Approaches to Integrated Housing, Health and Social Care Services:

1. Approaches to Integrated Housing, Health and Social Care Services: case studies from North Tyneside Council and Northumbria Healthcare Dr Dominic Aitken Innovation and Research Manager North Tyneside Council and Northumbria University @dom_aitken Helen Graham Senior Occupational Therapist, CARE Point, Northumbria Healthcare Helen.Graham@Northumbria-healthcare.nhs.uk 5 December 2016

2. Policy Context: Why Integrate? Care Act 2014: A duty to integrate services, including housing, to: Prevent care needs Delay care needs Reduce care needs

3. Service Fragmentation Lack of awareness and understanding of other services Demarcation of professional responsibilities Multiple access points into housing, health and social care systems Weak channels of communication between services Service gaps, fragmentation, lack of co-ordination, duplication Developed from Reed et al. (2005)

4. Approaches to Integration The potential for services to act as a conduit for delivery of other services The role of workforce development in aligning referral pathways The role other services can play in achieving shared outcomes Understanding access processes within different services Integrated Services

5. Safe and Healthy Homes Information, advice and guidance service Leverage private investment into housing Create hazard free dwellings Promote health and wellbeing through housing interventions Reduce hospital admissions, winter deaths, GP visits

6. Eligibility North Tyneside resident Private sector focus Health issue/vulnerability which is caused or exacerbated by housing issue

7. Referral Process • Call within 2 working days • Confirm Consent • Organise Visit • Visit • Complete Safe and Healthy Homes Checklist • Complete Health Survey Contact Landlord (PRS) Referral(s) Provide Information Environmental Health Further Action as Required Review

11. Primary Care Electronic Referral Pathway • Developed with Park Road Medical Practice and Northumbria Uni • Electronic flags for 200 most frequent users of surgery; later expanded to patients on registers for: • COPD • Asthma • Depression • Falls • High risk patients • System provides prompts: 1. Flagged patient attends 2. Nurse/GP checks if in private rented/owner occupation. 3. If so, asks if housing issue is affecting/causing health problem (or has clear potential to do so) 4. If so, asks if comfortable with referral to Safe and Healthy Homes team. 5. If so, nurse/GP makes referral. 6. If not, leaflet provided to patient such that they can self-refer.

13. Case Study • Client F was terminally ill, suffering from angina, diabetes, COPD, osteoporosis. Mobility problems; care needs met by partner • Practice nurse read flag on the system and offered referral to the SHH team. Select and Direct service able to install a second banister on the stairs Care and Connect service to connect with local exercise classes Service for the client’s boiler Occupational Therapist led to the installation of bathing equipment in the bathroom. Draught proofing of the property at no cost to client

14. Case Study • Ms F’s concerns about falls and cold have been reduced, and she now has more opportunity to engage in the community and become more active. • In her review questionnaire the client claimed that she had felt suicidal before the team’s involvement and stated that her Safe and Healthy Homes Officer saved her life.

15. Research into Clients’ Experiences • 15 qualitative interviews with clients of SHH; variety of housing interventions • Lack of knowledge or experience of local services, organisations and traders who could assist with rectifying housing issues: • “You see things in people’s houses, like my neighbour down the road, he’s got two stair banisters but you don’t think about how it was done.” • Low trust: • Poor previous experiences • Historical ineligibility for services • “I think the problem is we’ve never asked anybody for anything. We’ve just sort of mosied on and got on with it. And if something has gone wrong, it’s had to just stay wrong until we’ve had the coppers to [fix it].”

16. Research into Clients’ Experiences • Importance of facework • “[The officer] sat there…absolutely lovely, listened, you felt the compassion…and she says as soon as she walked in the door she thought ‘she needs a second banister’. Soon as she walked in the door she knew there were difficulties and she listened. • “I think that I was going [to my doctor] before because I probably needed the support, more than anything else. My knees [would] be sore – send you for an X-ray…You didn’t get the validation. And that’s one of the major things that started with the very first visit. So I think when someone has come out to your house and said, ‘Yes, you need that help, we will do it,’ it’s such an affirmation.”

17. Research into Clients’ Experiences • Access point into wider system • “Well [the officer] put us through different places for grants …he sorts like everything out for us like the light outside and Warmzone. I got the walk in shower put in…[the officer] got on to the occupational therapist for us and suggested ‘a rail going up the stairs might be helpful’…[the officer’s] really helpful, he gives you all the details and contact numbers, everything…to get you in touch [with traders]…if I’m worried about something I’ve got his contact number straight direct to him and I phone him… I didn’t know where to turn, I needed help… I was in rock bottom…until I went [to the officer] and ever since he’s been good.” • Participants now ‘knew how the system works and what services are out there.’

18. Health & Well-being Programme Helen Graham Gail Blood

19. Integration: Opportunities for Preventative Health Service Delivery Appropriate Demographic Accommodation specifically for those aged 60+ Preventative Service Delivery Health Services Appropriate Delivery Sites Integrate with local specialist housing services e.g. NTL

20. Background The National Institute of Clinical Excellence (NICE) guidelines (2016) recommend that any older person with recurrent falls or assessed as having an increased risk of falls should be considered for individualised multifactorial intervention. Components to this are strength and balance training, home hazard assessment and intervention, visual assessment and medication review. The multifactorial nature of falls prevention and management strategies means that working as an effective multidisciplinary team member is vital (COT 2006).

21. Health & Well-being Programme Six weekly sessions Including: Home hazard assessment Programme of educational sessions Balance and gait exercises Outcome measures

22. Overview of Topics Session 1 – Exercise and What to do if you have a Fall Session 2 – Environmental Hazards Session 3 – Medicines Session 4 – Food and Nutrition Session 5 – Vision Session 6 – Footwear and Foot care

23. Exercises completed each week • Exercises in this programme are aimed to improve the following: • Strength • Balance • Muscle power • Endurance • Joint flexibility • Co-ordination • Reaction time

24. Outcome Measures Home Falls And Accident Screening Tool (HOMEFAST) Tinnetti Gait and Balance Tool Falls Efficacy Scale –International (FES-I) Hospital Anxiety and Depression Score (HAD)

25. Stats Results • n=12 • Classes not definitely responsible for changes • Different numbers of sessions attended by participants

26. Qualitative Feedback “Keeping fit helps wellbeing and happiness; singing gives confidence and helps breathing. Getting together helps everyone” “Enjoyed the group, had a good laugh, feel a lot better” “I have enjoyed the class and hope that it will continue, everyone very helpful and very happy” “I feel like I have benefitted from the exercises and the girls are all canny and helpful. Not sure if I would continue unless it was organised, I have enjoyed it” “I had a fantastic time and sorry it had to come to an end, the team was excellent in manner and knowledge”

27. Qualitative Feedback “I found the class very beneficial” “Best thing ever, the girls were really good. I feel it has been really beneficial and will continue with the exercises myself” “I enjoyed the weekly keep fit. It gave me ideas of what I can do in my own home. And the staff were really helpful and so pleasant.”

28. HOMEFAST The largest proportion of houses had no home hazards, things like non-slip flooring and level access showers with grab rails already in situ. Members made changes to footwear Equipment provided to improve independence with chair/bed transfers and transportation of meals. Remaining hazards were rugs and inability to reach into kitchen cupboards.

29. Outcome Measures Post intervention The Tinnetti balance score demonstrated a significant improvement following therapy Sit to stand was one of the main improvements observed following intervention Gait, confidence, anxiety and depression scores remained predominantly the same with one or two individuals making the most amount of improvement. The finding suggests that participants were significantly more likely to have improved balance after attending sessions than before and that they were also significantly less concerned about falling

30. Conclusion • This would suggest that patients who receive a multifactorial falls programme can: • Make improvements to balance and confidence • Reduce falls risk • Individuals with less functional mobility at the start of the programme made the most improvement • General enjoyment and socialisation were also valued components of the sessions.

31. Conclusion • Integrating preventative health service delivery with sheltered housing services creates opportunity to target primary demographic in appropriate setting • Second pilot completed • Third pilot to take begin January/February 2017. Further integration planned with: • Adult Social Care’s Rehab Officers • Leisure Services