Bridging the gap between housing,
health and social care
Jeremy Porteus
Director, Housing LIN
Glasgow, 4 June 2013
About the Housing LIN
• Previously responsible for managing
the DH’s £227m Extra Care Housing
Fund and £80m Telecare in England
grant
• 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
policy, research and practice
developments in housing, care and
support for older people
• Member of the Prime Minister’s
Challenge on Dementia Group
• 9 regional ‘learning labs’, dovetails
with ADASS regions in England but
also 1,507 members in Scotland
Housing for Older People in Scotland
• Review of Older People’s Housing (March 2013)
•
The Scottish Government is committed to enabling older people to remain
living in their own homes for as long as possible
• Age, home and community: A strategy for housing for
Scotland’s Older People 2012-2021 and delivering plan
(December 2011)
•
Older people in Scotland are valued as an asset, their voices are heard, and
older people are supported to enjoy full and positive lives in their own home
or in a homely setting.
Transforming health and social care
• Societal changes: demographic factors; consumer orientated; IT
literate but still many excluded groups
• Structural changes: Out with the old (SHAs/PCTs), in with new
(CCGs); Public Health into local government; creation of NHS
England and Public Health England
• System changes: outcome focussed – NHS Mandate, social care
and public health outcomes frameworks; HWBs & JSNAs
• Resource allocations: Health £20b efficiency savings; local
government reduced spend; housing related support revenue
support cuts; personal budgets/personal health budgets resulting
reduced spend; Care & Support Fund (Dilnot, self-funder/partnership
model) as well as welfare reform
• Policy priorities: Integrated care; care closer to home; prevention and
managing long term conditions; market facilitation, NHS asset
management; innovation/QIPP
• Health and social care in the media spotlight; Baby P, Francis
Report, Winterbourne View Review, Leeds hospital heart unit
• Brand reputation: NHS is safe! Social care?
Why integration matters - drivers for health and
social care system reform
Reduce Demand
• Prevent or reduce levels of demand e.g., acute (inpatient, A&E
and outpatient care), primary (community health) and social care
(residential, intensive home care, sheltered or extra care)
Reduce Costs
• Reduce unit costs e.g., tariffs for condition specific interventions
• Reduce costs of existing and new packages eg renegotiate block
contacts
• Reduce staffing costs/overheads, redesign service
Contributions from citizens
• Use of personal budgets, self-funder market
Different levels of prevention:
demand management
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 reduce demand within the system
• 3’Rs’ - recovery, re-ablement, recuperation
• Right level of health care
Partnership working to deliver improved outcomes
• Better housing choices, energy efficiency, tackling fuel
poverty, telecare, aids & adaptations, equipment &
advice
Making integration work: making housing count
• A consortia of housing providers have been meeting with the
NHS Commissioning Board (now NHS England) to formulate a
Partnership Agreement that recognises the role of housing
• Joint select committee report on Care and Support Bill
recommended extending the scope of what constitutes
wellbeing to include, safe and settled accommodation
• Department of Health £300m Care and Support Specialised
Housing Fund higher quality thresholds to deliver care ready
housing for disabled and older people that can improve health
and wellbeing
• Recent government statement on integration and a call for a
“pioneering” approach
• NHS Confederation briefing, Stronger Together, HWBs need
closer engagement with providers, including housing
Specialist housing: specialised solutions
• A change in social ethos is required
through public education
• Produce a clear definition of what
constitutes extra care housing
• Deinstitutionalization of older people
• Develop a more integrated health and
social care services, include extra care
• Allocate resources for specialist housing
to aid wider housing market
• Support professional development and
training
Understanding the older people’s housing market
• Public sector policy direction is still fostering new models of provision &
develop new capacity to reduce costs and improve outcomes. For
example:
i)
ii)
iii)
by a shift towards unregistered ‘housing’ accommodation with high
levels of support to replace traditional care home placements &
reduce hospital use for respite, assessment, rehabilitation and
intermediate care
through new housing based & domestic style models for dementia
care at all needs levels
a ‘de-institutionalisation’ of expensive health services for long term
mental health & chronic illnesses
And why? What are the drivers for change?
• Over 15 million people in England with a
long term condition eg heart disease,
diabetes, asthma, respiratory problems
and dementia
• Older people account for 55% of GP
appointments, 68% of outpatient
appointments and 77% of inpatient bed
stays
• Overall, the state spends £140b on older
people of which 6% is on social care, 35%
on health and 59% on welfare/pensions
• More likely to have other complex needs
leading to disabilities which require care
and/or support
What triggers a move in later life?
Capital and revenue investment
• HCA Affordable Housing Programme
Guarantee (deadline 21 May)
• DH £300m specialised housing fund
• DH £261m social care capital grant
(2013/2015)
• DH £40m contribution to DFG to support
reablement, more ahead?
• 3 million lives campaign for
teleare/health, but
• Impact of welfare reform and Supporting
People in England - new HB
arrangements and commissioning within
tighter eligibility criteria and increasing
self-funder market
• Use of equity release to move to
‘downsize’ to purpose-built ‘care ready’
housing and/or to pay for personal care
and support
Alternative funding sources: what’s new?
• Institutional lending, pension funds,
bond and/or social finance
• LA grants, loans and/or Special
Purpose Vehicle
• Other procurement frameworks
• Insurance-backed products
• Public/Private partnerships (new
PFI/LIFT shared risk arrangements)
• ‘Downsizer’ market - personal
equity/individual asset management
• Neighbourhood based solutions eg coproduction/community led or cohousing
• Other public capital/revenue eg
learning disability/mental health trusts
• Use of NHS Estate/ public land
disposal (Building a better Britain)
Developing age-friendly approaches
• Naturally Occurring Retirement
Communities – where there are
already older populations <35%
• Lifetime Neighbourhoods –
designing built environment
• Age Friendly Cities (WHO) –
investment in wider infrastructure
•
“That Government should make specific
provision in the National Planning Policy
Framework on planning for an ageing
society, to facilitate the supply of sufficient
housing for older people to meet the
demands of an ageing population and
overcome barriers to moving” (APPG)
• Strategic Housing for Older People:
planning, designing and delivering
housing that older people want
I-Care and I-Design: delivering better outcomes
I-Care
• Make best use of technology and
equipment – from 4th generation
telecare/health to Ipad/internet
• End of Life Care – avoid hospital
admission
• Preventing costly health interventions
eg, as a result of a fall
• Building effective social capital to enable
greater community engagement/informal
or family care/volunteering
• Less dependency on high cost care
I-Design
• Accessible and adaptable HAPPI homes
• Providing meaningful housing choices
and lifestyle aspirations to meet
personalisation objectives
Developing your Market Position Statement
• Working with DH, ADASS and IPC on
how might accommodation and care
for older people change over next 2030 years – use Housing LIN SHOP@
• What impact will changing wealth and
tenure on accommodation and
services older people might want as
opposed to might need
• What will the implications of levels of
personal equity held (Dilnot link)
• What policies/strategies in place for
Lifetime Neighbourhoods and future
adaptability?
• Are you clear what your core
business is in balancing choice and
safeguarding housing for older and
vulnerable people?
An Agenda for Scotland?
• What scope is there for better planning, commissioning and/or
access capital funding to promote innovation in lifestyle
choices for older people or stimulate a housing with care
market as an alternative to institutional provision?
• Can Age Friendly communities help partners such as not-forprofit, churches and statutory health and social care services
support more people in the community, meet growing demand
of an ageing population, any targets / cost-benefits?
• Is there the case for Extra Care for maximising independence
for people with dementia or is the future more residential care
and home based care and support?
• Are there other market opportunities such as aids and
adaptations, telecare, co-housing, homesharing, social capital?
• What strategies and policies are in place to engage, involve
and listen to the housing with care needs of older people and
their carers in Scotland?
• Join the Housing LIN to stay connected with latest ideas
Thank You
www.housinglin.org.uk/healthandhousing/
Jeremy Porteus
Director
Housing LIN
c/o EAC, 3rd Floor
89 Albert Embankment
London, SE1 7TP
Email: j.porteus@housinglin.org.uk
Tel: 07899 652626
Website: www.housinglin.org.uk
Email: info@housinglin.org.uk
Tel: 020 7820 8077
Twitter: @HousingLIN