Jeremy Porteus, Director of the Housing LIN, discusses the importance of integration and collaboration between housing and health partners. The Housing LIN works to improve partnership working through online resources, regional learning labs, and papers on innovative policy. Key issues discussed include the aging population and increasing need for housing support, as well as opportunities for housing to support health goals through adaptations, specialist housing, and partnerships with the NHS. Examples of successful partnerships that reduced costs and improved outcomes are provided.

1. Jeremy Porteus
Director
@HousingLIN
Integration and Collaboration:
Developing healthy and sustainable
partnership working with housing
Manchester, 10 May 2017

2. About the Housing LIN
• Previously responsible for managing the DH’s
£227m Extra Care Housing Fund and £80m
Telecare in England grant
• 40,000 members across housing, health and
social services to help improve partnership
working and integration on housing and care
• Essential online resources on housing with care
for older people to support commissioners,
funders and providers in market development,
innovation and investment
• Publish papers to brief on latest innovative policy,
research and practice developments in housing,
care and support for older people
• 10 regional ‘learning labs’ in England and Wales
supporting local information exchange, peer-to-
peer shared learning and improvement activities,
and exemplar study visits (+ NW Leadership Set)

3. • APPG on housing and care - 10 key age-friendly ‘care ready’
design principles to live well at home
• Care Act 2014 – market shaping and better assessment for
wellbeing, duty to cooperate
• Next Steps and NHS 5 Year Forward View and vanguard sites –
NHS England quick guides
• Making best use of NHS Land – NHS estate asset could deliver
£6bn residential for supported housing (NHF)
• Housing White Paper – Getting
the right plans in needs of older
and disabled people
• Adult Social Care Green Paper
(forthcoming) - additional levers for
integration, greater choice and control?
At a glance: what’s happening nationally?

4. Making integration work: building capital
• £2bn boost for adult social care announced
in March Budget
• The shared statement on the health and
social care Better Care Fund makes
reference to £431m Disabled Facilities
Grant and other capital grant funding
(c£135m) per annum
• DH £400m Care and Support Specialised Housing Fund,
administered by the HCA and GLA.
• DH £25m Housing and Technology Fund and £100m NHS
England capital to support Transformation Care Partnerships
• HCA 2016-2021 Affordable Housing Programme – Continuous
Market Engagement
• Healthy New Towns, including Runcorn and Fylde in the NW

5. Memorandum of Understanding
Key objective
• “Integrated health, care and support, and housing
solutions could make best use of the budgets
across the NHS, local authorities and their partners
to achieve improved outcomes for less; for example,
drawing on the Better Care Fund to support service
transformation”.
Key actions
• System leadership: LAs and their role in supporting
health & wellbeing
• Knowledge & analysis: population data and health ‘intelligence’ eg
Joint Strategic Needs Assessments (Public Health)
• Developing solutions: workforce development, primary care and
preventative services, support people with complex needs

6. Some facts and figures
• There is a rising older population across the region: the
over 65 population across the North West is set to increase by
nearly one-third (31%) between 2015 and 2030
• There are increasing numbers of older people living with
dementia and other long term conditions, many of whom
will be living in social housing not specifically designed
for older people: The number of older people with dementia
in the North West is projected to rise from 88,000 in 2015 to
over 135,000 in 2030, representing an increase of 54%.

7. What does supply look like?
• Assuming there is no change in
policy and provision of alternatives
to residential care, the number of
older people living in care homes in
the North West is projected to
increase by 55% to over 67,000
between 2015 and 2030
• There is still an undersupply of extra
care housing, especially for sale.

8. What high impact ‘dividends’ should you be looking for?
• Support acute sector with preventing
avoidable/unplanned hospital
admissions to achieve cost diversion
eg falls prevention
• Enable easy transfer of care back
from to enable speedy hospital
discharge to reduce inpatient spend
• Help improve ‘patient experience’ in
a setting of their choice
• Other: End of life care, dementia
care, medication management,
healthy living/lifestyle choices…

9. Challenging operating climate: NHS
disinvesting to achieve financial balance
• Two thirds of NHS Trust behind on
their savings.
• CCGs need to accelerate
delivery of their Sustainability and
Transformation Plans in
order to “invert triangle of care”
• Lean thinking: reduce management overheads, decommission
services, renegotiate contracts, charging for lifestyle health
choices, disposal of land/NHS estate, create public/private
partnerships, engage 3rd sector/social enterprises
• But, providers tend to hold much smaller contracts, ie less than
£100k. Large contracts still predominantly held by the NHS.

10. It’s all about long term care management!
Total NHS budget spend across for
people with long term conditions (LTCs)
is over £70bn – nearly £40bn on older
people, £20bn on MH, nearly £10bn on
people with learning disabilities, plus spend on physical disabilities
• LTCs represent nearly 70% of health & social care spend
• LTCs represent nearly 80% of in patient bed days
• LTCs represent 55% of GP appointments
• LTCs represent nearly 70% of outpatient and A&E attendances
• Proportion with LTCs increases with age (70% over 85 have LTCs)

11. Where can housing make a difference?
To stop people entering system
• Public Health – exercise, eating, drinking, etc
• Health Care – the right treatment and preventive measures
(stroke recovery or falls prevention)
• Information and Advice to support self care/management
To reduce demand within the system
• Recovery, re-ablement, recuperation
• Right level of health care at home/out of hospital
• Partner with community-based organisations and housing
Wider environmental solutions
• Better housing choices, energy efficiency, fuel poverty, telecare,
aids & adaptations, equipment & advice

12. Housing - task orientated: outcome focussed
• Specialist housing - delay move to costly residential or nursing care
• Housing support - to prevent homelessness, support wellbeing
• Mainstream housing – design quality and accessibility (such as
HAPPI) to offset future health and social care costs
• Home improvement agencies and handyperson services - deliver
aids and adaptations that can reduce hazards, falls, fuel poverty,
support hospital discharge, reduce hospital readmissions
• Environmental health - tackle chronic disrepair and environmental
conditions that can lead to a long term condition (mental health),
disease (COPD) or increased health inequality
• Regeneration and renewal – promote sustainable health outcomes
via health neighbourhoods/age-friendly communities
• Spatial planning - support housing growth and link to strategic local
needs eg STPs, JSNAs, NHS estate strategies

13. Housing and health partnerships (1)
Adaptations to prevent hospital admissions - Wigan
Wigan Council and Wigan Borough CCG are piloting a new, non-means-
tested, Home Adaptations Grant in order to reduce unplanned hospital
admissions. The service delivers major adaptations in private sector
homes using the DFG. The focus is on providing showers, stair-lifts and
facilitating access to the home using modular ramps with an average cost
of around £5,500
Airedale Telehealth Vanguard
East Lancashire CCG is a partner in the Airedale and Partners health in
care homes vanguard, which aims to improve the quality of life, and end of
life experience of thousands of nursing and care home residents. The
vanguard is being delivered with a number of organisations including
CCGs and their member practices, NHS providers, care home providers,
social services, the third sector, technology partners and academic
partners including the University of Bradford.

14. Housing and health partnerships (2)
Extra care housing – Hare Hill, Rochdale
Hare Hill is Rochdale Boroughwide Housing's flagship affordable housing
development for the town's ageing population. The purpose built extra care
scheme consists of 43 apartments and is the first scheme of its kind to be
provided within the Rochdale area, inc supporting people with dementia
Healthy Homes Liverpool
The Healthy Homes programme was originally commissioned by Liverpool
PCT, and the programme transferred with public health to Liverpool City
Council in 2013. Healthy Homes Advocates visit properties in the areas
with the greatest health and housing support needs and gather information
about the occupants and their health needs, as well as the condition of
their homes.

15. An example of award-winning practice –
Protheroe House, Bruce Grove, London
• Early hospital discharge and reduces bed blocking – Approx. saving of
£400 - £700 pc pw on excess bed days
• 72% return home or other appropriate accommodation
• 30% reduced care packages
• Aids and adaptations installed at home during admission
• 95% of move on’s avoided Residential Care
• 20% of customers previously unknown to ASC
• Improved quality of life through confidence and
reskilling
• Continued therapy and support at home if
necessary via MDT onsite referrals
• Reablement offers an improved ‘home from home’ experience

16. Space to operate or innovate?
• At a strategic level, do you
understand the health and social
care structures in the
communities you work in?
• Are you represented in the
leadership of NHS Trusts, Clinical
Commissioning Groups, Care
Pathways etc
• Do you have a local
Memorandum of Understanding?

17. Imaginative solutions
• NHS and others back partnerships with housing associations that
offer long-term health, care and housing benefits = estimated £1b
• Smith Institute research found billions could be saved by
admissions avoidance and reduced length of stay if NHS land and
assets were used for step-down facilities or supported housing
• On-going revenue stream for NHS from its
estate through development of affordable
housing
• Work with housing associations, local
authorities and others to develop:
• Reablement/intermediate care/hospital at home
• Supported housing – eg mental health
• Specialist housing – eg extra care
• General needs housing

18. Useful Housing LIN resources
Health Intel
Comprehensive online resources and
peer-to-peer information exchange portal
to share latest policy and practice examples
that make the connection between health
and housing
www.housinglin.org.uk/healthandhousing
Housing LIN report for KSS AHSN
•Health and Housing: Building the Evidence
Base
NHS England Quick Guide
• Better use of care at home guide
on health and housing

19. Thank you
c/o EAC
3rd Floor, 89 Albert Embankment
London
SE1 7TP
email: info@housinglin.org.uk
tel: 020 7820 8077
website: www.housinglin.org.uk
Twitter: @HousingLIN