Challenges & Opportunities A home – is a fundamental right and a critical determinant of good health Individuals who are unable to access safe, secure, affordable and appropriate housing will have both a reduced quality of life and an increased need to access other social and health support and treatment services. The lack of adequate and appropriate housing will directly result in increased costs in health and social service sectors. In many respects the UK government is refashioning social housing social housing is increasingly seen as an emergency safety net. Fixed term tenancies are a further attempt to erode the positive features of social housing –affordability and security – to the point they are not worth defending. A council home for life will become a thing of the past A council home for life has become a thing of the past Future security of tenure will only be for those who can afford to buy their own home It is becoming increasingly clear that investing in housing services for the high health risk populations is a critical element of an fully integrated health and social care service delivery system. Through investment, health and social care authorities can avoid having to pay higher costs to meet health needs created by inadequate housing.

Housing Development in Wales 2007-15 There is a dire shortage" of housing in the UK - continuing to drive up prices 2007 UK government set a target for 240,000 new homes to be built a year by 2016 We do need to release under-occupied accommodation – extra care offers an offers an opportunity to address the dire housing shortages across the nation Stats Wales

Social Services &Wellbeing (Wales) Act The Social Services and Well-being (Wales) Act is in force from April 2016. It is the new legal framework that brings together and modernises social services law. The Act is supported by Regulations – Secondary legislation where further detail is required Codes of Practice – Guidance to help people and organisations to work within the law The Act is made up of 11 parts: The Act imposes duties on local authorities, health boards and Welsh Ministers that require them to work to promote the well-being of those who need care and support, or carers who need support. The Social Services and Well-being (Wales) Act changes the social services sector: People have control over what support they need, making decisions about their care and support as an equal partner New proportionate assessment focuses on the individual Carers have an equal right to assessment for support to those who they care for Easy access to information and advice is available to all Powers to safeguard people are stronger A preventative approach to meeting care and support needs is practised Local authorities and health boards come together in new statutory partnerships to drive integration, innovation and service change

Issues We have a health and care system focussed on crisis intervention. It is not sustainable. The new Social Services & Wellbeing (Wales) Act is the cornerstone of a care system for the current and future generations. We need to move from crisis management to a preventative, personalised model of care which has wellbeing and empowerment at its core We need to build on people’s strengths not reinforce their dependency There is a lack of available supported housing for seniors which is purpose designed to support aging in place, is affordable and is linked to a broad range of support services (e.g. housekeeping, meal service, emergency monitoring and response, recreational services and laundry). Housing options with these elements (e.g. congregate housing) are available at market rates for seniors with adequate incomes. However, with few exceptions, options to assist the low income senior to remain independent as long as possible are virtually non existent. This gap may result in some seniors being admitted to Continuing Care facilities sooner than necessary. Prevention, Reablement and Integration

Well-being A good home Individual rights respected Physically, mental and psychological contentment Access to education, training, sports and play Safeguarded from abuse, harm and neglect Affirmative relationships with family and friends Engaged in the community Sufficient money for a healthy life The Social Services and Well-being (Wales) Act 2014 has, at its heart, placing the citizen at the centre of all considerations about what makes up the very best care and support.

Promoting well-being People need to feel that the social worlds they inhabit, are ones that recognise and include them Quality relates to the time spent with people, the quality of information and the flexibility and sensitivity of support provided People’s experience is a reflection of the attitudes and responses they encounter Wellbeing is consistently underpinned by the values of respect, reliability reassurance, and trust Ultimately wellbeing is about choices

Extra Care Self-contained accommodation Control of your own front door; Support available 24/7; A thriving community with neighbours, looking out, not in; The chance to choose whether to eat and socialize together with those neighbours, family and friends; A focus on activities to keep people healthy Strengths based support One of the original features of 'extra care' was a mixed and balanced community, with 33% of tenants requiring substantial care and support, 33% requiring limited support and 33% requiring not care and support at all. As tenants and owners grow older, the balance changes or possibly disappears. At the same time, commissioners expect 'extra care' to be able to provide for and respond to increasing numbers of older people with complex conditions and increasing frailty.

Whole Systems approach - a 'rich tapestry' People lead lives that have multi-faceted components family, neighbourhood faith, work hobbies and health Staying amongst friends and family and in a familiar environment will always be a first choice Essential that we do not deny older people the chance to continue to grow and develop, remaining in control of what matters a 'whole system approach', easily tripping off our tongues, but an approach that acknowledges that people lead lives that have multi-faceted components, e.g. family, neighbourhood, faith, work, hobbies and health. We often refer to it as a 'rich tapestry' and it remains essential that we do not deny older people the chance to continue to develop that tapestry for themselves.

Mixed-tenure! There is a distinct advantages to mixed tenure: Increases diversity in people's lives and settings. Sales bring in much needed capital that creates the opportunity for cross-subsidy Opportunity for a wider and richer range of facilities and activities

Service at the heart of community Non-stigmatising Traffic going both ways Tenants and owners using local shops Local people making use of the facilities Gym, Restaurant and Coffee shop The scale of a scheme becomes an important determinant of the range of facilities on offer At their best, extra care housing schemes are part and at the heart of a neighbourhood and community, with traffic going both ways, tenants and owners using local shops, services and facilities and local people making use of the facilities that the housing scheme has to offer, e.g. gym, restaurant and coffee shop. In addition, there was recognition that the scale of a scheme becomes an important determinant of the range of facilities on offer.

Research – Aston University The average number of planned admissions to hospital reduced for ExtraCare participants by 12 months by 31% (no change for control participants) Number of unplanned admissions did not change for either group After 12 months GP usage (planned) by ExtraCare residents in the sample had decreased by 46%. There were reductions in BMI and Waist circumference between baseline over 18 months in ExtraCare residents while these remained unchanged in control group NHS costs in total reduced significantly The reduction for the frail residents at baseline and follow-up, this changed from an average of £3274.21to £1588.04 average per person. Investment in the maintenance of wellbeing and independence has never been so critical, but in these financially straitened times, there are real concerns that prevention measures will come to be seen as a low priority. It is, therefore, vital to be able to demonstrate their cost effectiveness.  Research can be a real aid in thinking about what works best and we considered the findings from Aston University's research into the model of support offered by Extra Care Charitable Trust. This has some encouraging signs about reducing unplanned hospital stays and cost savings on social care (available from Extra Care Charitable Trust or Aston Research Centre for Healthy Ageing).

The Enabling State! A fundamental rethink of the state’s relationship to citizens and communities has begun. Although we must continue providing the public services that it excels at supporting the mot vulnerable. We must also take on a new role, that of the ‘Enabling State’, empowering and supporting communities, individuals and families to play a more active role in improving their own wellbeing. Progress towards this shift need to be less piecemeal if it is reduce the potential risk for transformative of leaving behind the most vulnerable . Carnegie UK Trust (2016)

The future Extra care housing has to be more visible so that more people can exercise a choice about their housing needs and wishes Government should also make it clear that it believes extra care housing is a preferred environmental planning option now and for the future. Development of a whole system approach, combined with conversations with older people about what matters to them and what can make a difference to their lives. The hope and ambition that surrounds 'extra care' is reflected in the Social Services and Well-Being (Wales) Act 2015 and therefore the potential for realising that is probably increased, with the backing of legislation and political determination for the Act to fundamentally change the offer made to the people of Wales.

The challenge Finding the capital for new developments Developing a whole system response Signposting evidence that supports effective models of housing and related support Agree priorities for development – National, Regional & Local Creating housing solutions that contribute to health and wellbeing