1. Connecting housing with the health and social care landscape: a person centred approach SW Housing LIN conference, The Exchange, Bridgewater, 9th June 2008 Jeremy Porteus, CSIP Networks, DH

2. Session outline: Policy perspective Growing needs New markets for commissioners and providers New opportunities for older people Emerging issues for housing providers New tools from CSIP What next?

3. Independence, well-being and choice “Housing supply has increased substantially in the last few years but it is still not keeping up with housing demand from an ageing, growing population (Source: Homes for our Future, Housing Green Paper, Communities and Local Government, 2007) “Shifting care closer to home is one of the pillars that supports our vision of improved community health and social care” (Source: White Paper. Our health, our care, our say: a new direction for community services, DH 2006)

4. Policy – housing, health and social care: Preparing Older People’s Strategies: linking housing to health, social care and other local strategies (ODPM 2003) DH White Paper (2006) and Putting People First (DH 2007) National Strategy for Housing in an Ageing Society (CLG, Feb 2008) The thrust of these policies is to help people to remain more independent, and to have greater control over their lives and how services are delivered

5. Policy – personalisation and commissioning Shift towards services that are personal, sensitive to the needs of the individual and focused on maintaining independence Reorient services towards promoting health and well-being, and proactive prevention of ill health Create a stronger focus on commissioning for outcomes, across health and local government, working together to reduce health inequalities and promote equality

6. What are the health drivers for good quality housing? over 15 million people in England with a long term condition includes heart disease, diabetes, asthma, respiratory problems and dementia proportionally far higher users of NHS and PCTs Account for 55% of GP appointments, 68% of outpatient appointments and 77% of inpatient bed stays more likely to be older and have other complex needs leading to disabilities which require care and/or support they live in poor housing, which could exacerbate their condition and make them more likely to be admitted to a care home Need a closer look at preventative aspects of housing and related services to promote well-being of individuals and achieve greater improvements/efficiencies in local health & care economies

7. Knowing the market in your region Significant age shift Changing users’ aspirations eg lifestyle choices and needs Diverse range of needs eg age, ethnicity, disability Diversification housing and care markets eg from specialist to adaptable, from single tenure and institutional to mixed tenure and community based By 2025, a quarter of the entire adult population will be over 65 Projected % of England's adult population aged 65 and over

8. Growing demand for wider housing and care choices Sheltered Housing with ‘Extra’ Facilities Very frail or dependent people need support and care No rigid definition Also known as Housing with Care, Very Sheltered Housing, Assisted Living etc. Falls between traditional sheltered housing and residential care

9. Describing best what Extra Care Housing is General Descriptor “Purpose built accommodation in which varying amounts of care and support can be offered and where some facilities and services are shared” (Extra Care Housing Toolkit, Housing LIN 2007) Self contained flats Staff facilities Built to wheelchair standards Communal areas – lounge, restaurant etc On site management of building and care staff

10. What should you be looking out for? Better outcomes for frail older people Usually mixture of dependencies, and schemes operate as local communities of older people Demography – more frail older people Some older people enter residential care just because of inadequate housing New form of housing choice Active ageing, healthy ageing Under control of older people Growing use of Personal Budgets

11. What type of services do people want? those that are personable and meet their whole needs not just sickness and crisis response i.e., low level support as well as FACS offer genuine choice and control i.e., individual budgets support people to remain independent in safe and caring communities i.e., floating support, telecare and role of carers are delivered as near to their homes as possible i.e., advice and information, handyperson services are better designed for “liveability” and lifetime neighbourhoods are joined up so that people don’t have to struggle to find their way through the system or be given the same information time and time again i.e., common assessments and ‘one stop’ approach

12. The DH Extra Care Housing Fund? DH promotion of ECH by capital grants Started in 2004 To date- £147 million - 59 schemes - 4,035 units Links to Housing Corporation and other funding Can only be developed by partnerships Doing nothing is not an option!

13. Independence by design Scale of development i.e 30 or 300 units of accommodation Size of units i.e 54m2 (1bed) 68m2 (2bed) Residents/users’ requirements Location and spatial planning Sustainability on-site/community Accessibility/design standards Interior design/external space Integrated care/facilities Smart technology

14. Shaping and building the market Commissioning for health and wellbeing Involving social enterprise and 3 rd Sector Commissioning for innovation –Prevention –Telecare –Housing –Personalised care Commissioning for improvement eg dementia Partnership working, Health Act flexibilities and Supporting People

15. Building up the evidence base to support bids (1) Collate - evidence demonstrating positive practice by providers and commissioners of housing for older people – including factors that influence success and maximise health/care benefit/impact Partnerships - picture of good links between housing and the health and well-being agendas:- practice/service based strategic links – eg (meaningful) inclusion of HIAs, extra care and related services in Local Area Agreements or in local strategies for older or other vulnerable people Better understand - where housing and housing related care and support services for older people sit (or do not sit) within national and local policy frameworks

16. Building up the evidence base (2) better outcomes - the importance of good safe housing conditions for health and wellbeing has been well evidenced smarter intelligence - evidence about the specific impact of housing and related services is largely anecdotal – need for a better research evidence closer integration - housing and related services are very largely commissioned/funded by Supporting People – only few examples of PCT involvement, although vast experience in other programmes for vulnerable adults and childrens’ services investment opportunities - significant amount of equity, public subsidy/grants eg PFI credits, ECH grant, DFGs, HC affordable housing programme, social enterprise, rental/sale streams etc

17. What next for the housing and planning sectors? move from opportunism to strategic partnerships with health? understanding system changes in health and social care eg new NHS operating framework investing in relationship building to influence key stakeholders in health and social care? implications of future revenue housing streams from grants to equity release, from benefits to self directed support meet new and emerging performance targets and outcomes for National Housing Strategy for an Ageing Society make the case of the value of agencies such as HIAs and avoidance of later demand on state funded services

18. Some final hints and tips? do you understand the needs and aspirations of existing residents and those in areas where you are keen to develop? have you taken into account major policy changes and impact on capital and revenue eg personalisation, regulation and inspection how plugged in are you to local strategic partnerships at a corporate level, especially with health and social care? what safeguards have you made for downturn in housing market? what impact does the local labour market have on workforce development, recruitment and retention? would you move into the scheme you are commissioning and/or developing?

19. Tools and resources from the Housing LIN Extra Care Housing Toolkit (2007) Housing for Older People implementation guide and information pack, More Choice, Greater Voice (2008) Connecting Housing with the health and social care agendas (2007) Regional Advisory Note and resource pack (forthcoming 2008) Comprehensive list of factsheets, casestudies and on-line resources national and regional network meetings and events

20. Thank you! Jeremy Porteus, National Programme Lead CSIP Networks Enquiries: housing@csip.org.uk Website: www.icn.csip.org.uk/housing