Revolution in the air: integration of housing health and social care


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Our keynote speaker, Sue Adams of Care & Repair England presented these slides to the Cambridge sub-regional housing board event in October 2013.

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Revolution in the air: integration of housing health and social care

  1. 1. 'Revolution in the air’ Integration of housing, health and social care Sue Adams, CEO, Care & Repair England
  2. 2. Who?  Care & Repair England; national housing charity aims to address poor and unsuitable housing conditions amongst the older population, particularly low income home owners (est. 1986)  Pioneers local initiatives; local Care & Repair services, Minor works grants, Handyperson, Housing Options, Healthy Homes, Older People’s “Housing Activism”  Policy shaping: Older people’s housing – Chair Housing & Ageing Alliance, Home Adaptations Consortium, HCA, DCLG, NHS England Integration Task Group, DH Care Legislation reform…
  3. 3. Brief  Why integrate ? – key drivers  Current state of play at higher level policy level  Immediate challenges  Real world example
  4. 4. Lost Link  Addressing the health and social problems arising from poor housing were key drivers of early housing improvement  Could this be the case again…..
  5. 5. Better Homes = Healthier Workers  Examples: Philanthropic Garden Villages/ Garden Cities  Results: Healthy, sociable places to live = better health
  6. 6. Why integrate now?  Austerity - reduce expenditure  Efficiency – do more with less/ rising demands  Integration – reduce duplication  Prevention - cut demand Fundamental shift in vision for the NHS (& social care) Renegotiating the role of the state and the individual
  7. 7. Kings Fund Analysis "Current service models assume that we get ill, are treated in hospital and go home; yet 70 per cent of health and care spend is on people with chronic conditions requiring long-term support, not one-off episodes of care. Their needs defy traditional demarcations between ‘health’ and ‘social care’." Richard Humphries, The King’s Fund
  8. 8. Kings Fund Analysis  Reducing emergency admissions and ensuring that longer lengths of stay are clinically necessary has the greatest potential for hospital efficiency savings  Estimated potential savings: £1b pa  Also - Better for patients DATA Briefing: Emergency bed use; what the numbers tell us (2011) Kings Fund
  9. 9. On the front line - HWBB  Public health, hence HWBB, have critical role to play in achieving efficiency gains through:  Prevention & reduction of crisis driven demand through addressing the wider social determinants of health and  Leading on Integration
  10. 10. Homes & neighbourhoods are…..  Major determinant of health & well-being (mental and physical)  Influential factor in the need for health and social care Housing impacts on NHS and Social Services expenditure Poor housing costs NHS c£600m pa (BRE & CIEH 2010) Good housing leads to good health toolkit from CIEH
  11. 11. Efficiency? Look at NHS use  Chronic health conditions  Incl. heart disease, stroke, respiratory conditions, mental health, arthritis, macular disease {dementia}  60% of GP visits are by people with long term conditions Main LTCs have causal link to, or are exacerbated by, poor or unsuitable housing
  12. 12. Reduce hospital use  C. 66% of general and acute hospital beds are occupied by people 65yrs +  70%+ of hospital bed days = emergency admissions  80% of emergency admissions for 2 weeks or more = over 65yr olds
  13. 13. Health & care needs & ageing Demographic change* (2030 vs 2010)  51% more people 65+  101% more people aged 85 Crucial to  prevent need for health & care services  use systems more efficiently Housing’s potential contribution to this is significant *Ready for Ageing? Lords Inquiry 2013
  14. 14. Ready for Ageing? House of Lords Inquiry led by Lord Filkin concluded that country is ‘woefully underprepared’ for population ageing and concluded that “The split between healthcare and social care is unsustainable and will remain so unless the two are integrated. Sufficient provision of suitable housing, often with linked support, will be essential to sustain independent living by older people.“
  15. 15. Ready for Ageing? Recommended:  A better health and social care system to support people to stay living independently needs adequate housing and support in the home  The work done by housing adaptation and repair charities is commendable, but needs to be universal  The housing market is delivering much less specialist housing for older people than is needed
  16. 16. Why plan homes for ageing? ‘Older people see housing as ...the most essential factor in whether they will be able to manage and live well’ Clough R et al(2003) Homing in on Housing Lancaster ESR
  17. 17. Make the housing connection Step 1: Consider where older people live  90% in mainstream housing  75%+ home owners  occupy third of all homes Step 2: Consider housing stock condition  Most non-decent housing is in the owner occupied sector (higher ppn in private rented but lower no)  1m vulnerable older people (75+) in non-decent housing, mostly in the owner occupied sector
  18. 18. Make the housing connection Step 3: Consider stock suitability & adaptability  Need for adaptations  1.4 million individuals have a medical condition or disability that means that they need specially adapted accommodation: 22% consider their current home unsuitable (SEH)  Based on current population projections, by 2036 around 810,000 people 75yrs + would be living in unsuitable homes (70%+ in owner-occupied properties) C&RE, Time to Adapt
  19. 19. Make the housing connection  Housing was identified as an important social determinant of health in the Marmot Strategic Review of Health Inequalities  Applicable to all age groups, with body of evidence:  Children & accidents  Chronic health conditions – all age groups  Neighbourhood /housing & life expectancy  Overcrowding & educational attainment  Mental health/ housing link evidence strong
  20. 20. Example of housing link: Falls  One in three people over 65yrs and one in two of those over 80yrs will suffer a fall each year with home the most common place for falls.  Over 75% of deaths due to falls occur at home  Falls= half of hospital admissions for accidental injury  Falls =10-25% of ambulance call-outs for this age group  Hip fractures cost £2b pa/ £6m day – most are due to falls Quantified link = falls and housing defects (HHSRS Cat 1 Hazard) Falls reduction – HWBB role to look strategically and address tri-partite prevention (muscle tone/ drugs/ environment)
  21. 21. Example: Cold Homes The Marmot Review team special report on cold homes and health concluded that there is a strong relationship between cold temperatures and cardio- vascular and respiratory diseases. It noted that cold housing;  increases the level of minor illnesses such as colds / flu  exacerbates existing conditions such as arthritis and rheumatism  negatively affected mental health  is related to excess winter deaths
  22. 22. Public Health – Vision for HWBB  “By giving local govt public health resources …can create healthy places to …grow older in, with new partnerships in important areas, such as housing.”  “Neighbourhoods and houses can be better designed to support people’s health, such as by creating Lifetime Homes” Housing is noted as a factor that drives health inequalities White Paper, Healthy Lives, Healthy People 2010
  23. 23. Heath, housing and care: ‘The triangle of independence’ 23 Enabling housing & environment Good health Social networks and care Independent person Services in one area fail the person if other parts missing Evidence on key reasons for loss of independence are inter-action between health, social, housing Multi-disciplinary approach more successful. Housing often missing link
  24. 24. Integration vision at the top  Health Minister, Norman Lamb at ADASS/ ADCS “People need to be able to return to a home [after hospital admission] that is safe, warm and meets their needs, and this is particularly important in the case of older people. In order to achieve this health, housing and social care must work in partnership.”
  25. 25. Care Bill Amendments 9th Oct Lord Howe “…housing, along with health, and care and support, should be considered as the three legs of the stool. Housing is a wider determinant of health..[it]can have an enormous impact on your health and well-being. To reflect this, the “suitability of living accommodation” is listed as part of well-being in Clause 1(2).  Amendment 12 clarifies that housing is a “health- related” service, and that both local authorities and the NHS are required to promote integration between care and support, health and housing. “
  26. 26. Integration Transformation Fund  £3.8 billion announced by DH in July 13 spending review  Stated aims is to bring about integration of health and social care  described as a ’single pooled budget for health & social care services to work more closely together in local areas based on a plan agreed between the NHS & local authorities’.  Plans for use of the pooled monies to be developed by CCGs and local authorities (usually top tier) and signed off by the local Health and Wellbeing Board
  27. 27. Integration Transformation Fund £1.1 billion Existing transfer from health to social care (from 2014- 15) £130 million Carers’ Breaks funding £300 million CCG re-ablement funding c. £350 million Capital grant funding (including £220m of Disabled Facilities Grant) + new specialist housing funding £1.9 billion from NHS allocations Includes funding to cover demographic pressures in adult social care and some of the costs associated with the Care Bill. Includes £1 billion that will be performance related, with half paid on 1 April 2015 (anticipated that this will be based on performance in 2014-15) and half paid in the second half of 2015-16 (which could be based on in-year performance). £3.8 billion
  28. 28. Timeframe August to October 13: Initial local planning discussions and further work nationally to define conditions etc November/December 13: NHS Planning Framework issued December 13 / January 14: Completion of Plans March 14: Plans signed off
  29. 29. Housing Solutions Current housing stock  help with home adaptations  ‘handyperson’ services to do small but crucial tasks/ safety/ security/ falls/ aids  vision for wider home improvement agency role to serve (large majority) owner occupied sector  Cold homes initiatives  Hospital2home making housing link  Information & advice to enable self help
  30. 30. Housing Solutions Future homes - recommended  Build new homes to Lifetime Homes Standards*  Design Lifetime Neighbourhoods  Creates flexible, inclusive places for all ages *Applied in London to date
  31. 31. National Housing Solutions  Stimulate better specialist provision  HAPPI reports/ DH money  DH money adaptations  DCLG money HP  Independent information & advice about housing and care options / empower OP as informed consumers – FirstStop
  32. 32. Housing: What makes a good place to live?  Good design of the home : Adaptability, flexibility, space standards  Location: Neighbourhood accessibility/ features , transport, shops, services, social opportunities, proximity to family & friends, safety, security, outdoor space
  33. 33. Research: What makes a good place to live?  Access to services: to practical support for daily living at home  Wider social factors: history, identity, status
  34. 34. Pioneering a Vision of Active Ageing Vision and shared values across sectors:  choice and self determination in later life  enable older people to remain active and socially engaged  enable independence and quality of life  older people viewed as a positive contributor  home vs 'accommodation' - acknowledgement that home is more than bricks and mortar
  35. 35. Looking forward together  Adopt a positive, healthy & active ageing vision and ethos across health, housing & social care  This will underpin integrated planning It is all our futures…..
  36. 36. A Story  Mr H – lived in small, cold, damp house - disrepair, uneven floor, steep stairs  Fell– hip fracture, hospitalised  Discharged to living room - sleeping on sofa, catheterised/ using commode  Two carers twice a day Three readmissions due to infections resulting from lack of bathing/ hygiene issues arising from this ‘living’ situation
  37. 37. Care & Repair Somerset West Organised re-housing – no further admissions, reduced care package. Cost benefit - health*: Prevention of the hip fracture £12,000 3 emergency admissions £7,782 Cost benefit social care* Saving £5,876pa * PSSRU Unit Costs of Health and Social Care (2011)
  38. 38. Care & Repair Weston-S-Mare Miss C fell trying to open a window and on floor for hours before helped. 4 days in hospital, discharged home alone/ no care unable to get out of bed/ use WC, hence readmitted 3 days later. C&R worker arranged for pendant alarm and neighbour key holder, self closing hinges on windows + other falls reduction, special chair/ equipment
  39. 39. Care & Repair Weston-S-Mare NHS cost benefit of earlier intervention 2 x unplanned hospital episodes @ £2,334 per episode £4,668 2 x emergency transport £520 Total £5,188 Potential social care savings Prevention of residential care admission c£28,000+ per year
  40. 40. Information to enable self help  ‘If only I had known..’ reports Plus six Housing and Health Condition practical guides then Click on Home from Hospital  Hospital2Home pack - Briefings & mailing list – send your details to
  41. 41. HWBB – key to commissioning  Unless housing interventions (and provision such as these schemes) are included in the plans for the Integration Transformation Plans there will be costly consequences for health and social care  Unless HWBBs influence wider housing & Planning decisions, the right homes will not be built to enhance the health of future generations, let alone meet the current and approaching needs
  42. 42. Evidence and Resources: Misc  The Real Cost of Poor Housing - BRE/ CIEH  Better Outcomes, Lower Costs, Heywood F, ODI  Health Risks and Health Inequalities in Housing: an Assessment Tool Prof. Tim Blackman Housing LIN  Survey of English Housing, DCLG (annual)  Time to Adapt: Home adaptations for older people, Care & Repair England  A Perfect Storm? An ageing population, low income home ownership and decay of older housing, C&RE  Housing & Ageing Alliance: