The document outlines plans to transform housing support across Leicestershire through a new integrated service called Lightbulb. Lightbulb will provide a proactive and targeted approach to addressing housing needs, with the goals of improving health outcomes, reducing costs to health and social care, and creating a better customer experience. Key aspects of Lightbulb include establishing Housing Support Coordinators, a Hospital Housing Enabler team, and a holistic housing assessment. Pilots of Lightbulb services demonstrate reductions in service usage, falls, and delayed hospital discharges as well as improved customer outcomes.

1. Transforming Housing Support
Across Leicestershire

2. • Housing Offer to Health 2013 - Leicestershire’s HWB Board recognises opportunities to
capitalise on the part housing plays in maximising health, wellbeing and independence
in the home.
• £1m Transformation Challenge Award from DCLG - to transform housing support into a
new integrated offer – including a new Hospital Housing Enabler service specifically to
support hospital discharge
• National and local strategic drivers support the case for Lightbulb service
transformation
– Areas being encouraged to think strategically about use of home adaptations and
technologies through the BCF
– Leicestershire’s ageing population; increased demand on services
– Costs to NHS of poor housing, falls and LTC are significant
– DFG work can delay the need for residential care and is cost effective but DFG
process can be unnecessarily lengthy
– Unified Prevention Offer in Leicestershire’s Better Care Fund
– Leicestershire Adult Social Care Strategy; preventing, reducing, delaying need
– Home First Workstream of the Leicester, Leicestershire and Rutland Sustainability
and Transformation Plan
HOUSING OFFER TO HEALTH

3. Our vision for Health and Care Integration
in Leicestershire
We will create a strong, sustainable,
person-centred, and integrated health
and care system which improves
outcomes for our citizens.

4. LIGHTBULB AND CUSTOMER EXPERIENCE
Initial customer insight project 2015 followed by ongoing engagement through
insight questionnaire:
•30% don’t feel their voice would be heard about how best to meet their needs
•Health, housing and social care not seen as separate services; 95% of
respondents want a joined up approach & less people to deal with
•Customers would welcome a proactive approach
•Local dimension to services is important
•People are prepared to pay for what they need if charges are fair and
transparent

5. THE LIGHTBULB OFFER
• The lightbulb philosophy, offer, operating model and all processes within it have been
co-designed with Districts
• The offer is a targeted, proactive approach including via GPs and other health/care
professionals such as those in integrated locality teams
• Early assessment and triage of housing issues at key points of entry
• Hub and spoke model - integrated locality Lightbulb team in each District Council area
offering:
• Minor adaptations and equipment
• DFGs
• Wider housing support needs (warmth, energy, home security)
• Housing related health and wellbeing (AT, falls prevention)
• Planning for the future (housing options)
• Housing related advice, information, signposting
• Common functions (management, performance, Lightbulb development etc) will sit
within the central ‘hub’

6. THE LIGHTBULB OFFER
• New Housing Support Co-ordinator (HSC) role encompasses functions currently
carried out across District and County Councils - supported by OT and technical
officer expertise (the locality team)
• HSC job role will include trusted assessor element, supported by competency
framework – countywide training package being developed
• Customer focussed assessment and solutions through the Housing MOT
checklist
• Offer supports both step down from hospital and step up in community
settings
• Integrated working with other key stakeholders such as community fire and
rescue/home safety teams also in place

7. THE LIGHTBULB OFFER
• Lightbulb staffing model based on demand analysis across the county
• Includes recognition of Leicestershire demographic trends (e.g. population
aged 65-85 is projected to grow by 56% by 2037 and 85+ population by 156%)
and an assumption of some proactive uplift in demand, due to new service
offer/channels.
• Funding model based on redirecting existing resources , which currently sit
across different organisations/contracts/services.
• This includes historical staffing resources associated with processing DFGs.
• Key funding streams were identified across Adult Social Care and District
Councils that will form the ‘Lightbulb pot’ which are being redistributed based
on the new offer and demand model.
• Lightbulb Programme Board and Steering Group critical to developing the
model and funding approach across multiple partners

8. HOSPITAL HOUSING ENABLER TEAM
• Central part of Lightbulb Offer
• Targeted to a key Better Care Fund aim and metric e.g. delayed transfers of care
• Housing Enablers & Community Support workers based in hospital settings, both
acute and mental health
• Quickly established as essential members of integrated discharge team
• Seek a wide variety of innovative and pragmatic housing solutions
• Access to budgets to help with rent deposits & furniture
• Formal evaluation using PI care and Health data and simulation modelling
• Links with wider Lightbulb offer and Housing Support Coordinator role
• Excellent results!

9. TESTING THE NEW MODEL
• We have tested :
– A targeted, preventative approach, including with GPs
– Integrated processes for the delivery of Disabled Facilities Grants (based on
lean principles)
– The Hospital Housing Enabler (discharge focus)
– Our new holistic Housing MOT with a wider, joined up support offer
• Pilots have helped to:
– Inform the final operating model for the integrated service pathway and
processes
– Develop the performance framework, KPIs and data capture to evaluate the
impact of housing interventions on an ongoing basis
– Capture measurable benefits, including savings for housing, health and social
care and the benefits to individuals
– Seek political and managerial buy in, based on evidence, including via case
studies
– Inform the financial model for the service and the under pinning demand
management analysis

10. BENEFITS OF CHANGE TO THE SYSTEM
• Lightbulb delivery costs, including Hospital Housing team approx £1m pa
against a potential £2m pa saving to the Leicestershire £ and wider health
economy
• Pilot Lightbulb service evidences measurable savings to health and social
care through
– Reduction in service utilisation (health and social care)
– Reduced admissions
– Reduction in A&E attendance
– Reduction in Delayed Transfers of Care
– Falls prevention
– Targeting patients with long term conditions
• Projected savings on DFG delivery costs through more efficient processes
and staffing efficiencies

11. BENEFITS TO CUSTOMERS
• One clear, consistent offer across Leicestershire
• Simplified journey with less waiting time
• Wider offer through the Housing MOT checklist
• Evidence of improved outcomes across a number of domains through
Lightbulb pilot:
– Physical and mental health
– The home environment (repairs, hoarding, suitability)
– Home security (risk of crime, safety measures)
– Personal safety in the home (fire safety, phone access, lighting)
– Getting around the home and garden (risk of falls)
– Managing in the home (AT, aids, equipment, adaptations)

12. BENEFITS TO CUSTOMERS
• Proactive, targeted approach reaching those that need support earlier and
delaying/avoiding crisis
• Case studies demonstrating customers are at the centre of the process.
Positive feedback through pilots
• Individuals helped to come home from hospital as soon as they are medically
able

13. The Current Journey The Lightbulb Journey
Mr T was discharged from hospital following aortic valve replacement surgery. Mr T’s
wife contacted the Customer Service Centre for assistance with bathing:
• Positive customer experience
• Holistic assessment included support
to claim attendance allowance, falls
prevention advice
• More handoffs and longer waiting
time
• Single issue approach
BENEFITS ILLUSTRATION

14. Evidence of outcomes –
Housing support co-ordinators
• Over a period of 18 months, the Housing Support Co-ordinator pilot helped
265 residents with support for their housing needs
• On average each resident benefited from 3 housing support interventions
(excluding advice and signposting)
• 11% cases analysed using the NHS number and PI’s Care and Health Trak tool
• This showed a reduction in service usage of 66%
• Two months post intervention saw adult social care costs reduced by 23%
• Scaled up to include all potential Housing Support Co-ordinator cases, this
could lead to cost savings of up to £250,000 to Adult Social Care per year
• 18 cases analysed where residents had previously fallen. 17 reported no falls
since they received their interventions
• A reduction of 1 fall per year for these 17 people alone would result in a cost
saving of £21,000 per year for the local health and care economy
• All reported feeling safer and more confident around the home

15. Evidence of outcomes – Hospital Housing Enabler
• In 2016 / 17 UHL service received 349 referrals and Bradgate
Mental Health unit received 151
• Primary reasons for referral for UHL were homelessness and
home no longer suitable and for Bradgate Homelessness and
family refusing return
UHL service three months post intervention analysis on 357 patients
saw:
• - 57% reduction in A&E attendances
• - 54%reduction in A&E admissions
• - 27% increase in no activity
• - 84% reduction in NHS costs for this cohort of patients 3 months
post intervention – saving £222,000, scaled up this could mean a
potential £550,000 saved over 12 months

16. Evidence of outcomes – Hospital Housing Enabler
115 patients at the Bradgate Unit analysed saw:
•920 delayed bed days saved
•Of 40 service users who continued to receive support in the
community following discharge only one was readmitted
•Over 12 months the projected housing DTOC costs would be
£175,000 compared to £650,000; a potential reduction of £475,000
•Referrals to the Bradgate Unit have risen by 67% in last 6 months. In
contrast resolution times have reduced by 60% meaning despite the
rise in referral patients are receiving a speedier service reducing the
chance of delays

17. STAKEHOLDER MANAGEMENT & GOVERNANCE
• Joint SROs
– District Council CE & Director of Health and Care Integration
• Lightbulb Programme Board – director level
• Lightbulb Steering Group – operational level, subject matter
experts, wider stakeholders
• Housing and Health Members Advisory Group
• Programme Plan
• Detailed Governance Planner for business case approval and
financial modelling assurance
• Dedicated PMO team, hosted by a District Council
• Comms resource/comms plan

18. STAKEHOLDER MANAGEMENT & GOVERNANCE
• Constant, intensive engagement with individual districts
including regular:
– Member engagement
– Programme Board Officers
– District CEs and s151 Officers
• Maximum use of TCA grant spanning 2 financial years
• Complexity of (conflicting) DFG guidance and associated
allocations issues during the programme period
• Recognition of local factors and differences
– Different historical arrangements for DFG processing and cultural
differences in service offer
– Different starting points/appetites for change
– Different levels of demands and financial pressures
– DFG allocations don’t necessarily match actual demand by District

19. SUPPORTING INFORMATION

20. Case study
• GP Referral to Lightbulb for 89 year old lady, blind in one eye, has had falls previously and
remains at risk of further falls
• Uses a stick and furniture to mobilise around her home
• Had been reluctant previously to have any involvement from services
• Housing Support Coordinator visited and the Housing MOT identified a range of support
needs and solutions:
– Community equipment including perching stool for kitchen to make it easier to prepare
meals and wash up
– minor adaptations to help her to get around her property more safely and minimise the
risk of further falls
– assistive technology (lifeline), giving her husband the peace of mind that he could go out
in the knowledge that his wife could call for help if needed
– sensor lights to help her get to the toilet safely during the night, minimising the risk of
falling
– Home Fire Safety Check which identified a faulty smoke alarm
– CO2 alarm to improve home safety
– garden clearance to reduce the chance of her becoming a victim of crime or anti social
behaviour and enabled her to enjoy the garden again
From the referral date to the completion of the all work was four weeks, involved two visits in
total by the Housing Support Coordinator who organised all of the work to be undertaken.

21. Case study
• Patient admitted to hospital after being found by police wandering & confused
• Required a package of care before she could go home but carers would not go into property
because it was very cluttered and unclean
• Referral to Hospital Housing Enabler Team from the social worker within the hospital
• Multi Disciplinary Team meeting arranged including Housing, Social worker and specialist
discharge nurse
• Patient medically fit to be discharged and an interim residential care placement was being
sought
• Hospital Housing Enabler team worked with the patient and arranged for the property to be
deep cleaned and for main access areas to be cleared in order for the care package to be put
in place
• The team have access to a small budget to fund this work; without this funding the only
avenue would be to go down an enforcement route against the individual
• Due to intervention from the team, the patient only spent 5 days in the interim residential
care placement before being able to return home with a care package in place
• Additional support at home was also provided by the team for the first few weeks following
discharge
• Without the team’s intervention the patient would have remained in residential care while
enforcement action was taken against her regarding the condition of her property
• As well as avoiding the anxiety and upset this would cause for a confused individual, the
team’s intervention has saved an estimated £8,500 in avoided residential care costs by
enabling her to return home at the earliest opportunity

22. The Lightbulb offer and what happens where
Locality Lightbulb team:
•Assessment and ordering minor adaptations
and equipment
 Bathing aids
 Ramps
 Grab rails
 Stair rails
 Bed chair raisers
 Perching stools
 Trolleys
•Assessment and delivery of DFGs
 Trusted Assessor
 OT
 Technical work
•Assessment and resolution of wider practical
housing support needs
 Warm homes
 Energy efficiency
 Handyperson
 Home security
•Housing related health and wellbeing
 Assistive technology
 Falls prevention
 Advice and signposting
 Accessing local support services
• Planning for the future
 Housing choices and options
• Advice, information, signposting
 LAC
 First Contact
Supported centrally by a countywide hub:
•Overall management of the Lightbulb
pathway (Lightbulb Service Manager)
 Strategic oversight and
management of locality hubs
 Links with wider prevention offer
 Proactive targeting/offer to
health
•Countywide operational management of
locality teams (Senior HCS x2)
 Resilience planning, staff cover
 Line management of HSCs (matrix
management arrangements)
 Clinical supervision of trusted
assessor function
•Performance management
 Gathering and analysis of agreed
datasets
 Production of reports for local
accountability
•Lightbulb development
 Single supplier lists
 Countywide SLA for RSLs
 Cost effective solutions (eg
modular ramping)
•Admin and processing of minor adaptations
works
•Management of handyperson service
•management of any externalised
contracts/supplier lists etc
•Warm homes specialism?
•Assistive technology?
Contact and triage - Adult Social Care
Customer Service Centre and First
Contact:
•Housing expertise based at earliest
point of contact (Adult Social Care
Customer Service Centre/ First Contact)
•Housing informed triage, managing out
simple cases at this point of contact and
before they reach the locality
•An enhanced self help prevention offer,
including housing (through CSC and First
Contact)
•Suitable cases are passed to the locality
following triage
•Links and referrals with other District
council teams
•Hospital Housing team; resolving
housing issues to avoid delayed transfers
of care
Customer focused, preventative solutions

23. DFG process
Stairlifts
Pass to admin to prepare approval letter
then to manager for sign-off
Non-complex DFG
Worker emails stairlift
company with details of
requirements
Stairlift company
advises locality works
complete
Stairlift company fit
Stairlift company visit
Worker Completes
application form if necessary
with customer
Worker completes at first visit (depending on identified need):
Initial MOT assessment, PTOR, Authority to Act, proof of
benefits, draft DFG application, proof of tenure, SL Quote
Contractor visits and quotes
T.O arranges contractor (from
framework)
Worker reassigns case to Tech Officer who visits
customer to prepare scheme and complete DFG
application and collates documents for TOR
Works begin
Contractor advises
locality works complete
T.O. visits to get quotes / complete TOR / finalise
application then checks quotes against scheme /
pricing guidelines
T.O. arranges architect visit who prepare s scheme
/ arranges planning and building control if
necessary
OT passes case to T.O. Joint visit organised if
necessary. T.O. advises customer of Architect and
quotes procedure and assists if required
Complex / Children’s DFG
Possible interim visits to check work.
These can be with OT or Architect or
building control
Locality admin: update DFG / IAS / FC records, arrange
payment of invoices, write and send closure letter,
contact customer for evaluation feedback, process any
grants, collate performance data
From HSC / OT
process
Worker visits to check works
complete and to sign-off
Final test of resources completed

24. BCF Theme 1 – Unified Prevention Offer
• Developing a model for social prescribing and a core menu of prevention
services that sit behind the social prescribing “front door”.
– Design a core menu of effective prevention services to wrap around
integrated locality teams.
– Design a consistent approach to social prescribing – proactively targeting the
menu of prevention services to specific cohorts of people who will most
benefit from them in the community.
• Social prescribing definition – a means of enabling primary care service to
refer patients with social, emotional or practical needs to a range of local,
non-clinical services, often provided by the voluntary and community
sector.

25. Theme 1 – Unified Prevention Offer
• First Contact Plus
– Provides one point of contact for a range of wellbeing support
– Facilitates early help via information, advice and onward referral to a broad
range of preventative services.
– New web-based referral system which will facilitate efficient clinical referral
(e.g. from GPs) and also self-referral and “self-help” via public facing options.
– Clinical referrals launched Nov 16.
• Local Area Coordinators
– Work within the community to identify vulnerable people and resolve low
level needs, to avoid escalation to require more costly/formal services.
– Piloted in 8 areas within Leicestershire.
– Independent evaluation completed in Autumn 2016
– Business case developed during December 2016 ,with options appraisal for a
part or full county roll-out.

26. Theme 1 – Unified Prevention Offer
• Lightbulb housing offer
– Joined up support across housing, health and social care to keep people safe,
well, warm and independent at home for as long as possible.
– Business case signed off by Lightbulb Programme Board.
– Phase 1 roll-out in to begin on 1st
April in Blaby area.
• Falls pathway
– Developing a consistent approach to the prevention and treatment of falls in
residents over the age of 65 in LLR.
– Innovative Falls Risk Assessment Tool implemented with EMAS, now an app based
tool, with Leicestershire’s good practice being considered by other parts of the
country.
– Business case developed – sign-off process during March/April.
• Carers Services
– Support for carers to care efficiently and safely; to look after their own health and
well-being; to fulfil their education and employment potential; and to have a life
of their own alongside caring responsibilities.

27. For Further Information about Leicestershire’s
Integration Programme
Contact:
Cheryl Davenport
Director of Health and Care Integration
Cheryl.Davenport@leics.gov.uk
0116 305 4212
07770281610
Visit: www.healthandcareleicestershire.co.uk
Follow: @leicshwb
Stakeholder Newsletters at:
http://www.healthandcareleicestershire.co.uk/health-and-care-integration/health-
and-care-integration-newsletters/