Delivering personalised housing services Jeremy Porteus – 12 November 2010

1. Delivering personalised housing servicesJeremy Porteus – 12 November 2010

2. Why make the case between health and housing? • 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)

3. What are the health drivers for 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)

4. An Ageing Population • Significant age shift • Changing users’ • aspirations eg lifestyle • choices and needs • Diverse range of needs eg • age, ethnicity, disability • Diversification housing • and care markets eg from • specialist to adaptable, from • single tenure and • institutional to mixed tenure • and community based

5. 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)

6. 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

7. 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)

8. 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

9. General Population “Low Level” Advice & Support Support At Home Institutional Care Acute Care People choose less dependent options: this is typically more cost effective TRANSFORMING SOCIAL CARE Information Crisis Response Re-ablement/ POPPs Transforming Community Equipment Support Related Housing & Assistive Technology Commissioning and Brokerage Models of Support Planning

10. Transformed Care System Universal 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

11. LA Commissioned Older People's Residential Care as a Proportion of Total Older Peoples Spend (inc SP) 80% 70% 60% 50% Percentage 40% 30% 20% 10% 0% LAs What proportion of the spend goes into Residential Care? High 71% National Average is 52% Difference of 45% Low 26%

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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?

18. 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’

19. 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)

20. 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?

21. Thank you