HOUSING AND HEALTH WHERE ARE THE OPPORTUNITIES FOR WORKING WITH HEALTH?

1. HOUSING AND HEALTH WHERE ARE THE OPPORTUNITIES FOR WORKING WITH HEALTH? PETER MOLYNEUX Friday 9th November 2012

2. “My biggest concern is that the Bill distracts management attention from delivering the Nicholson Challenge” Stephen Dorrell

3. The Nicholson Challenge The NHS needs : to manage demand for healthcare to reduce spending by £20bn over four years to respond to new technology and new drugs to avoid high cost / institutional forms of provision

4. Delivering the QIPP Agenda • Improve quality through innovation to increase productivity and prevent need for care; • Work with agencies that people trust, stop protecting them and help them navigate the world; • “Currency” needs to be clear • Clarity of outcomes

5. New Structures (1) Commissioning Board for England - sets policy - sets required outcomes (targets) - assures CCG performance - commissions specialist services. Public Health (England) • Gathers public health intelligence • Provides information and support and health • Responsible for immunisation and vaccination programmes • Director of Public Health leads on JSNA

6. New Structures (2) Health and Well-being Boards Authorisation • Involved in authorisation of clinical commissioning groups (CCGs) Commissioning • Powers to promote joint commissioning, integrated provision • Expectation that NHS commissioning plans to follow local health & wellbeing strategy and JSNA Health and wellbeing strategies • Produce Health and Well-being Strategy • Commission JSNA • Consulted by NHS Commissioning Board on contribution of CCGs to delivery of local health and wellbeing strategy • More public involvement, as well as Healthwatch

7. New Structures (3) Clinical Commissioning Groups will : • range of clinicians commissioning patient care; • mainly GPs but at least one registered nurse and secondary care clinician on governing body; • Will commission planned hospital care, rehabilitative care, urgent care, community health services, learning disability and common mental illness; • Manage budgets based on their patients needs; • Decide what they will commission themselves and what they will commission with others. Clinical Commissioning Groups will not : • Commission primary care • Commission most aspects of public health

8. CCGs : The NHS Commissioning Board The NHS Outcomes Framework Housing Care and Support can contribute to : • Under 75 mortality rate from respiratory disease • Enhancing QoL for people with mental illness (metric = employment levels) • Helping older people to recover independence after illness or injury (metric = proportion at home 91 days after discharge)

10. Housing’s Contribution to Prevention Falls reduction interventions • Most “obvious” to CCG members, • Housing adaptations improve mental health and avoid falls and can be cost-saving Mental Health and Housing _ Early intervention and crisis avoidance services - Rapid discharge and step-down to recovery Extra Care housing • Varied, some evidence of reduction in costs to health sector and informal care, but not necessarily all sectors • Dementia study showed residents half as likely to move into nursing care, fewer hospital admissions and higher QoL Source : Molyneux, P (2011) Opportunities to improve Health and well-being: Integrating Secondary and Acute Health Care and Housing in the New NHS. http://www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Information_Packs/IP1_Briefing4_NHS.pdf

11. Cost reduction evidence... Source : Frontier Economics (2010) Financial benefits of investment in specialist housing for vulnerable and older people: A report for the Homes and Communities Agency http://www.frontier-economics.com/_library/pdfs/frontier%20report%20-%20financial%20benefits%20of%20investment.pdf

12. INTEGRATION

16. Deciding where to act • H&WB Board • Key strategic body developing JSNA and JH&WB Strategy • CCG has to be in line with priorities • Development of integrated commissioning and community budgets • CCGs • Control over 80% of NHS budget • New to thinking beyond individual patient and medical model • Foundation Trusts • Looking for ways to improve outcomes and reduce costs on contracts with CCGs • Incentives to integrate and and include housing services in care pathways

17. Health and Well-being : Key to differentiation ? Creating Sustainable Neighbourhoods Health and well-being : walking and cycling Promote resilience : Drought, flooding, fuel poverty Designing Homes for Healthy Living Accident prevention e.g. fire and falls prevention Lifetime homes standards, ventillation, light and materials Promoting Independence Developing non-institutional forms of provision New models of floating support Equipment, adaptations, telehealth and telecare Promoting Healthy Choices Promote self-care Health trainers re exercise and healthy cooking and eating

18. Health and Well-being : Key to differentiation ? Preventing Admissions; IAPT and early intervention services Support and monitoring of people with long-term conditions Enabling Faster Discharge; Step down to recovery; Support transition to home. Strengthening Asset Management. Facilities management Green space

19. WHAT ARE WE DOING NOW THAT COULD BE PACKAGED DIFFERENTLY ? WHICH OF THESE WOULD DELIVER THE MOST BENEFIT TO TENANTS ? WHICH OF THESE PLAY TO OUR EXISTING STRENGTHS ? WHAT RELATIONSHIPS DO WE NEED TO DEVELOP ?

20. Peter Molyneux Common Cause Consulting E:peter.molyneux@btconnect.com M: 07970 841824