1. Housing’s Contribution to the Health Agenda pat.potter@care-consult.freeserve.co.uk

2. Housing’s Contribution to the Health Agenda Older people as citizens and consumers Key issues for PCT s National Service Framework for Older People (NSF) – roles for housing and support Issues in older people’s housing Developing a vision for older people’s services New ways of working together

3. Older People and the Citizenship Agenda Focus on citizenship and older people challenges traditional accommodation, health and care models Broader engagement, citizenship and ‘quality of life’ strategy for an ageing population e.g. Better Government for Older People Older people seeking information and involvement – to be heard and to facilitate positive choice Focus on well–being: whole person approach to promoting independence / self-help is key objective Context of most older people living in ordinary housing

4. Inverting the Triangle of Care - support for people today: focussing on 15% of older people with the most severe needs Source: All Our Tomorrows-Inverting the Triangle of Care, LGA/ADSS, October 2003

5. Inverting the Triangle of Care - support for people tomorrow: focus on promotion of well-being

6. Key Roles for PCTs Commissioning throughout the healthcare system – primary and acute care Commitment to modernising the NHS, culture change and shifting the balance of power Strategies and action plans - for doing things differently Partnerships with local councils, social care and voluntary sector Joint commissioning/shared posts and services across PCTs Monitored through Strategic Health Authorities 3 year planning cycles Have to deliver on a wide range of targets

7. Some of the Issues Facing PCTs Developing organisations Financial Issues Monitoring needs and mapping services and processes Working across the health, care and support systems Working with change e.g. out of hours systems Combating insularity and silos Staff recruitment, pay, motivation and morale Delivering on targets Huge agenda – cannot do it alone!

8. Housing and the NSF for Older People …. Clear role for housing and related support services in every standard of the NSF - housing is part of integrated planning for older people and patient pathways …. 1. Age discrimination Tackling age discrimination could lead to a higher proportion of older people having treatment and remaining in or returning to a housing setting 2. Person-centred care Housing components around: Information on housing services and link to BCHS (paragraph 2.12) Commissioning/service models – “housing warden to be integral part of team” (2.24) Single assessment – accommodation and care of the home (2.29 and 2.34) Community equipment

9. 3. Intermediate Care Clear housing component: Step up and step down in very sheltered (3.14, and 3.18) Housing alternatives to residential care (3.24) Housing staff part of wider team (3.27) Multi-professional care plan (3.28) Assessing & actioning changes to the home – adaptations, safety checks, damp (3.29-3.30) Discharge planning should include “community support and housing” (4.30) 4. General hospital care Discharge planning should include “community support and housing” (4.30)

10. 5. Stroke Stroke planning and pathways should assess for suitability of accommodation, and need for adaptations, improvements, equipment and support (5.25, 5.28) 6. Falls Community strategy for falls (6.9) Pavements and street lighting Information Making property safer – lighting, stairs, loose carpets, slippery floors, grab rails, inaccessible lights or windows Triggering referrals to falls service (6.13) Assessment on risk factors to trigger interventions around equipment to improve safety, repairs or improvements, social care support (6.14), community alarms/tele-care (6.33)

11. 7. Mental health Housing elements include: Agreed working and referral arrangements between mental health team & housing workers (7.48) Presumption of support at home – tele-care and environmental technologies (7.51) Advice and outreach by mental health teams to sheltered housing (7.56 ) 8. Promotion of health & active life in older age Focus on healthy communities to link health agenda with regeneration agenda (8.2) Local initiatives to reduce poverty and improve housing conditions; improve quality of homes to reduce fuel poverty, prevent ill health and accidents (8.14) Energy efficiency schemes, social contact and community safety (8.17)

12. Housing and Older People Sheltered housing is changing: Increasing numbers of older people are owner occupiers; expectations of higher standards; choice; informed choice; home for life; consumer – not recipient of services Supporting people – emphasis on targeting housing support at most vulnerable groups and value for money Forthcoming new definitions of sheltered and supported housing for older people –general needs housing; retirement housing with access to support; purpose designed retirement housing with access to support …. Pressure towards increasing involvement of older people and integrated working with other agencies ….

13. Policy and Planning – key drivers for integrated services NHS Plan Health Development Plans - PCT led National Service Framework for Older People Single Assessment Process and Intermediate Care Local Strategic Partnerships and Community Plans Supporting People Strategies Quality and Choice in Older People’s Housing (2001) Preparing Older People’s Strategies (2002) Public Service Agreements and Targets Better Care, Higher Standards Charters

14. Delivering Joined-up Services Working Together: - health, housing, local councils, social care, voluntary sector Information and choice: - improving access to information on housing, care and support options for older people, carers and assessors Lead commissioning: - stocktaking total resources, pooling budgets and sharing risk Integrating management and practice: - changing working practices and developing protocols, joint posts, joint training, shared skills and mutual respect Single Assessment Process: - integrating housing into range of integrated and shared tools and processes Targeting Supporting People funding: - planning support; focus on vulnerability, diversity and services to people most in need; working in/with the community Coordinated monitoring and performance management

15. Breaking Down Barriers Housing Providers Health County Council / Care Boards / Non Execs Councillors Members CEOs and CEOs and CEOs and Directors Directors Directors Supported GPs, Service Managers, Housing Practice Managers, SP Managers, Managers Integrated Team Team Leaders Leaders Scheme Practice/ Assessors, Social Managers District Nurses, Workers, Dom. OTs, CPNs Carers

16. Working Together to Meet Targets Changing attitudes and culture – home as the norm – health promotion; focussed support; treatment near to home; telemedicine; aids and adaptations; telematics Improving hospital experience - admission and discharge arrangements for older patients key to meeting several acute sector targets; housing needs continuously assessed - informed housing champions on ward teams Community based intermediate care teams –providing step up / step down care – links to supported housing Linking support services, home care and intermediate care: - focus on prevention of inappropriate admission to hospital and res./nursing homes; promotion of enabling culture Ensuring effective use of total resources - integrated nursing, domiciliary care and support available 24/7

17. What Can Housing with Support Contribute? Security, support and stimulation – reducing loneliness and isolation; information, assessment and inter-agency liaison Targeted services and focussed support – development of mobile services to all older people irrespective of tenure Sheltered housing as a community resource – exercise groups; health promotion and information; resource centre; intermediate care flats for assessment and rehabilitation; role in hospital discharge Very sheltered housing - an alternative to residential care ; health gains for residents; intermediate care; extra care flats for people with dementia / functional mental health problems / learning disabilities

18. Ingredients of Extra Care Housing ssourcessource Source: Citizenship and Services in Older Age: The Strategic Role of Very Sheltered Housing (Housing 21)

19. Integrating Housing Resources Community alarms – linked to support, domiciliary and nursing care Mobile support services – low-key prevention linked to community health services Speeding up distribution of aids, adaptations and repairs Health improvement information to tenants Making housing information accessible – in libraries, local councils and voluntary organisations Use of health centres - to promote sheltered housing, Warm Front and Safe and Secure schemes Joined up information, consultation and participation

20. What gets in the way? Commitment, culture, insularity, information, communication Weak links at strategic level Poorly aligned goals, targets and monitoring Finance – debts, capital funding for short term housing, initiative/project funding Pace of change Identifying older people struggling at home Fragmented good practice Staffing – need for trained multi tasking staff groups Working practices - need to develop inter agency protocols and risk management frameworks

21. Housing and Health – Finding New Ways of Working Together Whole systems thinking Strategic alignment Shared agendas Pooling resources Partnerships and alliances at all levels Improved integration Improved communication – with other professionals and older people Working interdependently Focus on outcomes - with and for older people - not outputs Creating person centred services – close to home