Providing an alternative pathway

- the value of integrating

housing, care and support

James Berrington

EUKN Policy Lab Netherlands

‘Housing and Care’

3 September 2013

Housing - a key

determinant of health

Housing conditions affect people’s health.

Inadequate housing causes or contributes to

many preventable diseases and injuries,

including respiratory, nervous system and

cardiovascular diseases and cancer.

World Health Organisation (Europe) http://www.euro.who.int/en/what-we-do/health-topics/environment-and-health/Housing-and-health

• Look beyond basic health & safety of the home

to integrated services

Introduction

Report demonstrates:

• The enhanced value of integrated services

• The central role of housing

• Individuals get the care and support they need

• Savings from £2,946 to £17,992 per year

Case studies

• For health & social care audience

– Engagement through real individuals’ stories

– Focus on outcomes

• Builds on previous research

– Supporting People (housing related

support),£1.6bn annual investment = £3.4bn

savings

– HCA / Frontier Economics (capital investment

in specialist housing) - annual savings of

£639m

Report commissioner

National Housing Federation

• The voice of affordable housing in England

• Represent the work of housing associations

• Housing associations

– Independent, not-for-profit (may be charitable)

– State-regulated

• Members provide 2.5m homes for 5m+ people.

• Campaign for better housing

Report author

James Berrington

• Independent Consultant

• 25 years experience:

– National older & vulnerable people lead at

Homes & Communities Agency (government

housing investment & regeneration agency)

– Regulator of housing associations

– Manager & developer of specialist housing

Context

Health & social care

- in England

• Changing landscape – reform & restructuring

– Health, social care, local government, welfare benefits

• Movement of services toward communities

• Fiscal restraint

– NHS efficiency savings of £20bn required

– Reduced local authority funding & capital funding

– Increased local demands for social care

• Health services = free

• Care & support services = means-tested

• Housing = means tested

Health & social care

- new structures

• Clinical Commissioning Groups (Health led)

– services for community and secondary care d

• Health and wellbeing boards (Local authority led)

– Strategic leadership to improve health & wellbeing, through

locally set strategies

– Co-ordinating NHS, social care and public health at local

level (including encouraging close working with

commissioners of health–related services e.g. housing)

– Joint strategic needs assessments d

• Public health commissioning (Local authority led)

Outcomes frameworks

Nationally set frameworks set out domains for

improvement

• NHS Outcomes framework

• Adult Social Care Outcomes Framework

• Public Health Outcomes Framework

The case studies demonstrate how integrated

services deliver impact across all three

frameworks

Housing

- in England

• Housing strategies set by local authorities

– Ideally in close conjunction with social care, & based

on assessed needs

• Complications with two-tier local authorities

– Housing sits with Districts (lower tier)

– Social care sits with Counties (upper tier)

• Housing providers

– Local authority - affordable housing

– Housing associations - affordable housing

– Private sector

Housing and Health

• Homes & Communities Agency

– capital funding for specialist housing over 30 years, e.g.

£1bn 2008 - 2011 – o

• Department of Health

– capital funding for specialist housing since 2004 (mostly

older people), e.g. £200m+ 2013 – 2018 – o

• HAPPI Report - Housing our Ageing Population Panel for Innovation

– Produced by Homes & Communities Agency

– Government commission - by Department of Health +

Department for Communities & Local Government

Importance of integration

- 3 legged stool

• Growing importance

of ‘the home’ as a

place of treatment,

rehabilitation and care

• Management of long-

term conditions

becoming a way of

life for many

• Ageing population

Person

at home

Health

care

Social

care

Housing

Case studies

Anna

- Learning disability

Move from Institutional to community setting

Partners

• Yarrow

• Westminster Social Services

• Kingswood NHS Assessment

& Treatment Unit

• NHS psychologists,

psychiatrists, therapists

• Dolphin Square Foundation

Type of organisation

• Housing association

+ care provider

• Local authority social

care commissioner

• Health provider

• Health services

• Charitable foundation

Anna

- Learning disability

• Specialist house – Commissioned by Westminster City Council, planned with all

partners

– Capital funded by Dolphin Square Foundation

• Care & support services – Commissioned & funded by Westminster City Council, along with

NHS (health) continuing care funding

– Provided by Yarrow

• Impact – Prevented stay in assessment & treatment centre

– Prevented need for high levels of social care

– Annual saving of £17,992

Grace

– Older person, dementia

Positive move to specialist housing

Partners

• Accord

• Walsall Social Services

• Walsall Council joint housing

& social care allocation panel

• NHS services - GP,

occupational therapy etc

Type of organisation

• Housing association

+ care & support provider

• Local authority social

care services &

commissioner

• Local authority housing &

social care

• Health services

Grace

– Older person, dementia

• Extra care housing – Commissioned by local authority

– Developed and capital funded by Accord + central government

• Care services – Commissioned & funded by Walsall Social Services

– Individual budgets to purchase care services

– Provided by Accord

• Impact – Independence retained

– Delayed or prevented move to residential care

– Reduced hospital admission

– Potential social care saving £17,222 per year

Andy

– Mental health

Pathway from inpatient to independent living

Partners

• Look Ahead

• NHS Tower Hamlets

Clinical Commissioning

Group

• East London NHS

Foundation Trust

• Tower Hamlets Community

Rehab & Recovery Team

Type of organisation

• Housing association

+ care & support provider

• Health - Commissioner &

funder

• Health service provider

• Local authority social

care

Andy

– Mental health

• Housing – Developed and funded by Look Ahead

• Care services – Commissioned & funded by Health (Clinical Commissioning Group)

– Joint approach in contracting arrangement with local authority

ensures link between social care outcomes & clinical and health

outcomes

– Provided by Look Ahead

• Impact – Prevented need for residential care

– Reduced need for longer stay in high-support accommodation

– Overall saving of £241,670 over 18 months

Bruce

– Physical disability

Accessible housing & independent living

Partners

• Papworth Trust

• Huntingdon District Council

• Cambridgeshire County

Council

• Addenbrooke’s Hospital

rehabilitation team

Type of organisation

• Housing association

+ support provider

• Local authority (District)

- housing commissioner

• Local authority (County)

- social care commissioner

& provider

• Health - referral

Bruce

– Physical disability

• Accessible housing – Jointly commissioned by partners

– Developed and funded by Papworth

• Care services – Commissioned & funded by Cambridgeshire County Council

– Purchased by Bruce with his personal budget

– Provided by Papworth

• Impact – Reduced the need for social care

– Prevented mental health deterioration

– Saving of £15,230 per year

Beryl

– Older person, hospitalisation

Hospital to home reablement

Partners

• Midland Heart

• Leicester City Council

• University Hospitals of

Leicester NHS Trust

Type of organisation

• Housing association

+ support provider

• Local authority social care

commissioner & provider

• Health service – hospital

treatment

Beryl

– Older person, hospitalisation

• Beryl’s own home

• Reablement service – Commissioned, funded & provided by Leicester City Council Adult

Social Care in partnership with NHS Leicester City

• Floating support service – Commissioned by Leicester City Council Supporting People Team

– Provided by Midland Heart

• Impact – Return home from hospital as quickly as possible

– Prevented hospital readmission

– Saving of £1,360 per year

Lessons learned

What worked well

• Close partnerships between organisations

• Shared understanding of outcomes

• Focus on outcomes for individuals

• Innovation

• Staff open to doing things differently, thinking

beyond traditional service boundaries

• Understanding the value and importance of

housing (including specialist design)

Contribution of housing

associations

• Quality housing

• Accessible housing and neighbourhoods

• Specialist housing (with care & support)

• Housing adaptations

• Housing (floating) support services

• Safe and secure housing & neighbourhoods

• Sustainable, energy efficient homes

• Employment & training projects

• Community facilities

Potential Barriers

• Local authorities - budgetary challenges & organisational

change

• Health - major organisational change & budgetary

challenges

• Lack of knowledge of integrated service approaches

• Clinically-led nature of health service

• Political, professional and organisational barriers to

diverting budgets from acute to preventative services

• The above leading to retrenchment to ‘traditional’

systems and ‘safe’ working patterns

How to make it happen

- Short term

• Understand local service pathways

• Identify where housing can assist

• Identify what information is needed

• Talk to specialist housing providers & other

agencies – identify potential barriers, service

fragmentation, and solutions

• Open dialogue about impact of reduced

resources & potential service redesign

How to make it happen

- Longer term

• Local authorities:

– Include housing options in local market statements

– Establish register of adapted & specialist housing

– Health & wellbeing boards

• needs assessments to include housing

• plan for new specialist housing

– Information & advice services

• Jointly identify cost build-up areas in care &

health system - & identify housing solutions

Seeking legal requirement

for integration

• Care Bill

– Working through parliament

– NHF & others lobbying for legal requirement

for housing integration

– Providing an alternative pathway cited in

House of Lords debate

– Goes to House of Commons in Autumn

Integration = impact

Joint working between housing, health, &

social care can:

• Avoid or delay moves to residential care

• Reduce hospital admissions & avoid readmission

• Reduce demand for assessment & treatment centres

• Prevent the need for domiciliary care

• Prevent health emergencies, reduce A&E demands

• Prevent mental health deterioration

• Reduce health and social care costs

• Deliver better outcomes for individuals

Further resources

• National Housing Federation (2013) - Health, care and housing http://www.housing.org.uk/policy/health-care-and-housing/

• Housing LIN (2013) - Integration: healthy partnerships http://www.housinglin.org.uk/Topics/browse/HealthandHousing/Integration/

• Homes and Communities Agency & Frontier Economics (2010) -

Financial Benefits of Investing in Specialist Housing for Vulnerable

and Older People http://www.homesandcommunities.co.uk/sites/default/files/financial_benefits_of_investing_in_specialist_housing.pdf

• Homes and Communities Agency (2009 & 2012) – HAPPI Report

Housing our Ageing Population Panel for Innovation http://www.homesandcommunities.co.uk/ourwork/happi

• Department for Communities & Local Government (2009) - Supporting

people programme: financial benefits research https://www.gov.uk/government/publications/research-into-the-financial-benefits-of-the-supporting-people-programme-2009

Contact details

James Berrington

Independent Consultant

Housing, health, care, support

james.berrington@btinternet.com

+44 (0) 7989 968 955