The holy trinity
by Claudia Wood
Today I attended a seminar hosted by the Papworth Trust, discussing the implications of new research they have launched related to housing adaptations and care. A few months ago I blogged about how a holy trinity of demographic change, medical advances and a policy shift away from residential settings had catapulted housing to the top of the agenda when it came to health and social care.
Growing numbers of older and disabled people – all expecting to live more independently at home – has created a groundswell in demand for suitable housing, housing adaptations and equipment. It has also made the quality and suitability of housing the primary driver in escalating social care costs and an important factor in public health.
In the face of this, it is clear that our current housing stock – designed for when people lived until they were 60 and died in hospital, and when disabled people lived mainly lived in institutions – is woefully inadequate. But for many years, governments of all political persuasions have underestimated the importance of housing in health and care agendas.
While hours of policy time and resources of been poured into achieving integration and personalisation, a far more basic barrier to improved wellbeing and reducing NHS and social care costs has been consistently overlooked at the systemic level.
Thankfully, this government has come around to the realisation that the lack of suitable and adapted housing is fundamentally inhibiting the success of community care, independent living and prevention strategies. The White Paper announced new capital investment to increase suitable housing, investment for Handy Persons and telecare services, and so on.
But is this enough? We really have no idea of the size of the problem when it comes to the lack of suitable housing and problems with accessing adaptations. Some anecdotes about long waiting times for Disabled Facilities Grants was the only thing many had to go on.
But now, the Papworth Trust’s survey of older and disabled people has started to lift the lid on the current state of affairs. It confirmed what many on the ground had suspected was going on across the country - a quarter of people said they couldn’t get around their homes safely. One third said they couldn’t use all the features in their home.
Forty per cent said the design of their home meant they needed help to carry out day to day tasks (often, one imagines, funded through social care budgets). Yet two thirds of those surveyed had never heard of the Disabled Facilities Grant – the main source of funding for people’s home adaptations. Of those lucky enough to know about it, a quarter had had to wait more than a year for the grant. One woman had waited 8 years for a DFG before giving up and using her own savings to have her house adapted.
With findings such as these, the government must look at the housing related proposals in the White Paper and ask itself – is this enough? Are we identifying the right problems? The seminar today asked such questions and mulled over the implications of the findings. Access to information on housing adaptions, equity release for home owners, an increased role for social landlords were all raised – but much of the conversation boiled down to the lack of recognition of housing by counterparts in health and care.
In particular, making connections with Clinical Commissioning Groups (CCGs) and Health and Wellbeing Boards was seen as a huge and sometimes insurmountable challenge. Many health commissioners are simply not grasping the importance of suitable housing. However clearly the two might be linked at departmental level by the White Paper, on the ground, the message isn’t getting through.
In the housing, home repair and adaptation world, people are trying hard to 'speak the language' of health and looking into cost-benefit evaluations of the improved health outcomes associated with adapted housing, as a way of getting CCGs to take notice.
This effort is to be applauded, but does suggest that health remains king, while social care and housing have to bend and fit to its demands. CCG doors seem to remain closed to all those who can’t get with the programme - I know money is tight, but are we seriously at a point where we need a business case with quantified cost savings to health, in order to get the NHS to shell out for a £50 handrail for a frail pensioner?
I wonder if the predominance of health over social care and housing is reducing our thinking down to achieving evidenced clinical outcomes, rather than what people actually want and need. What health, housing and care can actually achieve, when they work at their best, is an immeasurable improvement in wellbeing and quality of life – and the Papworth Trust’s report showed that most clearly.
If health and care commissioners put this front and centre of their thinking, integration, personalisation and cost savings would surely all follow.