. [February 15]
Latest English Housing Survey Headline Report Published
Department for Communities and Local Government (DCLG) has today published the results of the 2013-14 survey. The English Housing Survey (EHS) is an annual analysis of people’s housing circumstances, e.g. tenure, and the condition of the housing stock. Whilst it provides a less detailed picture of the stock and its inhabitants than the English House Conditions Survey, which was merged with the Survey of English Housing back in 2008 to create the current EHS, it nevertheless is a critical source of data upon which policy decisions are made. Click here for the report [February 2015]
Design for an ageing population
The Royal Institute of British Architects (RIBA) has just published a web resource on design for an ageing population. RIBA has collected a vast amount of existing knowledge (over 450 items of research) from architects, other professionals, academics and researchers. It includes documents on housing, hospitals, outdoor spaces, offices and retail; RIBA’s Alternative Age Friendly Handbook and information on a research symposium held in 2014 on design for ageing. The research documents are
- categorised in key themes and introduced by experts and
- form RIBA’s ‘design for an ageing population’ knowledge base where you can search under various headings
Whilst RIBA’s primary goal is to help its members – and other built environment professions – to access the relevant knowledge to create buildings and places that meet the needs of an ageing society the resource will be useful for all concerned about good design for ageing. Click here for research documents [February 2015]
Paying for Care – What the New Act Means
Care & Repair England have developed a guide to the main changes being brought about by the Care Act. The Care Act changes the rules in England about who gets support for care costs from local councils and how much they have to pay for care. The changes start in April 2015, with some starting in April 2016. This guide is not a detailed explanation of all the changes, but is an overview about some of the main changes which you will need to take into account when thinking about your housing and care choices. As the new legislation is so complicated, it is recommend that you always take independent, specialist advice about the changes that will affect you. First Stop, Independent Age and AgeUK all offer specialist advice for older people – the contact details are at the end of our brief guide. [February 2015]
Innovation in adaptations and disabled facilities grant Help us share good practice about ‘what works’ Have you found an innovative way to improve delivery? Are you breaking new ground/ found ways to save money/ deliver help more efficiently/ integrate provision with health? Then please share it! Many people are trying to do ‘more for less’ and are front line pioneers but don’t have time to write up their achievements, let alone tell others what they are doing. Care & Repair England has been commissioned by Public Health England to produce cameos of DFG/ Adaptations provision good practice. We want to talk to people about what they are doing and then will do the hard work of distilling this into short good practice notes that will be widely publicised and shared. If you think you can contribute please reply by email to email@example.com with:
- 1 or 2 paragraphs describing very briefly what your innovation/ good practice is (linked to the above list if possible).
- Contact details of the person/ people that the researchers can contact to get more information (name, position, email and tel no). If available, please include a link to your website or to any reports that give more information about your service/ innovation. [January 2015]
DEADLINE: FRIDAY 13TH FEBRUARY
Paying for Care – BBC launches calculator
Many people who need repairs and adaptations to their homes are also concerned about the possible cost of care and whether they will have to sell their homes to pay for this. From April 2015 the new social care payment system comes into force. Whilst technically people will not have to sell their homes to pay for care, they will have to use the equity in that home to meet care costs – it is just that the actual sale can be deferred and a charge (with interest and administrative costs) will be placed on the property. The BBC have developed a care calculator that explains the forthcoming changes and enables people to find out how much they could have to pay for care in later life. It is simple to use and is tailored to localities using average residential care home cost/ social services payment limits in a particular local authority area. You can access the calculator by clicking here Housing organisations alarmed at DCLG plan to cut back housing intelligence The Dept for Communities & Local Government have published a Consultation on the future of the English Housing Survey (EHS), including a proposal to only publishing information every two years instead of annually. As the sole source of in depth analysis of the housing situation in England (covering household composition/ tenure trends/ stock condition etc) this would represent a major loss of information upon which to base policy and decision making. The deadline for responses is 17th February. [January 2015]
Cold comfort – poorest hit hardest by energy bill increases
The energy bills of the poorest 10% of households have risen almost twice as much as those for others between 2010 & 2013, according to research by the House of Commons Library. See link here
- electricity bills increased by 39.7% for the poorest 10% of households, compared to 7.5% for the top 10% and an overall average of 22.2%
- for gas bills the increases were 53.3% for the poorest 10% of households, compared to 23.9 % for the top 10% and 29.2% average rise [January 2015]
Grants for home repairs from energy company fines
The Foundations Independent Living Trust (FILT) has been selected as one of the main beneficiaries of recent energy company fines – to the tune of nearly £900,000. Details are still to be announced. FILT provides funds which enable local home improvement agencies (HIAs) to provide essential repairs and improvements to people’s homes. [January 2015]