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Jeremy Porteus Ageing Well presentation
- 1. Innovative Housing Options Jeremy Porteus – 25 January 2011
- 2. Why make thecase between health and housing? • A fall at home that leads to a hip fracture costs the state £28,665 on average – over 100 times the cost of installing hand and grab rails • Where it is appropriate, postponing entry into residential care for one year saves an average of £28,080 per person • A hospital discharge service that enables older people to return to a safe and suitable home environment saves over £100 per day – the amount charged to local authorities when patients ‘block beds’ (source: Fit for Living Network Position Statement, hact 2010)
- 3. What are theperceived challenges for you as an organisation? • What is your future vision for care – residential, home care, intermediate care, respite care, extra care? • Is housing development or management a key component 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 foster innovation, diversification and development? • How to realise and evidence benefits eg dementia • Motivate staff/create a learning and knowledge sharing environment for workforce – sector care academy? • Regulation and inspection – lighter touches, self- assessment but balance against safequarding.
- 4. What are thehealth drivers for good quality housing with care? • over 15 million people in England with a long term condition, includes heart disease, diabetes, asthma, respiratory problems and dementia • proportionally far higher users of NHS and PCTs • Account for 55% of GP appointments, 68% of outpatient appointments and 77% of inpatient bed stays • more likely to be older and have other complex needs leading to disabilities which require care and/or support • they live in poor housing, which could exacerbate their condition and make them more likely to be admitted to a care home (recent Sir Michael Marmot Review, 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 medical condition or disability that requires specially adapted accommodation (2006) • The most common reason for older people considering a move is that their home is inappropriately adapted for their mobility health needs (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
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- 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 outcomessought • 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)
- 17. 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
- 18. 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
- 19. 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
- 20. Revenue Funding • Blockcare 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?
- 21. 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
- 22. Going Forward • Affordablerent 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
- 23. Future arrangements • Marketpresence: 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?
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