Providing an alternative pathway - the value of integrating housing, care and support James Berrington EUKN Policy Lab Netherlands ‘Housing and Care’ 3 September 2013
Feb 10, 2017
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
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
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
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
+44 (0) 7989 968 955