This year’s Research in Practice for Adults (RiPfA) annual Partnership Conference will examine social care, housing and homelessness. It will explore National policy context; Legislation – recent changes and capacity; Housing and social care interfaces – working together effectively; Homelessness and complexity; and Housing supply – its role in maintaining independence for longer and relieving pressure across other areas of the system.
The day will hear from key speakers as well as offering interactive opportunities for discussion among delegates.
4. Setting the scene – national picture
and policy – the importance of
housing and social care to each
other
Lyn Romeo
Chief Social Worker for Adults, Department of Health
and Social Care
5. National Picture and Policy - the
importance of housing and social care
to each other
Lyn Romeo, Chief Social Worker for Adults
@LynRomeo_CSW
chiefsocialworkerforadults@dhsc.gov.uk
8. Loneliness
Studies have shown that loneliness leads
to an increased likelihood of developing
certain health conditions. Specifically,
socially isolated people are:
• 3.4 times more likely to suffer
depression
• 1.9 times more likely to develop
dementia in the following 15 years
• 2 to 3 times more likely to be physically
inactive, which may result in a 7%
increased likelihood of developing
diabetes, an 8% increased likelihood of
suffering a stroke and a 14% likelihood
of developing coronary heart disease
9. Rough sleeping and the
role of Social Care
Supporting better outcomes through:
- Mental health services and addiction services
- Integrated working with housing, health care, social care and
public health
The Rough Sleeping Strategy
- Cross Government strategy was published in August 2018-
with a goal of halving rough sleeping by 2022 and it entirely
by 2027
- The strategy goes further than any other government has
done before
Continuity of Care
- Challenges in maintaining continuity for homeless people
- Effective hospital discharge models can support the
homeless, ensuring support is in place
- NIHR funded research is due to be published in 2019- it has
reviewed the effectiveness of different models of provision of
hospital discharge & primary care services for rough sleepers
- DHSC will be supporting the dissemination of this research
10. DHSC strategy to
support a rough
sleeping strategy
- Audit of local services
- Testing models of community-
based provision
- Health and wellbeing boards
- End of life care
- Safeguarding
- NHS long term plan
- Homelessness Reduction Act –
duty to refer
11. Social Care
Professional
Values
- Respect, dignity and valuing all
people
- Protecting human rights
- Prompting social justice and
reducing inequality
- Kindness, empathy and
compassion
- Integrity
- Maintaining boundaries
14. Law – recent changes in housing and
social care law and how they
interact with each other
Siân Davies
Barrister, 39 Essex Chambers
15. Recent changes in housing and
social care law
Siân Davies
Barrister, 39 Essex Chambers
Research in practice for Adults
16. Key legislation
• Housing Act 1996
• Homelessness Reduction Act 2017
• Care Act 2014
• Mental Capacity Act 2005
• Children and Families Act 2014
• Children Act 1989
17. Overview
Housing Act 1996
• Part 6: allocations. LA required to have allocation
scheme for priority between applicants
• Part 7: homelessness & Code of Guidance
Homeless + priority need + local connection + not
intentionally homeless
PN is the area of overlap with social care “vulnerability”
s.189(1)(c) Hotak v LB Southwark [2015] UKSC 30
18. Care Act 2014
• Wellbeing principles - duty to “have regard” s.1
• Co-operation duties s.6 and 7 “relevant partner”
• May not provide anything a LHA is required to provide:
s.23
• Must assess (s.9)
• Must meet assessed eligible needs (s.19)
19. Homelessness Reduction Act 2017
• Advice and assistance duty (s.2)
• New duties in case of threatened homelessness (new
s.195 HA 1996)
• New s.213B HA 1996 – duty upon specified authority to
notify local housing authority (with agreement)
20. Duty on social services to refer to
housing HRA 2017
• In force 1st October 2018
• Homelessness Reduction Act 2017 and revised Code of
Guidance
https://www.gov.uk/guidance/homelessness-code-of-
guidance-for-local-authorities/overview-of-the-
homelessness-legislation
21. Mental Capacity Act 2005
• Presumption of capacity
• Unwise decision does not equal lack of capacity
• Support and assistance to make decision
• Best interests decision making framework if lacking
capacity
• Best interests requires involvement of P and taking
account of wishes and feelings
22. Children and Families Act 2014
• EHCP up to age 25 so will include adults
• E H C Plan
• Co-operation duties s.28
• Referral duty s.23
23. Children Act 1989
• Applies to adults - s.17 (support for families) and s.23C
(support for care leavers formerly looked after)
• S.17 requires a “child in need” assessment focusing on
what the child needs and what its family can and cannot
provide
• Leaving care provisions require pathway plan - what?
Who? When? How?
25. Why?
• Multi- agency involvement secures better outcomes
• Avoids “from pillar to post” see R(AM) v LB Havering
[2015] EWHC 1004 (Admin) and service users falling
through the net
• Budget pooling = better use of scarce resources
• Holistic assessment of circumstances rather than focus
on single issue
• In context of children “TAC” approach
26. When co-operation/ consultation goes
wrong…
• R(AM) v Havering: failure of communication between
housing and children’s services and between two LA
children’s services
• R(Juttla) v Hertfordshire Valley CCG: CCG decision to
cease funding respite for disabled children, failure to
consult LA which would assume responsibility
27. More examples of what can go wrong…
• R. (GS) v LB Camden [2016] EWHC 1762 (Admin):
assessment of no eligible needs under Care Act 2014
because only need was for housing (upheld), but failure
to consider use of Localism Act 2011 power to
accommodate, elevated to duty because of breach of
art.3 ECHR
• R. (KI) v Brent LBC [2018] EWHC 1068 (Admin); failure
of co-operation between leaving care services and
housing, each stating the other responsible for
accommodation needs unmet
28. Care leavers
• Leaving care support until age 21, statutory presumption
of “staying put” in foster placement
• Statutory guidance states that where c+s needs, this
should become a “shared lives” placement therefore
“specified accommodation” for CA 2014 purposes
• Children’s services report lack of co-operation from ASC
re pathway planning, assessment and shared lives
assessment / approval
29. Who should be talking to who?
• Care Act 2014 sections 6 & 7: “relevant partners” duty to
co-operate includes housing associations, NHS bodies,
emergency services
• Combined assessments and joint assessments
(statutory guidance/ Assessment Regs) allow more than
one person to be assessed / more than one body to
assess
30. Who does the talking? (cont’d)
• NHS: section 82 NHS Act 2006
• Housing referral to SS: s.213 HA 1996
• SS referral to housing where eligibility for housing: HA
1996 s.213B
• Children and Families Act 2014: EHCP process intended
to bring together health, education and social care see
specific duties s.23 and 28
32. P is homeless and has eligible care needs: he
needs help washing, dressing and with
cooking and cleaning.
He is told by housing that he should present to
social services. He is told be social services
that as he is homeless, he should present to
housing. Meanwhile, he is sofa surfing and his
needs are not being met…
Should his accommodation need be the
responsibility of housing or social
services?
33. Housing or social care?
• Part 7 HA 1996 section 189(1)(c): a person has PN if he
is “vulnerable as a result of old age, mental illness or
handicap or physical disability or other special reason, or
with whom such a person resides or might reasonably be
expected to reside”
• Overlap with “eligible needs” under CA 2014: unable to
meet two or more specified criteria without significant
difficulty
• If P lacks mental capacity to decide where to live, or to
enter into a tenancy…?
34. Capacity to be a tenant/ applicant for
social housing
WB v W District Council [2018] EWCA Civ 928
CA upheld the previous position (pre-HRA 1998): a
person lacking capacity to enter into a tenancy cannot be
an “applicant” for social housing under Part 6/7 Housing
Act 1996
35. Capacity and tenancy
• A MCA appointed Deputy cannot make the application
on P’s behalf unless the terms of Deputyship specifically
authorise this
• P who lacks capacity in this area is the responsibility of
social care, not housing, as regards accommodation
needs
36. Good practice guide
• What other agencies are involved? Consult them
• What other agencies should be involved?
Consult them
• Consider combined/ joint assessments
• Resolve any issues of capacity to make relevant
decisions at the assessment stage
• Use co-operation duties if other bodies resist
• If another body/ service is responsible, managed
handover…avoid “dumping”
39. Workshops:
Voices of Stoke –
housing and the Care
Act in practice
Bruno Ornelas, Head of
Service, VOICES
Room: Main conference
room
Homeshare
Deborah Fox, Policy and
Development Officer, Shared
Lives Plus (Homeshare UK)
Alice Williams, Sector
Development Officer, Shared
Lives Plus (Homeshare UK)
Room: Develop
41. The latest findings from the
Homeless Research Programme
Dr Louise Joly
Research Fellow, NIHR Health & Social Care Workforce
Research Unit
Dr Rob Calder
Research Assistant, NIHR Health & Social Care
Workforce Research Unit
42. Louise Joly & Rob Calder
NIHR Health & Social Care Workforce Research Unit,
King’s College London
Homelessness Research Programme
and the Rebuilding Lives Study
43. Presentation
Homelessness Research Programme, and the
HEARTH study
The Rebuilding Lives study:
a. Outcomes after five years for formerly
homeless people who were resettled
b. The importance of tenancy support
services and the challenges in providing
this help
44. Disclaimer
The views expressed in this presentation are those
of the authors, and not necessarily those of the
NIHR, the NIHR School for Social Care Research,
the Department of Health and Social Care, or the
NHS.r
46. Aims of Homelessness Research
Programme (HRP)
To contribute to the understanding of the causes
of homelessness, and the circumstances and
needs of homeless and formerly homeless
people
To contribute to policy and service development
regarding the prevention of homelessness, and
the improvement of services for homeless and
formerly homeless people
47. Current / recent HRP studies
Delivering primary health care to homeless people:
an evaluation of the integration, effectiveness and
costs of different models (HEARTH study)
Effectiveness and cost-effectiveness of ‘usual care’
versus ‘specialist integrated care’: a comparative
study of hospital discharge arrangements for
homeless people in England
Memory problems among older homeless people in
hostels
Studies funded by National Institute for Health Research
(NIHR) Health Services & Delivery Research Programme.
49. Aims of HEARTH Study
Identify extent and types of specialist primary health
care services in England for homeless people
Examine integration of primary health care services
with other services, and effectiveness of different
models in meeting health needs of homeless people
Evaluate over time the impact of different models on
service users’ health and well-being, and their
engagement with services
Examine resource implications & costs of delivering
services for the different models
50. Mapping of specialist primary health
care services for homeless people
Specialist primary health care services (SPHCS)
work primarily with single homeless people, or serve
general population but provide enhanced / targeted
services for homeless people
Identified 123 SPHCS in England. Various models,
e.g. specialist health centres, mobile health teams,
GP practices with homeless services, volunteer
health care services
SPHCS mainly located in urban areas
51. Evaluation underway of four models
Health centres specifically
for homeless people
Mobile health teams that
hold clinics in hostels and
day centres for homeless
people
GP practices with special /
targeted services for
homeless people
Generic GP practices that
provide ‘usual care’ to local
population, including
homeless people
53. Aims of Rebuilding Lives (RL)
To examine the longer-term outcomes for
formerly homeless people who were resettled
To identify the characteristics of those who
received or needed longer-term support
To explore the roles of different practitioners
in providing this support
Study funded by NIHR School for Social Care Research.
Collaborating homelessness organisations: Centrepoint;
Framework; St Anne’s Community Services; St Mungo’s;
Thames Reach.
54. Study design
Longitudinal study built on FOR-HOME
study (which followed up 400 formerly homeless
people for 18 months after being rehoused)
RL sample: 297 participants who were contacted
and housed at 18 months
Interviews with participants FIVE YEARS post-
resettlement
Interviews with 46 workers who provided
tenancy support services to participants
55. Housing conditions and coping
After five years:
Many were settled: three-quarters had created a
‘home’ and looking after accommodation
One-quarter struggling to cope – dirty
living conditions or hoarding
35% in housing in serious disrepair (dampness,
mould, faulty heating, electrical wiring
problems). Similar across all tenures
56. Homeless during the five years
16% homeless at some time in 5 years
Young people and those with long histories of
homelessness (10+ years) more likely to have
become homeless again
People who were rehoused in private rented
sector (PRS) had poorer housing outcomes –
36% became homeless again
Problems in PRS: high rents; ending of fixed
term tenancy agreements; conflicts with
landlords / other tenants
59. Income and finances
At five years:
Most on low incomes / struggling financially
Financial problems exacerbated by:
a. Social security benefits suspended / stopped
b. Casual / ‘zero-hours’ contract employment
Increase over time in debts, esp. among
young people
62. People receiving support
32% in receipt of support at 60 months; 40%
in last 12 months
People receiving support more likely to
have health / substance misuse problems
and long histories of homelessness
Less likely to have support: young people,
those in PRS, and those outside London
63.
64. Workers providing this help
Tenancy support / housing support workers
Homelessness sector staff
Housing wardens / housing officers
Drugs workers
Advice / advocacy workers
Mental health workers
Social workers / home care workers (mainly for
those aged 60+)
Others, e.g. probation officers
66. Main roles of support workers
Assisting people with finances – sorting out
social security benefit changes or stoppages.
Marked increase in this work over last 5 years
Assisting with accommodation problems – poor
conditions, disrepair, disputes with landlords /
neighbours
Helping to find alternative housing when PRS
tenancy agreement ends. Challenging as few
suitable housing options
67. Other challenges
Support is often time limited – insufficient
to resolve a person’s problems, esp. financial
difficulties
Increase in workload and the need for urgent
responses, especially for financial crises
Some people difficult to engage in support –
complex lifestyles, reluctant to admit problems,
isolated. Some only engage when in crisis and
their tenancy at risk
69. Increased workload and response times
“You may have a client that you used to see once a
month, but they suddenly go through a crisis where they
missed an appointment at a Job centre so their benefits
have stopped. And that situation may involve you seeing
them multiple times a week to contact their Job centre, to
write an appeal letter, to apply for a crisis grant, to
support them to go to the food bank, to go to the housing
benefits department, to submit a nil income letter, like
there’s so many things that can be involved…”
72. The need for tenancy support
Resettlement for homeless people works, but
many are vulnerable when rehoused and require
tenancy support
Some people require long-term support to
manage a tenancy; others require intermittent or
short-term support at times of difficulties
Support services are currently targeting many
with complex needs. Help is also needed for
young people and those who have little
experience of independent living
73. Contact details
Maureen Crane: maureen_ann.crane@kcl.ac.uk
Louise Joly: louise.m.joly@kcl.ac.uk
Jill Manthorpe: jill.manthorpe@kcl.ac.uk
Rebuilding Lives final report available at:
https://www.kcl.ac.uk/sspp/policy-
institute/scwru/res/roles/rebuilding.aspx
74. Table & Plenary Discussion
› What type of integration models have worked for
you in social care and why?
› What struck you from these research findings, and
what does it mean for your practice in the current
context?
› What other research would support your
social care practice with people who are
or have experienced homelessness?
75. Housing options to meet social care
need – an overview and critique
Jeremy Porteus
Chief Executive, Housing LIN
77. Housing Learning and
Improvement Network
• Sophisticated network bringing together
housing, health and social care professionals in
England and Wales to exemplify innovative
housing solutions for older and disabled people
• Recognised by government and the housing
with care sector as a leading ‘knowledge hub’
on specialist housing
• Online and regional networked activities (next
SW Housing LIN event – planned for May
2019)
• We connect people, ideas and resources to
inspire, inform and improve the range of
housing choices that enable older and disabled
people live independently
78. An ‘inward orientated home’
“From the viewpoint of many older
persons, the housing market for them is
lacking in the physical environment but
also in the emotional side of contact with
the wider community. The segregation
of one section of the community in an
‘inward orientated home’ just because of
age is a failed proposal and the ‘baby
boomers’ are looking for more
enlightened prospects for their later
lives.”
Ian Hooper, Housing LIN viewpoint
79. Getting the message across
“The focus for many has purely
been on bricks and mortar. If we’re
going to create truly aspirational
communities for seniors it needs to
move beyond design and be about
connection and relationships”
Sara McKee, Housing LIN Viewpoint
“The shortage of purpose-built housing for older people is ‘bed-
blocking’ the housing market.”
John Pankhurst, Inside Housing
80. What do we know about the national
trends?
• Much of our purpose-built stock
for older people predates 21stC
• Much of our mainstream housing
was built in the 20thC
• An increasing older population
with different needs & aspirations
• Significant numbers of older
people living alone (Onesis)
• Increasing numbers of people
living with limiting long term illness
• Increasing number of people living with dementia
• Significant numbers of older people provide unpaid care
81. Caring times?
• Personalisation: Long awaited Adult Social Care Green Paper
• Prevention: Prevention Green Paper
• Integration: NHS 10 Year Plan
• Partnership: Improved Better Care Fund
• Investment: Care and Support Specialised Housing Fund
• Shared vision: Improving Health and
Care through the Home – MoU
• But… Brexit
82. Deal or No Deal? Sector is woefully
unprepared
• Of those who worked for care and support organisations, only 1/3
said that their organisation had undertaken any Brexit planning
and/or risk assessments around staffing issues (recruitment and
retention)
• Of those working in the area of social housing, only 14% said that
their organisation had undertaken any Brexit planning and/or risk
assessments around the demand for housing with care/supported
housing
• Only 25% said that their organisation undertaken any Brexit
planning and/or risk assessments around the impact on customers.
There is concern that staffing issues may lead to instability and force
extra care developers to “move into more stable and profitable
sectors”. Other concerns raised include delivery of low-level support
services, delayed response to tenant issues and availability of
medicines
83. CLG Select Committee on Housing for
Older People; key recommendations
• The existing FirstStop Advice Service should be re-funded
by the Government
• Recognise the link between homes and health and
social care in the forthcoming social care green paper
• Additional funding for Home Improvement Agencies
• A range of measures to help older people overcome
the barriers to moving home
• Ensuring that national and local planning policy encourages the
building of more of all types of housing
for older people
• Specialist housing, and particularly extra care housing,
can promote the health and wellbeing of older people
and their carers, leading to savings in spending on
health and social care
• Recognising the HAPPI design principles, build all new homes to
accessible and adaptable standards
84. Getting our homes and communities
right
‘Residential Revolution’ (LGA, 2017) estimate
shortfall of 400,000 units of housing for older
people by 2030. Encourage councils:
• Having a clear vision: promoting awareness
and changing attitudes to later life
• Planning for an ageing population
• Delivering and enabling new housing for
older people across the public and private
sectors
• Promoting an integrated approach to
housing, care and health
• Sustaining older people in mainstream
housing
85. Impact of housing on NHS and social
care costs and outcomes: the evidence
Derby City Council, Healthy Housing Hub
• Housing related advice and support
• Prescribed housing support
• Healthy housing assistance
• Partnership links across health, housing,
social care and the voluntary sector
• Evaluation - positive outcomes / efficiencies
86. Home from Hospital – Interactive Map
• Developed jointly by Foundations UK
and Housing LIN
• Highlights where housing
organisations are supporting hospital
pathways in range of practical ways
• Projects from across England are
profiled, set alongside ‘DToC’ (Delayed Transfer of Care) data
• Aim: to inspire, support and inform local conversations
• Quarterly updates planned to capture new activity
• In future, include examples from Wales
• Visit https://www.housinglin.org.uk/home-from-hospital/
87. What does contemporary housing
for older people look like?
• Matching different housing options to
identified need in particular locations/
communities – rural v urban
• Based on strong partnerships - signalling
clearly to the market and providers what
types of later life housing options will be
required, including retirement housing
• New care and support delivery models,
including intermediate care
• Ensuring there is a balance and mix of
housing options (dwelling and tenure)
developed and available to meet future need
• Growth of downsizer, upsizer, or rightsizer
housing? But also ‘staying put’ options
88. Is our system safeguarding rights
or promoting choice?
Revenue
• Longer term implications of housing benefit/LHA reform
• Commissioned/self-funded housing & care
• Viability/VFM inc size and scale
Quality
• Design/location of accommodation
• HAPPI principles ‘reduce loneliness/isolation’
Financial Capital:
• New stock: business case for extra care housing?
• Existing stock: decommission, remodel/upgrade, refurbish
Social Capital
• A better quality of life for residents
• Improved health and wellbeing/compress dependency
• Reduce loneliness/isolation
• Community building
89. Dean Hawke’s Circadian House
• Longing and belonging –
the psychology of ageing
• Combatting loneliness and
isolation – social care of
ageing, friendships and family
• Home, place & community –
the environment for ageing
• Live in balance with nature –
follow the daily and seasonal
cycles of the outdoors
• Adaptability – adapt to changing
conditions ie ‘care ready’
• Sensibility – protection from
and control of environment ie
passive solar gain
90. Improving later life
Building personal resilience
Detachment from social participation in older age
can have negative impacts on health & wellbeing,
including depression, physical and cognitive
decline, and increased mortality
Building community resources to
resilience
Social mobilisation – providing ways and means to
build, enable and support older people’s
connections to social networks in the community
and to foster their mutual aid
Co-creating lifelong neighbourhoods
Older people are both the beneficiaries of and
contributors to all age-friendly activities that span
the generations
91. CollaborAGE – “my 6 I’s”
• Involvement: Ease of maintaining existing social networks and
opportunities for wider social interaction including multi-generational contact
• Independence: Privacy when wanted by having own front door and with
security of tenure
• Inclusion: Living in a community which will be “fun” and would foster self-
reliance, self-control and determination, interdependence and co-operation.
These being factors that contribute directly to continued independent living,
successful ageing and enhancement of a longer life
• Integrated: With health professionals embedded within but not dominating
the scheme, would ensure that residents, when hospitalised - not ‘bed-
block’ at time of discharge
• Inviting: Having open welcoming public areas and quality apartments
provide a retirement complex to which children and grandchildren will be
happy to visit and create ‘feel good’ memories for all, plus
• Inequalities: Effective housing interventions eg delivering better health &
wellbeing outcomes, improving housing conditions, tackling fuel poverty etc
92. Some principles of age-friendly HAPPI
design
• Easy access to outdoor space
• Homely and practical internal environment
• Therapeutically and psychologically
informed environment
• Shared activity space to tackle isolation
• Located close to community and health
facilities, ‘hub and spoke’
• Flexible to enable varying level of personal
care and support
• Engagement and partnerships with NHS
providers, commissioners and partners
• Link to Health & Wellbeing
93. Getting the design quality right
• Doing it for ourselves/co-design
a volunteer ethos- desire and
necessity for next generation of older
people; resident-led, self-care,
community-led or mutual ownership,
co-housing, ‘virtual’ villages, age-
friendly communities
• ‘Care ready’ housing
housing more closely integrated
housing, care and support
commissioned locally to reduce
dependency, address long term
conditions such as dementia
94. Some final thoughts…
• Leadership: What is really important to
your strategic leadership team and
partners in setting out your priorities ?
• Ambition: How can we ensure ‘visioning’
housing and care so it is best redesigned
meet local needs and services?
• Insight & intelligence: Where is there
robust evidence base to inform decision-
making locally?
• Integration matters: What is the
connection to wider integration and
transformation agenda with local
economy?
• Improved outcomes: What
measurements do you have in place to
measure resilience?
• Coproduction: what examples are there
of effective co-designing and coproducing
with residents?
95. So… opportunity or challenge?
• Is there the case for better housing with care
for maximising independence for people with
dementia or is the future more residential care
and home based support?
• What strategies and policies are in place to
engage, involve and listen to the housing with
care needs of older people and their carers,
and the wider community?
• Join the Housing LIN to stay connected
with latest ideas
97. Thank you!
Housing Learning and Improvement Network
c/o PRP, The Ideas Store
10 Lindsey Street, Clerkenwell
London EC1A 9HP
Email: info@housinglin.org.uk
Website: www.housinglin.org.uk
Twitter: @HousingLIN @HousingLINews
98. Drawing the threads together,
action planning
Lisa Smith, Assistant Director of Research in
Practice for Adults (Chair)
99. Up and coming RiPfA resources
› Brief guide – housing and wellbeing
› Practice Tool – relationships across the system
› Strategic Briefing – support people who are
sleeping on the streets
› Leaders Briefing – housing options to meet future
social care need
› Knowledge Exchange Workshop – working with
complexity
Use the sign up sheet on your table to tell us
that you would like to be involved as they
develop!
100. Drawing the threads together,
action planning
1. What will you: Stop, Start, Sustain in your
practice around housing and homelessness
2. What would you like RiPfA to take away
from the day and communicate to
others?
Care Act – well being – need for accommodation and security
Housing must be a key part of our thinking as we develop proposals for the future of social care and work towards our mission to ensure people live 5 additional years of healthy life.
There is solid evidence on the benefit that housing interventions can bring - both to the individual in terms of living more independently for longer, and across health and social care. For example:
On average, home adaptations delay the move to a care home by 4 years; and1
Relatively low-cost home modifications can lead to a 26% reduction in falls that need medical treatment and savings of £500m each year to the NHS and social care services in the UK.2
Therefore, it’s vital that housing and social care teams work well together because of the benefits a high-quality, safe, and suitable home can bring.
Housing development – how can local areas ensure there is suitable housing to meet future social care need - (Jeremy Porteous is doing a session on this in the afternoon)
Jeremy Porteous (from the Housing Learning and Improvement network) will talk about this in detail in this afternoon’s session but it is crucial for local areas to ensure that there are enough different types of housing to meet the needs of their local populations. As I referenced earlier, this can include adapted mainstream housing or more specialist accommodation.
MHCLG’s Housing for Older and Disabled People’s Guidance provides support guidance to local authorities around this. This is due for publication soon but the date has not yet been confirmed.
The Department works across Government - including with the Ministry of Housing, Communities and Local Government – as it is important for there to be a joined-up approach to policy-making and to ensure that competing and complementary priorities are reflected
For example. We work closely with MHCLG on the Disabled Facilities Grant (DFG), which supports disabled people, including older people, on low-incomes, to adapt their homes to make them suitable for their needs.
An independent review of the DFG - which assesses how the Grant is currently working and makes evidence-based recommendations on how it could change in the future – was published in December 2018. Together with MHCLG, the DHSC are carefully considering the review’s findings.
The DHSC provides funding to build specialised housing - through the Care and Support Specialised Housing (CASSH) Fund - for older people and adults with learning and physical disabilities, and mental ill health. More widely, we work with MHCLG, who provide the majority of capital grant funding for new supply of supported housing.
We are also working with BEIS and MHCLG, as part of the Ageing Society and Clean Growth Grand Challenges, to launch a new design and innovation competition later this year. This will prototype the homes of the future - built to a standard suitability for changing needs across a lifetime whilst also being environmentally sustainable.
Adult social Care Green Paper – how housing is likely to fit
The Government will be publishing a Social Care Green Paper at the earliest opportunity to bring forward proposals to improve the social care system, and the role of housing will be a crucial part of considerations
In developing the Green Paper proposals, we will be considering both existing stock and new builds, as well as the various kinds of housing options that are - and should be made – available, to ensure people are able to live in a ‘suitable’ home
Loneliness is an issue that affects many in our society and when people feel lonely most or all of the time, it can cause serious harm.
Studies have shown that loneliness leads to an increased likelihood of developing certain health conditions. Specifically, socially isolated people are:
3.4 times more likely to suffer depression;
1.9 times more likely to develop dementia in the following 15 years;
2 to 3 times more likely to be physically inactive, which may result in a 7% increased likelihood of developing diabetes, an 8% increased likelihood of suffering a stroke and a 14% likelihood of developing coronary heart disease
Three quarters of GPs surveyed by the Campaign to End Loneliness said they see between one and five lonely people a day.
Loneliness can also be associated with an individuals housing situation or their ability to connect with their community. ONS data shows that not feeling as if you belong to your neighbourhood is one of the factors found to significantly increase the odds of reporting loneliness.
Others at risk of loneliness are:
Renters (30% greater odds than those who owned their property)
Widowed older homeowners living alone with long-term health conditions
Addressing loneliness in communities
It is reported that people who went out socially in their local area felt more connected to the neighbourhood. Enabling people to have better access to places where they can get together or access transport that enables them to get to places where they can connect can help to build their social connections.
The Government’s loneliness strategy A connected society: A Strategy for tackling loneliness – laying the foundations for change (October 2018), sets out how government will work with local authorities, the voluntary sector, transport providers, and digital and social media companies to, among other things, place community at the heart of the design of housing developments and planning, by embedding it in planning and design frameworks and by researching how community-led housing could reduce loneliness.
People sleeping rough – what could / should social care’s response be?
From the health perspective, we want to see good mental health and addiction services brought to rough sleepers and we want local services to support people to come off the streets.
This involves housing, health care, public health and social care working together to support rough sleepers to lead to better outcomes.
Rough Sleeping Strategy
A cross-Government Rough Sleeping Strategy was published in August 2018, setting out plans to deliver our goal of halving rough sleeping by 2022 and end it altogether by 2027.
The strategy goes further than any other government has done before through its commitment to make fundamental changes to how we help people to maintain a stable home.
Continuity of care
Continuity of care is a challenge for homeless people who may need to access social care support packages, particularly those leaving treatment settings such as hospital, residential accommodation, or prison, if they are discharged or released with nowhere to live.
Effective hospital discharge models can support homeless people in ensuring this support is put in place, including ensuring patients can access social care support packages.
NIHR funded research is due to be published in 2019 which has reviewed the effectiveness of different models of provision of hospital discharge and primary care services for rough sleepers and we will be supporting the dissemination of this research.
Audit of local services
We are conducting a rapid audit among the 83 Rough Sleeping Initiative areas of health services targeted at people who rough sleep, with a focus on mental health and substance misuse services, as well as physical health services.
We sent a survey out to the 83 Rough Sleeping Initiative areas last November and we are pleased to see that 80% of local areas responded to the survey. The survey will inform national and local commissioning, helping us to understand the gaps in services. NHS England are already using the findings to inform the NHS Long Term Plan.
Testing models of community-based provision
We are providing up to £2 million in health funding to test models of community-based provision that enables better integration of services, particularly for people with both mental ill health and substance misuse issues, to see where local services can be delivered more effectively.
Health and wellbeing boards
We are working with the Local Government Association to support Health and Wellbeing boards to recognise and respond to the needs of those who sleep rough, and to provide leadership in developing homelessness and rough sleeping strategies.
End of life care
In December 2018, the Health and Wellbeing Alliance published ‘Care committed to me’ which aims to identify and share good practice in end of life care for three specific groups: people in Gypsy and Traveller communities, people experiencing homelessness and people who are LGBTQ. Dissemination activity for the publication is under way, including blogs, webinars and presentations.
Safeguarding
We are working closely with the Local Government Association to develop a series of national events in 2019/20 to look at safeguarding and homelessness and how we can share learning from reviews into rough sleeping deaths.
We have commissioned King’s College London to conduct a thematic review of the national Safeguarding Adult Review Library on homelessness and rough sleeping cases to identify themes and learning that can be shared.
NHS Long Term Plan
The NHS Long Term Plan includes a number of measures to provide support to rough sleepers.
The Plan includes measures to ensure all areas of the country will implement and be monitored against a ’12-point discharge plan’ to ensure discharges are timely and effective.
Homelessness Reduction Act – duty to refer
We have ensured NHS Trusts and Foundation Trusts are aware of their responsibilities under the Homeless Act, in particular their duty to refer patients who are homeless or those at risk of homelessness to Local Authorities. Guidance from Public Health England has been updated to support local organisations.
How underpinning social care professional values can benefit relationships across social care and housing practice e.g. strength based working, good supervision, relationship based practice
We must look more broadly than social care services alone, and incorporate the wider networks of support and services which help older people to live independently, and we agree that housing is integral to this
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?
Are there other market opportunities such as aids and adaptations, telecare, ‘hub & spoke’ models of housing and care
Use post it notes to record action points for RiPfA