Our keynote speaker, Sue Adams of Care & Repair England presented these slides to the Cambridge sub-regional housing board event in October 2013.

1. 'Revolution in the air’
Integration of housing, health
and social care
Sue Adams, CEO, Care & Repair England

2. Who?
 Care & Repair England; national housing charity aims to
address poor and unsuitable housing conditions amongst
the older population, particularly low income home owners
(est. 1986)
 Pioneers local initiatives; local Care & Repair services,
Minor works grants, Handyperson, Housing Options,
Healthy Homes, Older People’s “Housing Activism”
 Policy shaping: Older people’s housing – Chair Housing &
Ageing Alliance, Home Adaptations Consortium, HCA, DCLG,
NHS England Integration Task Group, DH Care Legislation
reform…

3. Brief
 Why integrate ? – key drivers
 Current state of play at higher level policy level
 Immediate challenges
 Real world example

4. Lost Link
 Addressing the
health and social
problems arising
from poor housing
were key drivers of
early housing
improvement
 Could this be the
case again…..

5. Better Homes = Healthier Workers
 Examples:
Philanthropic
Garden
Villages/
Garden Cities
 Results:
Healthy, sociable
places to live =
better health

6. Why integrate now?
 Austerity - reduce expenditure
 Efficiency – do more with less/ rising demands
 Integration – reduce duplication
 Prevention - cut demand
Fundamental shift in vision for the NHS (& social care)
Renegotiating the role of the state and the individual

7. Kings Fund Analysis
"Current service models assume that we get ill,
are treated in hospital and go home; yet 70 per
cent of health and care spend is on people with
chronic conditions requiring long-term
support, not one-off episodes of care. Their
needs defy traditional demarcations between
‘health’ and ‘social care’."
Richard Humphries, The King’s Fund

8. Kings Fund Analysis
 Reducing emergency admissions and ensuring that
longer lengths of stay are clinically necessary has the
greatest potential for hospital efficiency savings
 Estimated potential savings: £1b pa
 Also - Better for patients
DATA Briefing: Emergency bed use; what the numbers tell us (2011) Kings
Fund

9. On the front line - HWBB
 Public health, hence HWBB, have critical role to play
in achieving efficiency gains through:
 Prevention & reduction of crisis driven demand through
addressing the wider social determinants of health and
 Leading on Integration

10. Homes & neighbourhoods are…..
 Major determinant of health
& well-being (mental and
physical)
 Influential factor in the need
for health and social care
Housing impacts on NHS and
Social Services expenditure
Poor housing costs NHS
c£600m pa (BRE & CIEH 2010)
Good housing leads to good
health toolkit from CIEH

11. Efficiency? Look at NHS use
 Chronic health conditions
 Incl. heart disease, stroke, respiratory conditions,
mental health, arthritis, macular disease {dementia}
 60% of GP visits are by people with long term
conditions
Main LTCs have causal link to, or are exacerbated by,
poor or unsuitable housing

12. Reduce hospital use
 C. 66% of general and
acute hospital beds are
occupied by people
65yrs +
 70%+ of hospital bed
days = emergency
admissions
 80% of emergency
admissions for 2 weeks
or more = over 65yr olds

13. Health & care needs & ageing
Demographic change* (2030 vs 2010)
 51% more people 65+
 101% more people aged 85
Crucial to
 prevent need for health & care services
 use systems more efficiently
Housing’s potential contribution to this is significant
*Ready for Ageing? Lords Inquiry 2013

14. Ready for Ageing?
House of Lords Inquiry led by Lord Filkin
concluded that country is ‘woefully underprepared’
for population ageing and concluded that
“The split between healthcare and social care is
unsustainable and will remain so unless the two
are integrated. Sufficient provision of suitable
housing, often with linked support, will be essential
to sustain independent living by older people.“

15. Ready for Ageing?
Recommended:
 A better health and social care system to support
people to stay living independently needs
adequate housing and support in the home
 The work done by housing adaptation and repair
charities is commendable, but needs to be
universal
 The housing market is delivering much less
specialist housing for older people than is needed

16. Why plan homes
for ageing?
‘Older people see
housing as ...the most
essential factor in
whether they will be
able to manage and
live well’
Clough R et al(2003) Homing in
on Housing Lancaster ESR

17. Make the housing connection
Step 1: Consider where older people live
 90% in mainstream housing
 75%+ home owners
 occupy third of all homes
Step 2: Consider housing stock condition
 Most non-decent housing is in the owner occupied
sector (higher ppn in private rented but lower no)
 1m vulnerable older people (75+) in non-decent
housing, mostly in the owner occupied sector

18. Make the housing connection
Step 3: Consider stock suitability & adaptability
 Need for adaptations
 1.4 million individuals have a medical condition or
disability that means that they need specially adapted
accommodation: 22% consider their current home
unsuitable (SEH)
 Based on current population projections, by 2036
around 810,000 people 75yrs + would be living in
unsuitable homes (70%+ in owner-occupied properties)
C&RE, Time to Adapt

19. Make the housing connection
 Housing was identified as an important social
determinant of health in the Marmot Strategic Review
of Health Inequalities
 Applicable to all age groups, with body of evidence:
 Children & accidents
 Chronic health conditions – all age groups
 Neighbourhood /housing & life expectancy
 Overcrowding & educational attainment
 Mental health/ housing link evidence strong

20. Example of housing link: Falls
 One in three people over 65yrs and one in two of those over
80yrs will suffer a fall each year with home the most
common place for falls.
 Over 75% of deaths due to falls occur at home
 Falls= half of hospital admissions for accidental injury
 Falls =10-25% of ambulance call-outs for this age group
 Hip fractures cost £2b pa/ £6m day – most are due to falls
Quantified link = falls and housing defects (HHSRS Cat 1 Hazard)
Falls reduction – HWBB role to look strategically and address
tri-partite prevention (muscle tone/ drugs/ environment)

21. Example: Cold Homes
The Marmot Review team special report on cold homes
and health concluded that there is a strong
relationship between cold temperatures and cardio-
vascular and respiratory diseases.
It noted that cold housing;
 increases the level of minor illnesses such as colds / flu
 exacerbates existing conditions such as arthritis and
rheumatism
 negatively affected mental health
 is related to excess winter deaths

22. Public Health – Vision for HWBB
 “By giving local govt public health resources …can
create healthy places to …grow older in, with new
partnerships in important areas, such as housing.”
 “Neighbourhoods and houses can be better
designed to support people’s health, such as by
creating Lifetime Homes”
Housing is noted as a factor that drives health
inequalities
White Paper, Healthy Lives, Healthy People 2010

23. Heath, housing and care: ‘The triangle of independence’
23
Enabling
housing
& environment
Good
health
Social
networks
and care
Independent
person
Services in one area fail the person if other parts missing
Evidence on key reasons
for loss of independence
are inter-action between
health, social, housing
Multi-disciplinary
approach more
successful. Housing
often missing link

24. Integration vision at the top
 Health Minister, Norman Lamb at ADASS/ ADCS
“People need to be able to return to a home [after
hospital admission] that is safe, warm and meets
their needs, and this is particularly important in
the case of older people. In order to achieve this
health, housing and social care must work in
partnership.”

25. Care Bill Amendments 9th Oct
Lord Howe
“…housing, along with health, and care and support,
should be considered as the three legs of the stool.
Housing is a wider determinant of health..[it]can have an
enormous impact on your health and well-being. To
reflect this, the “suitability of living accommodation” is
listed as part of well-being in Clause 1(2).
 Amendment 12 clarifies that housing is a “health-
related” service, and that both local authorities and the
NHS are required to promote integration between care
and support, health and housing. “

26. Integration Transformation Fund
 £3.8 billion announced by DH in July 13 spending review
 Stated aims is to bring about integration of health and
social care
 described as a ’single pooled budget for health & social care
services to work more closely together in local areas based
on a plan agreed between the NHS & local authorities’.
 Plans for use of the pooled monies to be developed by
CCGs and local authorities (usually top tier) and signed off
by the local Health and Wellbeing Board

27. Integration Transformation Fund
£1.1 billion Existing transfer from health to social care (from 2014-
15)
£130 million Carers’ Breaks funding
£300 million CCG re-ablement funding
c. £350 million Capital grant funding (including £220m of Disabled
Facilities Grant) + new specialist housing funding
£1.9 billion from
NHS allocations
Includes funding to cover demographic pressures in
adult social care and some of the costs associated with
the Care Bill.
Includes £1 billion that will be performance related, with
half paid on 1 April 2015 (anticipated that this will be
based on performance in 2014-15) and half paid in the
second half of 2015-16 (which could be based on in-year
performance).
£3.8 billion

28. Timeframe
August to October 13:
Initial local planning discussions and further work
nationally to define conditions etc
November/December 13:
NHS Planning Framework issued
December 13 / January 14:
Completion of Plans
March 14:
Plans signed off

29. Housing Solutions
Current housing stock
 help with home adaptations
 ‘handyperson’ services to do
small but crucial tasks/ safety/
security/ falls/ aids
 vision for wider home
improvement agency role to
serve (large majority) owner
occupied sector
 Cold homes initiatives
 Hospital2home making
housing link
 Information & advice to enable
self help

30. Housing Solutions
Future homes -
recommended
 Build new homes to
Lifetime Homes
Standards*
 Design Lifetime
Neighbourhoods
 Creates flexible,
inclusive places for all
ages
*Applied in London to date
www.lifetimehomes.org.uk

31. National Housing Solutions
 Stimulate better specialist
provision
 HAPPI reports/ DH money
 DH money adaptations
 DCLG money HP
 Independent information
& advice about housing and
care options / empower OP
as informed consumers –
FirstStop
www.firststopcareadvice.org.uk

32. Housing: What makes a good place to live?
 Good design of the home
: Adaptability, flexibility,
space standards
 Location: Neighbourhood
accessibility/ features ,
transport, shops, services,
social opportunities,
proximity to family &
friends, safety, security,
outdoor space

33. Research: What makes a good place to live?
 Access to services:
to practical support
for daily living at
home
 Wider social
factors: history,
identity, status

34. Pioneering a Vision of Active Ageing
Vision and shared values across sectors:
 choice and self determination in later life
 enable older people to remain active and socially
engaged
 enable independence and quality of life
 older people viewed as a positive contributor
 home vs 'accommodation' - acknowledgement that
home is more than bricks and mortar

35. Looking forward together
 Adopt a positive, healthy
& active ageing vision
and ethos across health,
housing & social care
 This will underpin
integrated planning
It is all our futures…..

36. A Story
 Mr H – lived in small, cold, damp house - disrepair,
uneven floor, steep stairs
 Fell– hip fracture, hospitalised
 Discharged to living room - sleeping on sofa,
catheterised/ using commode
 Two carers twice a day
Three readmissions due to infections resulting from
lack of bathing/ hygiene issues arising from this
‘living’ situation

37. Care & Repair Somerset West
Organised re-housing – no further admissions,
reduced care package.
Cost benefit - health*:
Prevention of the hip fracture £12,000
3 emergency admissions £7,782
Cost benefit social care*
Saving £5,876pa
* PSSRU Unit Costs of Health and Social Care (2011)

38. Care & Repair Weston-S-Mare
Miss C fell trying to open a window and on floor for
hours before helped.
4 days in hospital, discharged home alone/ no care
unable to get out of bed/ use WC, hence
readmitted 3 days later.
C&R worker arranged for pendant alarm and
neighbour key holder, self closing hinges on
windows + other falls reduction, special chair/
equipment

39. Care & Repair Weston-S-Mare
NHS cost benefit of earlier intervention
2 x unplanned hospital episodes
@ £2,334 per episode £4,668
2 x emergency transport £520
Total £5,188
Potential social care savings
Prevention of residential care admission
c£28,000+ per year

40. Information to enable self help
 ‘If only I had known..’ reports
Plus six Housing and Health Condition practical guides
www.careandrepair-england.org.uk
then Click on Home from Hospital
 Hospital2Home pack -
http://housinglin.org.uk/hospital2home_pack/
Briefings & mailing list – send your details to
info@careandrepair-england.org.uk

41. HWBB – key to commissioning
 Unless housing interventions (and provision such as
these schemes) are included in the plans for the
Integration Transformation Plans there will be costly
consequences for health and social care
 Unless HWBBs influence wider housing & Planning
decisions, the right homes will not be built to enhance
the health of future generations, let alone meet the
current and approaching needs

42. Evidence and Resources: Misc
 The Real Cost of Poor Housing - BRE/ CIEH
 Better Outcomes, Lower Costs, Heywood F, ODI
 Health Risks and Health Inequalities in Housing: an
Assessment Tool Prof. Tim Blackman Housing LIN
 Survey of English Housing, DCLG (annual)
 Time to Adapt: Home adaptations for older people, Care &
Repair England
 A Perfect Storm? An ageing population, low income home
ownership and decay of older housing, C&RE
 Housing & Ageing Alliance:
www.housinglin.org.uk/AboutHousingLIN/HAA/