DFG Review 2018 and Beyond - focus on stairlifts and home lifts

Presentation by

Sheila Mackintosh

Research FellowUniversity of the West of England Bristol

Date: 29.04.19

• Context

• DFG Review findings – key issues

• Next steps for Government

• Next steps for lift manufacturers

Outline of presentation

Key trends1.Ageing population - regional variations, rural issues

2.Health inequalities at national/regional/local level, rise in people with multiple conditions/frailty, obesity a major issue

3.Trends in tenure – owner occupation people aged 65+ 79% (but will start to decline); PRS – now bigger than social housing, but possible increase in social housing in future.

4.Retrofitting existing homes – only building 165,000 new homes pa. Most people stay put or move within the existing stock

5.New-build housing - possibly new focus on housing for later life?? MMC – modern methods of construction (government goal 25%). New players e.g. L&G, Tata Steel - innovation.

6.Economics - 10 years of austerity

7.Finance – pension freedoms, new types of mortgages, but… need for home adaptations greatest for people with low income/wealth - DFG.

Ageing population

Source: ONS (2018) Overview of the UK population

https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigrati

on/populationestimates/articles/overviewoftheukpopulation/november2018

Prevalence of disability by age and gender UK

Policy trends

• Integration of health and social care (and housing) –Better Care Fund – integrated budget incls DFG

• Reduce demands on hospitals/A&E/care system -need for people to remain independent at home for an additional 5 years

• ‘Hospital at home’ - more people to be treated at home –more funding for community health

• Prevention – attempt to change focus from 60% of NHS expenditure on cure and only 5% on prevention

• Social Care Green Paper – paying for care, significant section on housing??

DFG Review 2018

Aims and objectives

• To make the case for joined-up action across

Housing, Health and Social Care

• To support more people to live in suitable

housing so they can stay independent for

longer

DFG Review covers England only

• England, Wales, Scotland, NI – different legislation, different policies re adapting homes

Engagement with the review

• LOGASnet data collected annually by MHCLG

• Freedom of Information requests to local authorities 2016-18

• Consultation events: Leeds, London, Wolverhampton

• Online consultation (43% Hsg and 44% OTs, 13% Other)

• Stakeholder interviews/discussions – LGA, DCN, CCN, ADASS, commercial partners and others

• Findings from: DFG Champions meetings, RCOT/Foundations DFG summit 2016, information/reports/data held by the team including EHS

• Parallel research: RCOT/Housing LIN Adaptations without delay; BATHOUT – RCT replacing baths with showers; C&RE/CAB – good practice and innovation; Northumbria Univ/CAB – lived experience.

Only 3 months for the review

Issues covered in DFG Review

A. Current situation

• Funding

• Who gets the grant

• Types of adaptations and costs

• Costs/benefits to LAs

• Processing and waiting times

B. How it should change

• Bigger picture

• Local delivery

• Working better together

• Allocation of resources

• Means test

• Upper limit and regulation

• Developing a market and supporting people outside the DFG

• Tenure and equality/common parts

DFG Review - key findings

Funding

? ?

Source: Annual Government allocations from official figures, LA contribution based on average percentage contribution from LOGASNET (2009/10 – 2014/15) and Foundations FOIrequest (2015/16 – 2016/17). 2016/17 shows negative contribution due to top-slicing of allocation for other purposes. Data on LA contribution not yet available for 2017/18 onwards.

Austerity BCF

Average number of DFGs completed per authority 2009/10 - 2016/17

Source: LOGASnet

Increase in average

cost of work:

• £7,000 2009/10

• nearly £9,000

2016/17

• Prices driven down

• Now rising to more

realistic levels

• But - increased

complexity of work

Average number of grants completed reduced in line with overall

reductions in funding – only just back to 2010/11 levels in 2016/17

What the DFG provides

65% 27% 7%

58% 34% 8%

Source: Foundations FOI Jan 2018

Source: LOGASnet

Uneven picture across the country

• Variable levels of DFG resources – some local authorities in surplus, others struggling to meet needs – historical legacy of funding formula

• Big differences in speed of service and range of options offered

• Some very effective, integrated (and often expanded) services, but others little change – still very traditional

• DFG capital resources have increased, but in most areas no additional revenue funding

• Few areas have had transformation funding – staff have had to deliver ‘business as usual’ while also trying to improve service delivery.

Split services

Budgets: • Housing - DFG budget• Health/Social Care - community

equipment, minor adaptations, sensory impairment, assistive tech, wheelchairs …

Legal responsibility:• Social Care - duty for disabled and

older people and disabled children • Housing authorities - mandatory

duty for the DFG

How do we put the customer at the centre?Overly complex for customers, professionals and industry

In county authorities: Social care – call centres and OTs at county level Housing – DFG teams at district level

National level:Dept Health and Social Care – fundingMinistry of Housing - policy

Recommendation - integrated services• A strategic partnership board and a strategic plan

• Pooled budgets – DFG + ICES + e.g. wheelchair budget

• Single access point

• Integrated teams under a single manager OT/technical skills.

• New cross-trained staff trusted assessor/grant officer/casework

• Regulatory Reform Order policy (RRO) - fast, flexible solutions

tailored to needs of locality

• Wrap-around services e.g. minor adaptations, major adaptations,

housing options, assistive technology, telecare, repairs, handyperson,

energy efficiency, safer homes initiatives, hospital discharge.

• Preventative services - advice, information, housing MOTs, falls

• End-to-end IT systems - NHS number/data sharing protocols

• Effective reporting - on outputs, outcomes and impact

Some authorities have more resources• Core of funding allocation still based on pre-2011 bids by authorities

• 2011 BRE developed new formula:

o No. of disability benefit claimants

o No. people on means-tested benefits

o Proportion of population over 60

o Proportion of stock still owned by councils (council stock does not use the DFG)

• All new money since 2011 allocated using this formula

• Some have ample funding, others struggling to meet needs

• Need new formula that takes account of demographic, housing stock, retirement age and benefit changes

Review recommendation: single formula - easy to understand, transparent, using readily available data.

Revising the means testCurrent means test:

• Targets aid on most needy

• A lot of drop-out - does not take account of cost of work/housing costs

• Based on housing benefit system that is being phased out

• Includes passporting for certain benefits

• Ideally should mirror social care means test (to stop confusion and people being excluded from DFG in error) but difficult to align.

Potential for home adaptations to contribute to ‘care cap’

• Social Care Green Paper likely to introduce a care cap

• Could encourage nil-grant applications with light touch assessments

• Less likely to need care and reach the care cap if living in a safe home

• Potential result - person spends less / government spends less

Backstop – uprate existing test

Review recommendation - remove means test for stairlifts provided there is there is a recycling policy

Upper limit

• Number of expensive cases varies – smaller authorities very few/none, others 20 or more a year

• Some authorities do not do extensions - rearrange internal layout or use reception rooms

• Ombudsman critical - does not provide satisfactory solutions

• Most areas try to keep within £30,000 limit - London costs higher

• Some LAs have used RRO policy to raise limit to £40k, £45k or £50k

• Review recommendation: need to take account of inflation, building costs and professional fees

Average extension costs by region 2016/17

Source: Foundations FOI 2018

Current upper limit

Maximum grant - new formula

Source: : https://www.costmodelling.com/regional-variations - Inflation from April 2008 to April 2018

Region New upper

limit

North East £42,250

North West £41,000

Yorkshire and Humberside £40,250

West Midlands £39,000

East Midlands £40,000

East Anglia £42,250

South West £42,250

South East £46,250

Outer London £44,500

Inner London £47,000

Existing maximum England £30,000

Proposed new formula includes:• Increase for inflation• Construction costs• 10% fee

Not just about maximum DFG

With better strategic oversight we could:

• Combine funding from different sources to give better long-term solutions

• Use personalised budgets - alternative solutions e.g. higher spec wheelchair + different types of adaptation

• Provide rehousing support - needs funding to provide better solutions for those willing to move - and earlier identification

Common Parts• Section 36 of the Equality Act 2010 (when enacted) will enable

disabled people to make requests for adaptations to the common parts of residential properties which cannot be unreasonably denied - e.g. entranceways, hallways and stairwells – a lot will involve lifts

• Very few DFGs currently approved for adaptations to common parts - difficult to predict impact of Section 36.

• Needs to includes fire risks

Recommendations of DFG Review:

• Works to common parts should be dealt with by new local ‘Housing and Health Partnership Boards’ rather than in a one-off piecemeal manner using the DFG.

• Look at feasibility of a national adaptations protocol for registered providers.

• Engage with landlords to deliver adaptations more effectively in the private rented stock.

Risks for lift manufacturers• Who pays for maintenance?

• Who is responsible for maintenance?

• How does an end user know their risks/responsibilities once warranties end?

Recent case:

A housing association was fined £1m following the tragic death of a five-year-old girl who became trapped while using a lift at her home in Weymouth. The lift maintenance company was also fined more than £500,000 over the case. The report of the case highlights:

• The need for regular maintenance for home lifts

• Clients to be made aware of the risks if they are expected to pay for ongoing servicing.

Read the full report here

Next steps – the beginning not the end

Funding has increased

o £55 million extra for the DFG in Oct 2018 budget (many authorities may have rolled this over into 2019/20)

o New allocations announced – overall DFG budget for 2019/20 is £505 million

o Long term funding after 2019/20 - ?????

Government response to reviewWill be written response - no date yet

Some issues dependent on other Government policies:

o Social Care Green Paper – expected 2019

o Better Care Fund Review - expected 2019

o Government Spending Review 2019

Legislative change or major government decisions:

• Upper limit

• Means test

• Allocation formula

• Changing the name

• Reducing application processing time to 4 weeks

• Support to move home to be included in DFG fee charging

• Better support for revenue costs and/or transformation funding

Other issues need guidance/training – Foundations role

What can industry do?• Procurement methods and lack of collaboration between authorities

makes it difficult for industry partners

• Local authority staff time-pressured and often lack up to date information - they need to justify costs

• Maintenance contracts – key issue

Engage with:

• Foundations

• Individual local authorities – some keen to innovate

• Housing associations – they are only just realising that their tenant group is ageing and that large numbers are disabled – they are looking for innovative VFM solutions – some have own budgets. Innovation initiative ‘Creating our Futures’ http://future.housing.org.uk

• House builders/MMC companies – need to make sure new-build is effective

• Lobby MPS and members of House of Lords

Publicise good practice

Changing attitudes - new approaches

Attitudes:• Attitudes to home

design have changed -people want stylish products

• But - people are not facing up to ageing

• Most only take action when they have to – after a bad fall or major health crisis.

Reaching a wider market:• Be more consumer

focussed – very trade-based/technical. Role in educating people to plan homes for later life

• Expand social presence – find influencers

Two examples of ways in which lift companies have tried to address the conundrum of

trying to talk about ageing and disability while at the same time not mentioning it!

Contact detailsSheila Mackintosh

Research Fellow

Centre for Public Health and Wellbeing

University of the West of England

Bristol

sheila.mackintosh@uwe.ac.uk

https://www.gov.uk/government/publi

cations/disabled-facilities-grant-and-

other-adaptations-external-review