1. Innovative Housing Options Jeremy Porteus – 25 January 2011
2. Why make the case between health andhousing?• A fall at home that leads to a hip fracture costs the state£28,665 on average – over 100 times the cost of installinghand and grab rails• Where it is appropriate, postponing entry into residential carefor one year saves an average of £28,080 per person• A hospital discharge service that enables older people toreturn to a safe and suitable home environment saves over£100 per day – the amount charged to local authorities whenpatients ‘block beds’(source: Fit for Living Network Position Statement, hact 2010)
3. What are the perceived challenges for youas an organisation?• What is your future vision for care – residential, homecare, intermediate care, respite care, extra care?• Is housing development or management a keycomponent of your delivery/growth plans?• Sustainability of markets in present climate?Uncertainty of funders, external relationships?• What can you offer that is different? Can you fosterinnovation, diversification and development?• How to realise and evidence benefits eg dementia• Motivate staff/create a learning and knowledge sharingenvironment for workforce – sector care academy?• Regulation and inspection – lighter touches, self-assessment but balance against safequarding.
4. What are the health drivers for good qualityhousing with care?• over 15 million people in England witha long term condition, includes heartdisease, diabetes, asthma, respiratoryproblems and dementia• proportionally far higher users of NHSand PCTs• Account for 55% of GP appointments,68% of outpatient appointments and77% of inpatient bed stays• more likely to be older and have othercomplex needs leading to disabilitieswhich require care and/or support• they live in poor housing, which couldexacerbate their condition and makethem more likely to be admitted to acare home (recent Sir Michael MarmotReview, Fair Society, Healthy Lives)
5. An Ageing Population• Significant age shift, especially older old• Changing users’ housing/care aspirations eg lifestyle choices and needs 30%• Diversification housing 25% and care markets eg from 20% specialist to adaptable, from single tenure and 15% institutional to mixed tenure 10% and community based 2004 2014 2024• But, rapidly changing economic and financial climate• And, what impact on both mainstream and specialist markets and consumer confidence?
6. Some General Facts & Figures...• 90% of older people live in ordinary housing,rented or owned• 67% of older people are owner-occupiers(2005)• Disabled people are twice as likely as non-disabled people to live in social housing• 1.5m individuals report having a medicalcondition or disability that requires speciallyadapted accommodation (2006)• The most common reason for older peopleconsidering a move is that their home isinappropriately adapted for their mobility healthneeds (Scottish Government ‘Time to Move?’2006, CLG New Horizons Research 2008)
7. Role of Housing• Every citizen should be able to live in an environment where they feel safe, they can afford and in which their care and support needs are increased – Wheelchair accessible – Equipment to support daily living – Community Alarms and Telecare/Telehealth – Daily support or floating support – Accessible for staff/service delivery
8. Retirement housing new-build
9. The Policy landscape • We will establish a commission on long-term care.• We will break down barriers between health and social care funding to incentivise preventative action.• We will extend the greater roll-out of personal budgets to give people and their carers more control and purchasing power.• We will use direct payments to carers and better community-based provision to improve access to respite care.• We will help elderly people live at home for longer through solutions such as home adaptations and community support programmes.• We will prioritise dementia research.• We are committed to an NHS that is free at the point of use and available to everyone based on need, not the ability to pay
10. Developing policy & funding• NHS White Paper – extend personal budgets• Comprehensive Spending Review• Revision of the NHS operating framework• Response to the Law Commission• Establishment of a Care Commission• New social care Partnership Agreement• Dementia Declaration and Pledge• Review Carers Strategy• Public Health White Paper• Social Care White Paper (forthcoming)• Welfare benefit reform (DWP)• Localism Bill (CLG)• Reform of planning (CLG) DH if not otherwise indicated
11. Types of outcomes sought• Less dependency on high cost care• Developing intermediate care and re-ablement services• Make best use of telecare and smart technology (grey and green)• End of Life Care – avoid hospital admission• Preventing costly health interventions eg, as a result of a fall• Providing meaningful choices and lifestyle aspirations to meet personalisation objectives• Building effective social capital to enable greater community engagement/informal care/volunteering• Appropriate housing, including supported and assisted living (not dependent on social grants)
12. Role of Housing• Every citizen should be able to live in an environment where they feel safe, they can afford and in which their care and support needs are increased – Wheelchair accessible – Equipment to support daily living – Community Alarms and Telecare/Telehealth – Daily support or floating support – Accessible for staff/service delivery
13. SUPPORTED LIVING OR UNIVERSAL HOUSING• Two models of housing both called extra-care housing – Care Village – Universal offer – Alternative to Residential Care• Models of cost effective housing solutions – Apartments with communal space for on-site care – Flats close together• Role of Technology to support re-ablement, eg telecare and assistive technologies – virtual extra care and supported living choices• The Beacon Centre, winner 2010 UK Housing Awards
14. Capital Funding• Councils Capital programmes• Homes and Communities Agency• Section 106 – Local Development Framework• Government capital grants – DH extra-care housing• Housing Associations – ability to borrow.• Prudential Borrowing• Private Finance Initiatives• LIFT in DH• Private Investment• Need to consider longer term financing – awaiting CSR
15. Revenue Funding• Block care contracts• Personal social care budgets• Personal Health Budgets• Supporting People• Means tested/non means tested benefits/HB• Self funders• Equity release/insurance• Continuing Care (NHS)• Other incentives and rewards?• Volunteers?
16. Going forward• Post CSR – All parties need to be more creative on capital & revenue (Supporting People) funding• Alignment of investment - local authorities, HCA, health sector and third sector within Local Investment Plans• Joint strategies and commissioning partnerships• Local (public) Land Initiative opportunities – land swaps• HCA’s Delivery Partner Panel• Local frameworks
17. Going Forward• Affordable rent packages with registered providers to include Extra Care• If care homes continue to close, reinvestment of land sale receipts in new projects• Place making, regeneration and development to meet the needs of the whole community• Extra Care is not the only solution for older people – is a different housing/care offer more appropriate?• Local authorities – commissioning providers and development partners, supported by HCA• Make sense of personal budgets and self funders’ markets
18. Future arrangements• Market presence: what is your offer to Housing, the NHS and social care? Have they heard you/know you are there re: extra care?• Protecting the bricks and mortar: Is your stock ‘fit for the future? Adaptable, remodel, decommission, ‘care ready’? Convert to extra care?• The extent of personalisation: what will this mean under a new govt. Will it extend choice and control even further?• Health and care outcomes: can you evidence tackling health inequality, preventing homelessness, sustaining tenancies, avoiding a move to residential care• Operating in a tighter financial envelope: Public sector spend looking for efficiency savings in all areas, access to capital/revenue streams, including HB and wider welfare benefit reform• Workforce arrangements: recruitment/retention, training and learning improvement• Leadership: Do you have the vision and capability (skills, knowledge etc) to change? Do you want to change?