2. Why make the case between health and
housing?
• A fall at home that leads to a hip fracture costs the state
£28,665 on average – over 100 times the cost of installing
hand and grab rails
• Where it is appropriate, postponing entry into residential care
for one year saves an average of £28,080 per person
• A hospital discharge service that enables older people to
return to a safe and suitable home environment saves over
£100 per day – the amount charged to local authorities when
patients ‘block beds’
(source: Fit for Living Network Position Statement, hact 2010)
3. What are the perceived challenges for you
as an organisation?
• What is your future vision for care – residential, home
care, intermediate care, respite care, extra care?
• Is housing development or management a key
component of your delivery/growth plans?
• Sustainability of markets in present climate?
Uncertainty of funders, external relationships?
• What can you offer that is different? Can you foster
innovation, diversification and development?
• How to realise and evidence benefits eg dementia
• Motivate staff/create a learning and knowledge sharing
environment for workforce – sector care academy?
• Regulation and inspection – lighter touches, self-
assessment but balance against safequarding.
4. What are the health drivers for good quality
housing with care?
• 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)
5. An Ageing Population
• Significant age shift, especially older old
• Changing users’ housing/care
aspirations eg lifestyle
choices and needs
30%
• Diversification housing 25%
and care markets eg from
20%
specialist to adaptable, from
single tenure and 15%
institutional to mixed tenure 10%
and community based 2004 2014 2024
• But, rapidly changing economic and financial climate
• And, what impact on both mainstream and specialist
markets and consumer confidence?
6. Some General Facts & 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)
7. 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
– Daily support or floating
support
– Accessible for staff/service
delivery
9. 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
10. Developing policy & funding
• NHS White Paper – extend personal
budgets
• Comprehensive Spending Review
• Revision of the NHS operating framework
• Response to the Law Commission
• Establishment of a Care Commission
• New social care Partnership Agreement
• Dementia Declaration and Pledge
• Review Carers Strategy
• Public Health White Paper
• Social Care White Paper (forthcoming)
• Welfare benefit reform (DWP)
• Localism Bill (CLG)
• Reform of planning (CLG)
DH if not otherwise indicated
11. Types of outcomes sought
• Less dependency on high cost care
• Developing intermediate care and re-ablement services
• Make best use of telecare and smart technology (grey
and green)
• End of Life Care – avoid hospital admission
• Preventing costly health interventions eg, as a result of a
fall
• Providing meaningful choices and lifestyle aspirations to
meet personalisation objectives
• Building effective social capital to enable greater
community engagement/informal care/volunteering
• Appropriate housing, including supported and assisted
living (not dependent on social grants)
12.
13.
14.
15.
16.
17. 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
– Daily support or floating
support
– Accessible for staff/service
delivery
18. SUPPORTED LIVING 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
– Apartments with communal
space for on-site care
– Flats close together
• Role of Technology to support
re-ablement, eg telecare and
assistive technologies – virtual
extra care and supported living
choices
• The Beacon Centre, winner
2010 UK Housing Awards
19. Capital Funding
• Councils Capital programmes
• Homes and Communities
Agency
• Section 106 – Local
Development Framework
• Government capital grants –
DH 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
20. Revenue Funding
• Block care contracts
• Personal social care
budgets
• Personal Health Budgets
• Supporting People
• Means tested/non means
tested benefits/HB
• Self funders
• Equity release/insurance
• Continuing Care (NHS)
• Other incentives and
rewards?
• Volunteers?
21. Going forward
• Post CSR – All parties need to
be more creative on capital &
revenue (Supporting People)
funding
• Alignment of investment - local
authorities, HCA, health sector
and third sector within Local
Investment Plans
• Joint strategies and
commissioning partnerships
• Local (public) Land Initiative
opportunities – land swaps
• HCA’s Delivery Partner Panel
• Local frameworks
22. Going Forward
• Affordable rent packages with registered providers to
include Extra Care
• If care homes continue to close, reinvestment of land
sale receipts in new projects
• Place making, regeneration and development to meet
the needs of the whole community
• Extra Care is not the only solution for older people – is
a different housing/care offer more appropriate?
• Local authorities – commissioning providers and
development partners, supported by HCA
• Make sense of personal budgets and self funders’
markets
23. Future arrangements
• Market presence: what is your offer to Housing, the NHS and social
care? Have they heard you/know you are there re: extra care?
• Protecting the bricks and mortar: Is your stock ‘fit for the future?
Adaptable, remodel, decommission, ‘care ready’? Convert to extra
care?
• The extent of personalisation: what will this mean under a new
govt. Will it extend choice and control even further?
• Health and care outcomes: can you evidence tackling health
inequality, preventing homelessness, sustaining tenancies, avoiding
a move to residential care
• Operating in a tighter financial envelope: Public sector spend
looking for efficiency savings in all areas, access to capital/revenue
streams, including HB and wider welfare benefit reform
• Workforce arrangements: recruitment/retention, training and
learning improvement
• Leadership: Do you have the vision and capability (skills,
knowledge etc) to change? Do you want to change?
