Housing-related services and the DH preventative agenda
Clare Skidmore, DH Care Networks
Some Facts and Figures...
Prevention in Housing, Health and Care
• “Lifetime Homes, Lifetime Neighbourhoods: a national strategy for housing in an ageing society, 2008
• Putting People First, 2007
• Next Stage Review, Darzi, 2008
• Care and Support Green Paper ‘Shaping the Future of Care Together’
• Ageing Strategy, ‘Building a Society for All Ages’
• National Dementia Strategy
• End of Life Care Strategy
Enablement
Assistive Technologies
Personal budgets
Person-centred support plans
Neighbours
Community Networks
Volunteers
Information advice and advocacy
ULOs
Leisure, transport etc Better housing
options
Responsive, flexible services
Housing and Prevention – Examples
Primary Prevention
- Universal information and advice services
Secondary Prevention
- Integrated housing, health and social care interventions
- Handypersons’ services offering ‘that bit of help’
Tertiary Prevention
- Home Improvement Agencies providing large scale adaptations
• Extra Care Housing - for rent and / or sale
Building an Evidence-Base
• ‘Low level support’ highly valued by older people.
• Proving benefits and cost-efficiencies requires establishment of a causal link between a specific service and its outcomes
• This is complex because:
– costs and savings often fall to different sectors and organisations;
– it is difficult to predict what would have happened had a particular intervention not been available; and
– many quality of life measures are perceived as subjective
Housing and Prevention - the Evidence
• DH Partnerships for Older People’s Projects
• DH Predicting Social Care Costs Project building on the PARR tool
• LinkAge Plus led by DWP
• Supporting People Benefits Realisation Local Model led by CLG
• Foundations Future HIA Project
• Health and Safety Rating System
POPP: 2008 Findings• 99,988 individuals received a service within the POPP across 470 projects including housing-based services
• Demonstrable effect on reducing hospital emergency bed-day use
• For every £1 spent on POPP, average of £0.73 saved on the per month cost of emergency hospital bed-days
• Positive effect on self-reported quality of life and health
• POPP programmes associated with wider culture change
• Health /social care partnerships and joint commissioning strengthened
• Almost half the staff in the projects were older volunteers
Predicting Future Social Care Costs
• Project led by Nuffield Trust, builds on PARR tool and combined model
• Using anonymised health and social care data to forecast which individuals in a population are at greatest risk of incurring social care costs through loss of independence due to age-related conditions and ill health
• If more effective investment is to be made in prevention, councils need ways of identifying individual risk accurately across their population so they can target effective interventions
• Strong interest in continuing to explore ways of exploiting health and social care information in the common aim of maintaining individuals’ independence and developing more cost-effective approaches
LinkAge Plus: 2009 Evaluation
• LinkAge Plus (LAP) - comprehensive approach for accessible joined-up services for older people
• Services include housing choices advice; home safety checks; and other housing-related interventions
• Benefits included: promoting older people’s independence; acting as a catalyst for the increased join-up of services across public services, and the community and voluntary sector
• Older people stress that it is the small things that make the difference
• Final evaluation demonstrates cost-effectiveness, including savings to the public purse
Useful References
• Clark,. H, Dyer, S. and Horwood, J. (1998) ‘That bit of help’ The high value of low level preventative services for older people, JRF
• Curry, N. (2006). ‘Preventive Social Care: Is it Cost Effective?’ Kings Fund Publication
• ODI’s ‘Better outcomes, lower costs’ report, Heywood and Turner, 2007
• http://www.kingsfund.org.uk/publications/kings_fund_publications/appendices_to.html
• http://www.dwp.gov.uk/ageing-society/linkage/evaluation.asp
• http://www.dhcarenetworks.org.uk/prevention/
• http://www.dhcarenetworks.org.uk/independentLivingChoices/housing/
• http://www.careandrepair-england.org.uk/pdf/healthyhomes.pdf
• http://www.viewcare.co.uk/Publications/fallsint.pdf
• Supporting People Benefits Realisation Local Model on the SPK website - http://www.spkweb.org.uk/
Conclusion• Evidence of the cost-benefits
• Proof is difficult in such a complex area
• Difficult economic times
• Wider transformation agenda
• Can commissioners afford not to invest in an integrated approach which includes housing-based solutions?
• Hand over to Steve Malone from Foundations, for interactive session focusing on the contribution of Home Improvement Agencies to prevention and early-intervention
[email protected]://www.dhcarenetworks.org.uk/IndependentLivingChoices/Housing/
Thank you