1. IPC Assessing Regional Housing Markets and Developing Effective Strategies for Meeting Older Peoples Housing Demands in the South West Region June 2008

2.  Centre of Oxford Brookes University.  A range of projects on commissioning and contracting for CSIP, DCLG, DfES and Welsh Assembly Government.  Delivery of specific activities to support the development or implementation of commissioning strategies in more than 20 local authorities in Wales and England in 2005-06.  IPC also facilitates a commissioning and performance network for community, primary care and children’s services. Around 40 members.  Key projects on JSNA, Outcomes, and the Health and Social Care Interface. Institute of Public Care

3. IPC s Housing Portfolio  ECH toolkit.  Work with two RSLS’s on reviewing their long term strategic role and function.  Work with a wide number of local authorities on developing accommodation strategies.  Raising the Stakes.  Developing Competencies for ECH managers.  Evaluating a Dementia Care ECH Scheme IPC and Housing

4. This Presentation  The National Challenges  What do older people want  Regional Demography  Sheltered Housing in the South West  Future Policy themes

5. The National Challenge  Demographic change  Transforming Social Care.  Learning Disability  Developing the capacity to target prevention.  Recognising the key role of housing.

6. UK Demographics  Ageing population identified by the Cabinet Office as one of the ten key challenges facing Britain.  44% increase in over 85 year old population over the next seventeen years.  Not much change in terms of incapacity in the final years of life.  In 2003-04 43% of all health care expenditure was spent on the over 65 population.  However change is not uniform, eg, Hackney faces a potential diminution in its population of older people aged over 80 over the next seventeen years, Northumberland faces an almost doubling of its numbers for the same age group.

7. UK Demographics Demographic change at its greatest in the Shires:  Population growth the highest.  Harder to deliver quick change because of their size and the two tier configuration of local government.  Costs of funding services is higher owing to transport and rural isolation.  Staffing is more problematic again owing to the demographics of rural depopulation and a higher cost of living.

8. Transforming Social Care  “Everyone who receives social care support, regardless of their level of need, in any setting, whether from statutory services, the third and community or private sector or by funding it themselves, will have choice and control over how that support is delivered.”  “In the future, all individuals eligible for publicly- funded adult social care will have a personal budget… a clear, upfront allocation of funding to enable them to make informed choices about how best to meet their needs, including their broader health and well-being.”

9. Transforming Social Care  This is a challenging agenda, which cannot be delivered by social care alone. To achieve this sort of transformation will mean working across the boundaries of social care such as housing, benefits, leisure and transport and health.

10. Learning Disability  Increased longevity, eg, In Nottinghamshire the numbers of people aged over 55 with a learning disability at a moderate or severe level (and likely to require social care services) is predicted to rise from 1,119 to 1,371 over the next seventeen years, an increase of some 22%.  Numbers small but costs potentially high.  Loss of family  Managing inherritance  Transfer of health funding.

11. Targeting the preventative agenda  Can we swim back up stream from care or hospital admissions to identify precipitating factors?  Are services outcome or output driven? Example: stroke.  Do we know what needs are being presented where targeted interventions could prevent worse outcomes but where this is not occurring? Example: dental services, continence services.  Are services delivered at the right time to have the maximum impact? Example: support to carers of people with dementia.

12. Housing  Need to recognise increasing diversity of demand.  Need to ensure a range of housing that health and care services can be delivered into.  Need to ensure that the housing asset of sheltered housing is not lost.  Making sure that not only are homes sustainable but also communities.  Getting planning involved much more closely in strategic commissioning and getting elected members to prioritise older peoples’ needs.

13. Lifetime homes, lifetime neighbourhoods  From 2009 new rapid repairs and adaptations services will be introduced to support more handypersons schemes across the country  Increased funding for the Disabled Facilities Grant by 31 per cent by 2011: increasing to £146 million in 2008-09, £156 million in 2009-10 and then £166 million in 2010-11.  £800 million additional funding for the Warm Front Programme over the next three years.

14. Lifetime homes, lifetime neighbourhoods  All public housing will be built to Lifetime Homes Standards by 2011. Our aspiration is that all new housing will be built to these standards by 2013. Lifetime Homes Standards will be made a mandatory part of the Code for Sustainable Homes and we will work to support industry to encourage take-up on a voluntary basis over the next few years. We will review take-up in 2010, with a view to bringing forward regulation in 2013.  Continued funding of the ECH grant by DH.

15. Investing for lifetimes  Invest a proportion of the capital funding programme on housing which meets the needs of an ageing society.  Co-ordinate funding and regulatory systems with those of other parts of government, particularly DCLG and DH.  Identify and promote best practice models / new ideas for the provision of housing, care and support.  Encourage providers to offer choice to older people (including the information to make informed choices) and a maximum degree of independence in the way they live their lives;  Ensure that the strategy is consistent with the Corporation’s equality and diversity policy.

16. Living Arrangements  All participants wanted to stay in their own home for as long as possible. However, we know that 25 % of older people move at least once in old age.  Most participants want either to stay in their neighbourhoods close to their friends, or to move closer to their children.  Moving to alternative accommodation was seen as a means of reducing maintenance responsibilities and costs.

17. Help and advice  Adaptations and alterations.  Help with gardening, decorating and improvements to heating and thermal insulation.  Security improvements.  Legal and financial advice. A number of people suggested a kind of one stop shop for the provision of information and advice but not just local authority services.  People did not want more leaflets but wanted to talk to a person.

18. Specialist housing  Housing options seen as limited and stigmatising.  In general sheltered and in particular ECH gets a good press.  Care homes were seen as the last resort and there was widespread concern about the quality of residential care across private, public and voluntary sectors among participants.

19. Neighbourhood and Community  Mixed messages about moving to rural idylls, as many people likely to move abroad.  Neighbourhoods sometimes seen as a reason to move, particularly where people had few community links.  There was much discussion and a lack of consensus about what kind of community people wished to live in. Some participants wanted to remain within mixed neighbourhoods and communities, while others felt that age segregated housing offered security and mutual support. The concept of retirement communities attracted some interest.

20. Being cared for  People felt the NHS was generally uncaring of older people.  People did not welcome the prospect of living with their children. This was not only because of the burden of caring (of which several people had experience), but also because it changed the relationship between older parent and child.  People who are not in a relationship feel pessimistic about the future although feel better placed than those who have the sudden death of a spouse.  People very pessimistic about dementia care services.

21. South West population  Highest proportion of people aged 65 and over, in England - projected increase of 44% by 2025  Highest proportion of people aged 85 and over, in England - projected increase of 57%, by 2025  Longest life expectancy (78.1 for men and 82.2 for women) in England  Growing numbers of older people living alone  Increasing diversity of older population: BME, people with learning disability, people with alcohol problems

22. South West population  Significant projected increases by 2025 of people aged 65+ with:  Limiting long-term illness, over 50% in Cornwall, Devon, Wiltshire, Somerset  Dementia, over 50% in Gloucestershire, Wiltshire, Somerset, Cornwall, Devon, S Glos, N Somerset  High levels of owner occupation: particularly among the younger old: 84% of 60-64 year olds  High net inward migration, mostly people aged over 45 moving to rural locations  Relatively high proportion of older people lack central heating, eg, 16% in Plymouth and Cornwall

23. Sheltered Housing in the South West  RSLs have 35,880 homes for older people in the South West  Less than 7% designed for wheelchair users  Move to decommission or remodel ordinary sheltered housing stock - unfit for future older population in terms of: design, size, space standards  In all areas (except Torbay), majority of older people’s housing is social housing for rent  Limited sheltered/retirement housing for sale  Little extra care housing; none for sale in more than half of local authorities

24. Some Policy Conclusions  Develop a sense of urgency and raise awareness of ageing population, housing needs and choices among professionals, from planners to providers, & older people themselves.  Focus on the need for a diversity of provision: from co-housing to retirement villages.  Review existing stock to establish what can be adapted, what replaced, etc.  Use limited health and social care resources more effectively, especially in rural areas. Bring together home care supporting people services, care and repair and alarm services under single providers.

25. Some Policy Conclusions  Use public funding sparingly to support individual and local activities that will provenly deliver the outcomes that the state desires and needs.  Develop improved diagnostic mechanisms for early targeting.  Recognise that solutions lie across the whole of the older peoples economy not just on one sectional part.