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1
Delivering personalised housing services
Jeremy Porteus – 12 November 2010
• 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)
Why make the case between health and
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)
What are the health drivers for housing?

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• 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
10%
15%
20%
25%
30%
2004 2014 2024
An Ageing Population
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)
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

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

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

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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
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
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

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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
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?
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’

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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)
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?
Thank you