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01.02.13

‘It’s a given that good housing is a key determinant of good health’

Source: Public Sector Executive Jan/Feb 2013

The National Housing Federation’s new report focuses on the important role housing can play in a truly integrated and person-focused health and social care system. PSE talks to author and NHF policy officer Amy Swan.

'Providing an alternative pathway: The value of integrating housing, care and support’, the new report from the National Housing Federation (NHF), highlights examples from across the UK of health, care and housing organisations working well together to support people to live more independent lives. The case studies all show how such support can cut the need for more expensive care and inpatient admissions, and save money overall.

We asked report author Amy Swan whether these were isolated examples of excellence, or whether they reflected nationwide progress.

She said: “It’s so dependent on local structures. It’s a given that good housing is a key determinant of good health. We know that settled housing can improve people’s health, we know it can reduce the instance of various diseases, and I think health and care professionals understand that and see good housing, in itself, as a preventative investment.

“In this report, we’ve tried to show the home as a ‘delivery channel’ for a range of healthcare and support services. The case studies are an example of how well that can happen, and where key partnerships have been built up around various complex needs to ensure people are able to live independently in the community, and reduce the overall need for care and prevent poor health in the future.”

Bridging the gap between care and independent living

“It’s about making sure housing is part of someone’s care pathway. We want to see a system in which GPs, social care professionals, providers, social workers, all know where and how they can access advice on housing options, and what specialist care and support solutions can be useful at different stages of diagnosis, care planning and condition management.

“But the second point is that we would like to see services being developed and commissioned through the home. Integration is really about bridging that gap between institutional care and independent living. The housing sector is all about independent living. We’d like to see more investment being put into preventative, community-based care and support, through the housing sector perhaps where appropriate, as we feel that can lead to better and more cost-effective outcomes for service users, and a better quality of life.”

Reversing fragmentation

Among the many NHS structural changes as a result of the Health & Social Care Act is the creation of Health & Wellbeing Boards (HWBs), which involve local government more directly in health decisions.

But more generally, Swan said, the NHF is concerned that the housing sector isn’t as involved in local commissioning structures as it should be.

“We’d like to see the NHS, housing providers and local authorities working together to understand the routes people take through local services.

“Where can closer working with housing providers give better results? Where are outcomes being limited by fragmented care services?

“We would like to see the housing sector better involved in HWBs, so we can work together to understand where costs are building up in different parts of the system, and identify housing-related services and a way of reducing those costs, and providing better outcomes.”

Capital funding

She welcomed the Department of Health’s announcement of £300m to develop new specialist care schemes for older and vulnerable people.

She said: “That’s fantastic, but those schemes are still very much dependent on the revenue – on those care and support services that will be delivered within schemes, and that’s the bit that’s hugely affected by cuts and the lack of structured social care funding coming from central government.

“There’s still a lot of insecurity, even though you have that capital funding coming into the sector.

“Local authorities are working very hard to continue to meet what is clearly an increased need on many levels, particularly when you take into account the amount of people with dementia and other complex needs, that are growing every day.

“They’re having to meet that with a decreasing amount of money. In the housing sector, we’ve seen huge cuts to housing-related support, which many local authorities value and see the good impact those services have, but they’re having to make cuts across the board.”

A key recommendation from the NHF to the Department of Health is that housing, health and care outcomes are considered when surplus NHS land is being disposed of, rather than the financial return being the only priority.

Swan said: “They did make a commitment to that in the social care white paper, but we’ve not seen any follow-up to that, which is disappointing. Certainly, in order to achieve their efficiency cuts, they’re going to have to dispose of land that’s surplus to requirements. We’re simply suggesting that we want to ensure that land continues to deliver good NHS outcomes.”

Extract from the report

Housing features heavily in the recent white paper, ‘Caring for our Future’, as part of an integrated health and social care system, which prioritises preventative care and speeds recovery to independence. Joint working between housing, health and social care can:

• avoid or delay a move to residential care
• reduce admittance to hospital and avoid readmission
• reduce the demand for assessment and treatment centres
• prevent the need for domiciliary care
• prevent health emergencies and reduce demands on A&E
• prevent mental health deterioration and overall deterioration in health and wellbeing.

These case studies, which provide practical examples of bringing together housing, health and care, deliver savings of between £2,946 and £17,992 a year compared to less integrated pathways. One service saved a total of £241,670 to local health and social care budgets.

At a time when local authorities have to cut spending while continuing to meet the needs created by changing demographics, it is imperative that we integrate as a way of improving outcomes while achieving efficiencies.

For the people who use these services, they do more than just provide good value for money. People get the care and support they need to live an active life-getting back into work, having friends and family to visit or simply going for a walk in the local park.

(Source: ‘Providing an alternative pathway: The value of integrating housing, care and support’, NHF) 

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