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Delivering personalised housing services

Jeremy Porteus – 12 November 2010

• Every £1 spent adapting 100,000 homes, could save the NHS £69.37 over 10 years

(source: Inside Housing 22/01/10)

• Every £1 spent improving 100,000 cold homes, could save

the NHS £34.19 over10 years

(source: Inside Housing 22/01/10)

• Every £1 spent on preventative services by social services,

could save the NHS in emergency bed days £1.20(souce: DH, POPPs report 2010)

Why make the case between health and housing?

• over 15 million people in England with a long term condition, includes heart disease, diabetes, asthma, respiratory problems and dementia• proportionally far higher users of NHS and PCTs• Account for 55% of GP appointments, 68% of outpatient appointments and 77% of inpatient bed stays• more likely to be older and have other complex needs leading to disabilities which require care and/or support• they live in poor housing, which could exacerbate their condition and make them more likely to be admitted to a care home (recent Sir Michael Marmot Review, Fair Society, Healthy Lives)

What are the health drivers for housing?

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• Significant age shift

• Changing users’ aspirations eg lifestylechoices and needs

• Diverse range of needs egage, ethnicity, disability

• Diversification housing and care markets eg fromspecialist to adaptable, fromsingle tenure andinstitutional to mixed tenure and community based

10%

15%

20%

25%

30%

2004 2014 2024

An Ageing Population

Some Facts and Figures...

• 90% of older people live in ordinary housing,

rented or owned

• 67% of older people are owner-occupiers

(2005)

• Disabled people are twice as likely as non-

disabled people to live in social housing

• 1.5m individuals report having a medical condition or disability that requires specially

adapted accommodation (2006)

• The most common reason for older people

considering a move is that their home is inappropriately adapted for their mobility health needs (Scottish Government ‘Time to Move?’

2006, CLG New Horizons Research 2008)

The Policy landscape• We will establish a commission on long-term

care.

• We will break down barriers between health and

social care funding to incentivise preventative action.

• We will extend the greater roll-out of personal budgets to give people and their carers more control and purchasing power.

• We will use direct payments to carers and better community-based provision to improve access

to respite care.

• We will help elderly people live at home for

longer through solutions such as home adaptations and community support programmes.

• We will prioritise dementia research.

• We are committed to an NHS that is free at the point of use and available to everyone based on need, not the ability to pay

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Developing policy areas• NHS White Paper – extend personal

budgets

• Revision of the NHS operating framework

• New Social Care concordat

• Review Carers Strategy

• Public Health White Paper (due 2010)

• Social Care White Paper (due 2011)

• Welfare benefit reform (DWP)

• Localism Bill (CLG)

• Reform of planning (CLG)

DH if not otherwise indicated

“…encourage the use of

services such as community health services; social care,

home adaptations (including telecare); and extra care housing….”

NHS Operating Framework (2010)

Putting People First• Think Local, Act Personal

• Reduce demand

• Greater choice and control

• Everyone able to have a personal budget

• Self-directed support incl, in residential and nursing care

• Closer integration of personal budgets

• Carer involvement

People choose less dependent options: this is typically more cost effective

Models of Support Planning

Commissioning and Brokerage

GeneralPopulation

Support At Home

“Low Level”Advice & Support

InstitutionalCare

AcuteCare

Information

Crisis Response

Transforming Community Equipment

Re-ablement/ POPPs

Support Related Housing & Assistive Technology

TRANSFORMING SOCIAL CARE

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Transformed Care SystemUniversal

Services

Information and Advice

Community Offer – social

capacity

Holistic checks

Opportunities

for work and education

Targeted

Interventions

Equipment and

Aids to daily living

Intermediate Care and Re-ablement

Telecare

Predictive Tools

Supported Housing/ECH

Falls clinics and other

Care and

Support

Choice and

Control

Self Directed

Assessments

Personal Budgets

Advocacy and Support

Brokerage

Supply

Commissioning the right range

of services

Macro and Micro

procurement

Contracts and Spot Purchasing

Cost and Volume of

supply

Direct Payments

vs Council/ 3rd

Party Purchasing

What proportion of the spend goes into

Residential Care?

National Average is 52%High 71%

Low 26%

Dif

fere

nce o

f

45%

LA Commissioned Older People's Residential Care as a

Proportion of Total Older Peoples Spend (inc SP)

0%

10%

20%

30%

40%

50%

60%

70%

80%

LAs

Pe

rce

nta

ge

Types of outcomes sought• Efficiency savings: keeping people out of residential care• Focus on prevention: developing intermediate care and

re-ablement services

• Innovation: make best use of telecare and smart technology (grey and green)

• Supporting people and carers: End of life care – avoid hospital admission

• Built environment: preventing costly health interventions eg, as a result of a fall

• Advice and information: Providing meaningful choices and lifestyle aspirations

• Engaging with service users: Building effective social capital

• Access to housing/sustaining tenancies: Appropriate housing, including supported housing, managing long term conditions

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Localism and supported living

• Identify cost effective local housing solutions. Supporting people in their own homes

• Targeted interventions and access to community resources

• Ensure right quality and sustainability of services

• Improve engagement with users of services in how services are planned, commissioned and purchased

• Need to engage effectively with providers to understand the new markets for housing, care and support

• A whole system transformation programme, including new accountability arrangements eg planning

Role of Housing

• Every citizen should be able to live in an environment where they feel safe, they can afford and in which their care and support needs are increased– Wheelchair accessible

– Equipment to support daily living

– Community Alarms and Telecare/Telehealth

– Accessible for staff

– Daily support or floating support

SUPPORTED HOUSING OR

UNIVERSAL HOUSING• Two models of housing both

called extra-care housing

– Care Village – Universal offer

– Alternative to Residential Care

• Models of cost effective housing solutions

– Group Homes

– Flats close together

• Role of Technology to support reablement, eg telecare and assistive technologies – virtual extra care and supported living choices

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Capital Funding• Councils Capital programmes

• Homes and Communities Agency

• Section 106 – Local Development Framework

• Government capital grants –DH – campus closures and extra-care housing

• Housing Associations – ability to borrow.

• Prudential Borrowing

• Private Finance Initiatives• LIFT in DH

• Private Investment

• Need to consider longer term financing – awaiting CSR

Revenue Funding• Block care contracts

• Personal social care budgets

• Personal Health Budgets

• Supporting People

• Means tested/non means tested benefits

• Self funders

• Equity release/insurance

• Continuing Care (NHS)

• Other incentives and rewards?

Ten key HAPPI criteria

• Space and flexibility

• Daylight in the home and shared spaces

• Balconies and outer space

• Adaptability and ‘care ready’ design

• Positive use of circulation space

• Shared facilities and hubs

• Plants, trees and natural environment

• Energy efficiency and sustainable design

• Storage space for belongings

• External shared services and ‘home zones’

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Some HAPPI recommendations• For whole system, including health and social care

- look at the cost benefit good design eg reduce accidents in the home

- prevent more costly adaptations at a later date- avoid residential care and/or facilitate hospital discharge/transfer of care

• For local authorities/HCA

- Get better intelligence of the age profile in their areas, link to JNSAs- develop an ethos of Lifetime Neighbourhoods- produce SPGs and include older people’s housing in funding streams

eg Extra Care- develop innovative approach to design

• For housing providers/housebuilders- look at opportunities for mixed tenure- carry out post-occupation evaluations- be innovative in design, procurement and construction techniques

- partnership working with health, social care and beyond

(Source: Housing our Ageing Population: Panel for Innovation, HCA 2009)

Future considerations• The extent of personalisation: what will this mean under

the new govt. Will it extend choice and control even further?

• Health and care outcomes: can you evidence tackling health inequality in housing through your JSNAs eg, preventing homelessness, sustaining tenancies, avoiding a move to residential care?

• Managing relationships: How close are you to your housing partners?

• Operating in a tighter financial envelope: Public sector spend looking for efficiency savings in all areas (CSR10), access to capital/revenue streams, including recent HB announcements

• Workforce issues: does COT have shared learning and improvement opportunities across agencies on personalisation and housing?

Thank you