Bridging the gap between housing, health and social care

1. Bridging the gap between housing, health and social care Jeremy Porteus Director, Housing LIN Glasgow, 4 June 2013

2. About the Housing LIN Previously responsible for managing the DH’s £227m Extra Care Housing Fund and £80m Telecare in England grant Essential online resources on housing with care for older people to support commissioners, funders and providers in market development, innovation and investment Publish papers to brief on latest policy, research and practice developments in housing, care and support for older people Member of the Prime Minister’s Challenge on Dementia Group 9 regional ‘learning labs’, dovetails with ADASS regions in England but also 1,507 members in Scotland

3. Housing for Older People in Scotland Review of Older People’s Housing (March 2013) The Scottish Government is committed to enabling older people to remain living in their own homes for as long as possible Age, home and community: A strategy for housing for Scotland’s Older People 2012-2021 and delivering plan (December 2011) Older people in Scotland are valued as an asset, their voices are heard, and older people are supported to enjoy full and positive lives in their own home or in a homely setting.

4. Transforming health and social care Societal changes: demographic factors; consumer orientated; IT literate but still many excluded groups Structural changes: Out with the old (SHAs/PCTs), in with new (CCGs); Public Health into local government; creation of NHS England and Public Health England System changes: outcome focussed – NHS Mandate, social care and public health outcomes frameworks; HWBs & JSNAs Resource allocations: Health £20b efficiency savings; local government reduced spend; housing related support revenue support cuts; personal budgets/personal health budgets resulting reduced spend; Care & Support Fund (Dilnot, self-funder/partnership model) as well as welfare reform Policy priorities: Integrated care; care closer to home; prevention and managing long term conditions; market facilitation, NHS asset management; innovation/QIPP Health and social care in the media spotlight; Baby P, Francis Report, Winterbourne View Review, Leeds hospital heart unit Brand reputation: NHS is safe! Social care?

5. Why integration matters - drivers for health and social care system reform Reduce Demand Prevent or reduce levels of demand e.g., acute (inpatient, A&E and outpatient care), primary (community health) and social care (residential, intensive home care, sheltered or extra care) Reduce Costs Reduce unit costs e.g., tariffs for condition specific interventions Reduce costs of existing and new packages eg renegotiate block contacts Reduce staffing costs/overheads, redesign service Contributions from citizens Use of personal budgets, self-funder market

6. Different levels of prevention: demand management To stop people entering system Public Health – exercise, eating, drinking, etc Health Care – the right treatment and preventive measures (stroke recovery or falls prevention) Information and Advice To reduce demand within the system 3’Rs’ - recovery, re-ablement, recuperation Right level of health care Partnership working to deliver improved outcomes Better housing choices, energy efficiency, tackling fuel poverty, telecare, aids & adaptations, equipment & advice

7. Making integration work: making housing count A consortia of housing providers have been meeting with the NHS Commissioning Board (now NHS England) to formulate a Partnership Agreement that recognises the role of housing Joint select committee report on Care and Support Bill recommended extending the scope of what constitutes wellbeing to include, safe and settled accommodation Department of Health £300m Care and Support Specialised Housing Fund higher quality thresholds to deliver care ready housing for disabled and older people that can improve health and wellbeing Recent government statement on integration and a call for a “pioneering” approach NHS Confederation briefing, Stronger Together, HWBs need closer engagement with providers, including housing

8. Specialist housing: specialised solutions A change in social ethos is required through public education Produce a clear definition of what constitutes extra care housing Deinstitutionalization of older people Develop a more integrated health and social care services, include extra care Allocate resources for specialist housing to aid wider housing market Support professional development and training

9. Understanding the older people’s housing market • Public sector policy direction is still fostering new models of provision & develop new capacity to reduce costs and improve outcomes. For example: • by a shift towards unregistered ‘housing’ accommodation with high levels of support to replace traditional care home placements & reduce hospital use for respite, assessment, rehabilitation and intermediate care • through new housing based & domestic style models for dementia care at all needs levels • a ‘de-institutionalisation’ of expensive health services for long term mental health & chronic illnesses

10. And why? What are the drivers for change? Over 15 million people in England with a long term condition egheart disease, diabetes, asthma, respiratory problems and dementia Older people account for 55% of GP appointments, 68% of outpatient appointments and 77% of inpatient bed stays Overall, the state spends £140b on older people of which 6% is on social care, 35% on health and 59% on welfare/pensions More likely to have other complex needs leading to disabilities which require care and/or support

11. What triggers a move in later life?

12. Capital and revenue investment • HCA Affordable Housing Programme Guarantee (deadline 21 May) • DH £300m specialised housing fund • DH £261m social care capital grant (2013/2015) • DH £40m contribution to DFG to support reablement, more ahead? • 3 million lives campaign for teleare/health, but • Impact of welfare reform and Supporting People in England - new HB arrangements and commissioning within tighter eligibility criteria and increasing self-funder market • Use of equity release to move to ‘downsize’ to purpose-built ‘care ready’ housing and/or to pay for personal care and support

13. Alternative funding sources: what’s new? • Institutional lending, pension funds, bond and/or social finance • LA grants, loans and/or Special Purpose Vehicle • Other procurement frameworks • Insurance-backed products • Public/Private partnerships (new PFI/LIFT shared risk arrangements) • ‘Downsizer’ market - personal equity/individual asset management • Neighbourhood based solutions eg co-production/community led or co-housing • Other public capital/revenue eg learning disability/mental health trusts • Use of NHS Estate/ public land disposal (Building a better Britain)

14. Developing age-friendly approaches Naturally Occurring Retirement Communities – where there are already older populations <35% Lifetime Neighbourhoods – designing built environment Age Friendly Cities (WHO) – investment in wider infrastructure “That Government should make specific provision in the National Planning Policy Framework on planning for an ageing society, to facilitate the supply of sufficient housing for older people to meet the demands of an ageing population and overcome barriers to moving” (APPG) Strategic Housing for Older People: planning, designing and delivering housing that older people want

15. I-Care and I-Design: delivering better outcomes • I-Care • Make best use of technology and equipment – from 4th generation telecare/health to Ipad/internet • End of Life Care – avoid hospital admission • Preventing costly health interventions eg, as a result of a fall • Building effective social capital to enable greater community engagement/informal or family care/volunteering • Less dependency on high cost care • I-Design • Accessible and adaptable HAPPI homes • Providing meaningful housing choices and lifestyle aspirations to meet personalisation objectives

16. Developing your Market Position Statement Working with DH, ADASS and IPC on how might accommodation and care for older people change over next 20-30 years – use Housing LIN SHOP@ What impact will changing wealth and tenure on accommodation and services older people might want as opposed to might need What will the implications of levels of personal equity held (Dilnot link) What policies/strategies in place for Lifetime Neighbourhoods and future adaptability? Are you clear what your core business isin balancing choice and safeguarding housing for older and vulnerable people?

17. An Agenda for Scotland? • What scope is there for better planning, commissioning and/or access capital funding to promote innovation in lifestyle choices for older people or stimulate a housing with care market as an alternative to institutional provision? • Can Age Friendly communities help partners such as not-for-profit, churches and statutory health and social care services support more people in the community, meet growing demand of an ageing population, any targets / cost-benefits? • Is there the case for Extra Care for maximising independence for people with dementia or is the future more residential care and home based care and support? • Are there other market opportunities such as aids and adaptations, telecare, co-housing, homesharing, social capital? • What strategies and policies are in place to engage, involve and listen to the housing with care needs of older people and their carers in Scotland? • Join the Housing LIN to stay connected with latest ideas

18. Thank You www.housinglin.org.uk/healthandhousing/ Jeremy Porteus Housing LIN Director c/o EAC, 3rd Floor 89 Albert Embankment London, SE1 7TP Email: j.porteus@housinglin.org.ukEmail: info@housinglin.org.uk Tel: 07899 652626 Tel: 020 7820 8077 Website: www.housinglin.org.ukTwitter: @HousingLIN