Sustaining Independence & and the Role of Preventative Services

1. Sustaining Independence & and the Role of Preventative Services Dave Arkle Housing Manager Amber Valley Borough Council

2. What Will I Cover? • Some of the work taking place in Derbyshire linking housing, health and social care • How we have developed the relationship with the Southern Derbyshire Clinical Commissioning Group and Adult Care • Insight into prevention • Transformation of access to adapted housing • Thoughts about the Future

3. What have we been trying to achieve? • Housing plays a critical role in enabling people to live independently and in helping carers to support others……suitability of living accommodation is one of the matters local authorities must take into account as part of their duty to promote…..wellbeing Care Act 15.53 • Trying to turn this into reality and therefore achieving the impossible

4. 75 year old lady with limited mobility and poor health • Living in a damp, cold and unmodernised bungalow with poor access • Extensive mould and ineffective heating • Husband in a nursing home, daughter clearly feeling the strain • House subject to equity release and she felt trapped • Solution to refer to access a sheltered housing scheme with adaptations already in place • Call from a GP through Single point of access

7. Making a real difference • Mr M had a stroke 18 months ago and returned home, wheelchair bound. He had not been out of the house for the entire time since • GP emailed Housing Team as Mr M was saying that he was struggling to keep warm • Carers were visiting and he was in a privately rented home • Just needed a single phone call and a visit to see Mr M and advise him about options and the local availability of accessible properties within social housing stock • Mr M now living in a level access suitable adapted property and he can leave the home

8. Impact of the Care Act • Housing Prevention is reasonably established in Amber Valley • Effective use of Home Improvement Agency to increase access to preventative services alongside Adult Care • Lots of conversations about housing • Openness to provision of information and advice • We are a lot busier with complex referrals and fewer solutions

12. Big Pieces of Work • Working with Public Health and all the Districts/Boroughs on a Housing and Health JSNA • Continued input into Southern Derbyshire Clinical Commissioning Groups shift to out of hospital care • Close work with public health on a number of housing related projects • Working with the County Council on the Transformation of access to adaptations • Focus on hoarding and safeguarding of vulnerable adults • CCG awarded AVBC £25,000 for energy efficiency measures which we were able to match then awarded DECC funding now have £150,000

13. Local Health & Social Care System Redesign • Current health & social care system unsustainable and unaffordable • Biggest component is increasing non-elective demand by a growing elderly population • Systems not currently set up to manage this and undergoing transformation • Huge pressure on primary care • Social capital/self-help and the role of the voluntary sector • Primary Care Plan in SDCCG “Aim to de-medicalise and use a wider range of non health services to support people and their carers”

14. Derbyshire Wedge

15. South Derbyshire Unit of Planning

16. What are the housing issues that will make a difference • Being able to keep warm • Being in a home that is right for your needs • Being in a home that you can safely access and use • Being in a home that is in good repair and secure • Relevant across most workstreams • Working with all Councils within CCG geographical area • Needs planning for retirement

17. Key Questions being asked by the CCG • What is it about housing that has an impact on people’s health and well-being and supports a shift away from hospital to community based support, where they have choice and control? • What are we already doing and where? • What are the gaps and what would it take to fill them? • What else / more could we do? • How do we make sure that everyone who needs to know about housing does actually know about it and make it work for people? • How do we demonstrate the benefits to the whole system of housing? • How do we involve people in co-producing this with us?

18. Derbyshire Partnership Forum Commitment • Partners are committed to improving access to adaptations as one of a number of options that can help to meet the housing needs of disabled residents. • This includes a commitment to improve access to and the delivery of adaptations. • There is a commitment to support individuals even where no public subsidy or service is available. Self-funding is increasingly common and services need to reflect a commitment to appropriate support. • There is a commitment is to develop efficient and effective local services across Derbyshire that provide access to adapted homes including the delivery of DFGs

19. Adaptations Transformation This will involve the following: • improving the access to adaptation options including DFG; • ensuring the options for resolving needs are presented at the earliest opportunity; • improving support to exercise choice where required; • reducing delays and waiting times in all aspects of the service; • delivering a joined-up approach to service delivery between partner agencies; • ensuring effective resident input to the process; • improving communication about progress • securing adequate levels of funding to support the delivery of the commitments

20. General Learning for others • Don’t rely on GPs, there are lots of other professionals that you can connect with • Growth of practice based community support teams are identifying more residents in need • GP practices are businesses and many face uncertain times as many look at merging • Don’t just focus on what health can do for you, what can you do for health? • Doors are open but perseverance is key • Older people are far more reliant on public services than families so the chance to influence is greater

21. GP Observations • opened our eyes to many of the non prescription help available to frail elderly + those with chronic diseases.... and so has helped to help access of patients to these • Our jointly developed scheme has been seen as valuable by the GPs and practices, and moreover by our shared residents/patients. I am convinced that clinicians are thinking differently as a result, and that much more can be achieved via community support teams, or with our recent discussions about sharing information to better target our interventions.

22. Summary • In Derbyshire we have a sound footing for supporting the health and social care integration agenda • Care Act is massively important as it places obligations on Adult Care • Role and independence of the HIA/Age UK critical • Prevention means different things to different professionals • Big changes are on the way and housing is on the agenda • Still huge cultural change required especially in the area of self-neglect • How do we help the asset rich cash poor older owner occupiers • We have to work together and not work in isolation

23. Final Case Study • Call from GP about a patient that was very poorly and had no heating • Visit made to the patient but unfortunately she died soon after, but husband was also in poor health • The husband was supported with some of his personal affairs including income maximisation • He was then supported to receive a new heating system through use of DECC funding and make sure that he could afford and use his new heating system • Simple, but has made a real difference to the patient, recognised by the GP

24. Thank You for Listening Dave Arkle David.arkle@ambervalley.gov.uk 01773 841334