Jeremy PorteusJeremy Porteus

DirectorDirector

Housing LINHousing LIN

Working in partnership to improve health and wellbeing through housing

CIH, 25 June 2015

About the Housing LIN• Previously responsible for managing the DH’s £227m Extra Care

Housing Fund and £80m Telecare in England grant

• 48,000+ members across housing, health and social services to help improve partnership working and integration on housing and care

• 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 innovative policy, research and practice developments in housing, care and support for older people

• 10 regional ‘learning labs’ in England & Wales supporting local information exchange, peer-to-peer shared learning and improvement activities, and exemplar study visits

At a glance: what’s happening nationally?

• Making best use of NHS Land – NHS estate asset could deliver £6b residential accommodation for supported housing (NHF) although only £56m disposals in 2013/14 according to HSJ

• Role of Public Health in local authorities and links with CCGs, health and wellbeing boards in England

• Care Act 2014 – better assessment for wellbeing, duty to cooperate etc

• NHS 5 Year Forward View – combating £30b NHS shortfall by 2020/21. At home care and support the new panacea?

• Dalton Review: New models of Care, Integrated Care Pioneers, 29 Vanguard sites

Making integration work: building capital • Working with NHS England, ADASS and a consortia of housing industry leads on the role of housing in delivering health and wellbeing in a new Memorandum of Understanding

• The shared statement on the health and social care £5.3b Better Care Fund makes reference to £220m Disabled Facilities Grant and other capital grant funding (£135m) per annum

• DH Care and Support Specialised Housing Fund, administered by the HCA and GLA. Phase One saw 122 new schemes in England approved for older and vulnerable people with long term conditions, with Phase Two (£155m) for London and rest of England

• DevoManc = horizontal integration but little vertical integration, especially with the acute sector

Memorandum of Understanding

Key objective:

“Integrated health, care and support, and housing solutions could make best use of the budgets across the NHS, local authorities and their partners to achieve improved outcomes for less; for example, drawing on the Better Care Fund to support service transformation”.

Key actions:

• System leadership: LAs and their role in supporting health & wellbeing

• Knowledge & analysis: population data and health ‘intelligence’ e.g. Joint Strategic Needs Assessments (Public Health)

• Developing solutions: workforce development, primary care and preventative services, support people with complex needs

Housing our ageing population

• Supported housing for older people accounts for less than 5% of the market (729,818 units)

• 1.5m individuals report having a medical condition or disability that requires specially adapted accommodation

• Shortfall of supply in specialist housing with care to keep pace with demand, including housing for people with dementia ranges from 164,000 to 240,000 by 2030 (Demos and Housing LIN/SHOP@)

• Research shows that investment in affordable mainstream and specialist housing produces health benefits and reduces demand on NHS/social care.

• Moving older people from inappropriate housing could save £8,000 per year (Frontier Economics, Affordable Housing Report, 2014).

Housing - task orientated: outcome focussed

• Specialist housing - delay move to costly residential or nursing care

• Housing support - to prevent homelessness, support wellbeing

• Mainstream housing – design quality and accessibility (such as HAPPI) to offset future health and social care costs

• Home improvement agencies and handyperson services - deliver aids and adaptations that can reduce hazards, falls, fuel poverty, support hospital discharge, reduce hospital readmissions

• Environmental health - tackle chronic disrepair and environmental conditions that can lead to a long term condition (mental health), disease (COPD) or increased health inequality

• Regeneration and renewal – promote sustainable health outcomes via health neighbourhoods/age-friendly communities

• Spatial planning - support growth and links to strategic needs eg JSNA, better use of NHS (and public) land

Releasing public land for housing

• Actively encouraged by the DH, the Treasury, Monitor and the Trust Development Authority• DH established £100m Growth and Efficiency fund to support release of public sector land for 100,000 homes, over 13% on NHS land • Savills estimate 300,000 homes could be built on NHS land (Spotlight 2014) but only 145 sites sold by NHS Property Services generating 2,045 new homes!• DH published disposal strategy in 2011 – including list of surplus land an working with HCA, NHS Property Services, Community Health Partnerships and NHS England• NHS asset holding = £31b, however, only c£180m capital receipts (NHS hospitals) in 2013/14 and £56m (primary care) for residential purposes

• Most rules require NHS to sell land at open market price to the highest bidder – can work against more imaginative and long-term models e.g. partnerships with housing associations for specialist housing or reablement .

The economic case for independence at home?

• Where it is appropriate, postponing entry into residential care for one year saves an average of £28,080 per person

• Providing an adaptation in a timely fashion can reduce social care costs by up to £4,000 a year

• The NHS spends £1.3m every year because of poor housing e.g. trips/falls, energy efficiency/fuel poverty

• Hospital discharge schemes offering housing help to speed up patient release save local social care budgets least £120 a day

Imaginative solutions•NHF and others back partnerships with housing associations that offer long-term health, care and housing benefits = estimated £1b

•Smith Institute research found billions could be saved by admissions avoidance and reduced length of stay if NHS land and assets were used for step-down facilities or supported housing

•On-going revenue stream for NHS from its estate through development of affordable housing

•Work with housing associations, local authorities and others to develop:

•Reablement/intermediate care/hospital at home

•Supported housing – e.g. mental health

•Specialist housing – e.g. extra care

•General needs housing

Joint Ventures: a healthy relationship

• Integrated community health and social care accommodation: This approach gives NHS bigger say in wider benefits to health and social care economy e.g. “ticket home” work in Harrogate and Ripon CCG Vanguard Programme

• Residential use: Released land could host both supported housing and private units e.g. use of former psychiatric hospital in Northampton for extra care ‘village’ and general needs housing

• Step down/intermediate care or rehab facilities with move on: NHS organisations and/or Las release land in partnerships with housing associations or private organisations e.g. The Gateway in Middlesbrough with Thirteen and Keiro Group – saves NHS £156m over 10 years!

More Ventures: a healthy relationship

• NHS can pay for building supported units, recouping savings by more efficient care pathway e.g. to meet continuing health care for people with dementia in Manchester

• Housing provider can both develop the units and provide care and support service that offer both independent living options but also develop ABCD approaches to inclusion and community resilience e.g. One Housing Group working Camden & Islington MHT and LB Hackney to provide housing for people with support needs

Where other partnerships are working well

• Windsor & Maidenhead CCG: Strategic Housing for Older People Market Assessment – alternatives to residential and nursing care

• Haringey HWB: Homelessness health equity audit to assess needs

• Staffordshire County Council: working with Accord to develop dementia care centres of excellence

• North Somerset: HIAs working at Weston-Super-Mare hospital to support transfer or care back home/access aids and adaptations

• Manchester: local CCG funding housing advice & info with Northwards

• Peterborough & Cambridge CCG: Better integrated older people’s pathway in out-of-hospital at home care to support frail & older residents

• Sutton Coalfield: reablement facility, hospital beds managed by Midland Heart HA at Good Hope Hospital

What’s the evidence?

Delivering outcomes that older people want• Less dependency on high cost care

• Developing intermediate care and reablement services

• Make best use of technology and equipment – internet, telecare e.g. to support continuing health care

• End of Life Care – avoid hospital admission, hospice at home

• Preventing costly health interventions e.g. as a result of a fall

• Providing meaningful choices and lifestyle aspirations to meet personalisation objectives

• Self-care, self management by building effective social capital to enable greater community engagement/informal or family care/volunteering

And finally, some questions for you!

• On NHS land and capital, are you talking with HCA investment teams, NHS Property Services, NHS England capital team or Local Partnerships

• On commissioning (revenue) local services, are you networked with the CEO of the CCG, Director of ASC or DPH?

• Are you engaged with your local Health and Wellbeing Board? Is there a housing representative?

• Have you commented on the local Joint Strategic Needs Assessment or allocation arrangements under the Better Care Fund in your area?

• Have you developed what your health and housing offer could look like?

• Do you have evidence about your social value, ‘health dividend’, efficiencies or improved outcomes you are delivering?

Useful resources

Housing LIN resources:

• Health Intel NHS Estate page www.housinglin.org.uk/Topics/browse/HealthandHousing/NHSestate

• Housing & Health Exchange www.housinglin.org.uk/HousingAndHealthExchange

Other resources:

• Health begins at Home (Family Mosaic)

• Integration that works: An evaluation of Tile House (One Housing Group)

• NHS Land for Supported Housing (The Smith Institute)

• Unlocking investment in Primary Care (British Property Federation)

• Releasing surplus NHS land for housing: information pack (HCA)

• The cost poor housing to the NHS (BRE)

Thank youThank you

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