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 Sue Adams, CEO, Care & Repair England
- 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
Peoples Housing Activism Policy shaping: Older peoples housing
Chair Housing & Ageing Alliance, Home Adaptations Consortium,
HCA, DCLG, NHS England Integration Task Group, DH Care Legislation
reform
- Brief Why integrate ? key drivers Current state of play at
higher level policy level Immediate challenges Real world
example
- 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..
- Better Homes = Healthier Workers Examples: Philanthropic Garden
Villages/ Garden Cities Results: Healthy, sociable places to live =
better health
- 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
- 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 Kings Fund
- 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
- 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
- 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 c600m pa (BRE &
CIEH 2010) Good housing leads to good health toolkit from CIEH
- 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
- 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
- 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 Housings potential contribution to this is significant
*Ready for Ageing? Lords Inquiry 2013
- 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.
- 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
- 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
- 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
- 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
- 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
- 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)
- 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
- 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 peoples
health, such as by creating Lifetime Homes Housing is noted as a
factor that drives health inequalities White Paper, Healthy Lives,
Healthy People 2010
- 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
- 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.
- 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.
- 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
- 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
- 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
- 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
- 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
www.lifetimehomes.org.uk
- 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
www.firststopcareadvice.org.uk
- 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
- 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
- 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
- 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..
- 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
- 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)
- 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
- 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 c28,000+ per
year
- Information to enable self help If only I had known.. reports
Plus six Housing and Health Condition practical guides
www.careandrepair-england.org.uk then Click on Home from Hospital
Hospital2Home pack - http://housinglin.org.uk/hospital2home_pack/
Briefings & mailing list send your details to
info@careandrepair-england.org.uk
- 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
- 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: www.housinglin.org.uk/AboutHousingLIN/HAA/