Opportunities and challenges for the housing sector 10 November 2016, HDRC, Worcester Jeremy Porteus Director @HousingLIN

About the Housing LIN Members of the Prime Minister’s Challenge on Dementia Health and Social Care Champions Group 48,000 members across housing, health and social services to help improve partnership working and integration on housing and care Essential online resources on housing with care for older people to support commissioners, funders and providers in market development, innovation and investment Publish papers to brief on latest innovative policy, research and practice developments in housing, care and support for older people 10 regional ‘learning labs’ in England and Wales supporting local information exchange, peer-to-peer shared learning and improvement activities, and exemplar study visits

Ready for Ageing? “The housing market is delivering much less specialist housing for older people than is needed. Central and local government, housing associations and house builders need urgently to plan how to ensure that the housing needs of the older population are better addressed and to give as much priority to promoting an adequate market and social housing for older people as is given to housing for younger people.” Select Committee on Public Service and Demographic Change, Lord Filkin (2013)

Still not Ready for Ageing! “We have a huge undersupply of retirement housing. New mainstream housing is, in the main, not being built to Lifetime Homes Standards, and older people are not being adequately supported to adapt their own homes. Significant numbers of older people live in housing officially classified as ‘unfit’.” Ready for Ageing Alliance (2016)

Challenging times - impact of austerity measures and risk to business Increase rent arrears, debt and homelessness (NAO report and DWP select committee findings on welfare reform) National Minimum Wage inc care and support staff – costs Exempt accommodation or LHA and -1% rent increase Future of Attendance Allowance – LA commissioning pot Social care planned care (block contracting) shifting to Individual Budget / personal budgets/ self funding (ADASS annual budget survey) Reductions in home care, day opportunities and respite care – what about community resilience? Residential care market failure? Increased pressure on acute health and accident & emergency services (Health Select Committee Report)

State of the Nation - the retirement housing market Extra care housing and market retirement housing will grow to meet customer demand (estimated at £3bn-5bn pa) HAs will continue to have access to capital funding for extra care housing via government grant, borrowing and asset management HAs being forced to shift to lower cost/technology based older people’s housing ‘wellbeing’ service model/s Market retirement housing operators looking to identify ‘smart’ and attractive solutions to support their customers’ lifestyle choices Change in revenue funding for older people’s housing in the social sector from 2019/20 - largest structural change in 15 years Merger activity in the HA sector will accelerate as the financial drivers and regulatory pressures increase Upmarket retirement housing developers beginning to grow ‘middle market’ extra care housing for sale (est. 590,000+ units needed in next 10 years) Housing wellbeing and ‘hub’ service model example: Hanover HA : wellbeing strategy Affinity Sutton: Have rebranded sheltered housing as ‘LiveSmart’ and sought to make it a more attractive ‘downsizing’ offer. It has started to install Wi-Fi at some of its schemes. South Yorkshire Housing Association (SYHA): providing a range of services to promote wellbeing, including a social prescribing pilot, a LiveWell centre offering day activities and cross-tenure housing support for older people; Eden Housing Association: transforming a contracted support service to sheltered tenants into a pay-as-you-go ‘independent living service’ open to all, in which Eden acts as the gateway to a range of trusted local providers (from domiciliary care to decorating).

Opportunities and risks Seek larger local authority partners that have a ‘strategic commissioning’ approach to develop extra care housing for rent and sale at scale LAs - use of telecare/care enable technology to reduce use of registered care – e.g. learning disabilities. New Department of Health Housing and Technology Fund LAs - technology enabled care services for Dementia specialist extra care housing schemes CCGs – benefits/outcomes from some of the Vanguard sites & supporting local STPs/NHS Plans to deliver care at home, triaging to reduce hospital A&E admissions, ambulance services or tackle delayed transfers of care Vanguard – Airedale example Risks: Securing telehealth and other digital health commissions from NHS commissioners requires a very significant investment of management time and resources often with the need to go through the process of internal NHS business cases and potentially external procurement exercises Whilst some of the integrated primary and acute care systems vanguards offer potential for the use of patient data on a large scale as part of integrating a range of services, there is very limited evidence to date that housing providers have been successful in building these types of partnership and working arrangements with NHS commissioners or providers.

Opportune or opportunities? Extra care growth – HA new build; charitable sector retirement villages; new market retirement sector entrants Larger HAs that are merging or will ‘acquire’ additional OP housing stock New ‘wellbeing’ offer to residents and shift to digital (other likely will follow to reduce staff costs – enable greater self care/ models of resilience) Specialist extra care provision – dementia / learning disability CCGs - replicate the benefits/outcomes from some of the NHS Vanguard sites to support future commissioning of ‘out of hospital’ services at scale

Impact of social care and health factors on the retirement housing market Local authorities are increasingly taking strategic commissioning approaches to developing extra care housing (to deliver planned care and address growing number of self/private funders) LA funding constraints - continuous pressure to reduce expenditure on residential/nursing care and home care (ADASS budget survey) Demand increasing for extra care housing suitable for people living with (moderate/severe) dementia and people with other LTCs eg a learning disability Housing models that deliver tangible benefits to NHS growing but still relatively micro scale

Forthcoming Housing LIN report – emerging findings Development of schemes has often been opportunistic dependent on local or grant funding Sizes varied with typically between 50 and 100 apart from in the larger villages Integrated models of support reflected local arrangements between housing providers, housing authorities and social services There was no explicit exclusion of people with dementia from the schemes (depending instead on allocation panel interpretations of being able to meet needs)

Other findings from Housing LIN report There was a perceived tension in design and creating dementia friendly environments which are also attractive to the public and people not living with dementia There was a variable knowledge base about dementia design, but a strong commitment from individual managers and schemes who took part to do their best for people with dementia. Further research could usefully explore: impact of when someone moves into a scheme dependent on their individual dementia journey triggers for someone to leave and how they might be overcome through either integrated working and / or environmental design 

Building the evidence base Housing and Dementia Research Consortium – group of national housing providers developing robust mechanisms to evaluate housing and dementia Housing and Dementia Charter Other examples of research/good practice: Guinness Partnership toolkit Accord Housing Nameste project JRF, DEEP project and Dementia-friendly York The Pocklington Trust, visual impairment and dementia ExtraCare Charitable Trust, Enhanced Opportunities Programme University of Sheffield: DWELL report

Key Housing LIN resource on dementia Dementia: Finding Housing Solutions (in partnership with NHF, Foundations and University of Stirling Dementia Centre) 3rd of people with dementia living in specialist housing Alzheimer's Society report on Dementia-friendly Communities Important how we design inclusive communities Several Housing LIN case studies and workforce and training resources (Making a Start) Housing LIN Viewpoint with the University of Warwick Checklist of creating dementia-friendly environments

Housing LIN dedicated web resource In Focus: Innovations in Housing and Dementia Essential information on meeting the housing and care needs of people with dementia. 9 key areas: Recollections Commissioning Provision Design and environment Dementia-friendly communities Practice, workforce and training Legislation and regulation Dementia Action Alliance Useful links http://www.housinglin.org.uk/Topics/browse/HousingandDementia/

Thank you www.housinglin.org.uk c/o EAC 3rd Floor, 89 Albert Embankment London SE1 7TP email: info@housinglin.org.uk tel: 020 7820 8077 website: www.housinglin.org.uk Twitter: @HousingLIN