1. Getting to Grips with Integration
The role of housing
Caroline Hawkings
Policy Officer
9 December 2011
Pick up on the themes which Nick has highlighted
Many approaches to integration
Many challenges, different circumstances
Essential elements: co-ordination & collaboration
Role of housing
Case studies

2. Integration is a journey...
not a destination.

3. Housing is a critical milestone on the journey.
homes at the centre- settled homes are critical to person centred approach, as a delivery channel, and as a base from which people can access a range of health and other services and enables them to receive support at home or closer to home
Diagram of NHS Redbridge East London of their polysystem’: networks of primary and community services which place the home at the centre.

4. Context
Housing providers have much to contribute in a landscape where...
Localism is the ethos – doing everything at the lowest possible level
Decentalisation is the process – giving away power to individuals, communities and local institutions
Big society is the outcome – where people & neighbourhoods have more power & responsibility & use it to create better services & outcomes

5. Public Health
Growing clinical evidence on importance of built environment and physical neighbourhoods inc Marmot Review.
 Housing is a health investment in itself: reduced incidence of respiratory disease & less use of acute services
PH White Paper Nov 2010 – LAs take a more active lead on public health, & NHS providers to look beyond traditional services to wider therapies and types of support.
PH update July 11 ‘effective spend on prevention will release efficiency savings elsewhere.’
Health budget protected – but under pressure. NHS has to make £20bn saving
Marmot review: reducing health inequalities, sustainable communities, prevention
Public Health White Paper Nov 2010– improving public health and reducing health inequalities.

6. Think Local, Act Personal
Personalisation
Think Local, Act Personal
Social Care Vision: Capable Communities and Active Citizens
‘a broad range of choice in the local care and support market, including housing options, and personalising the way in which care and support services are delivered’ Think Personal, Act Local 2010
Personalisation a key theme/driver in Government policy, and within that the ideology of individual responsibility
Councils, health bodies, providers and other community organisations will need to work more closely so individuals, their families and carers have greater choice and control over their care and support.
Personalisation here to stay –Think Local, Act Personal – new concordat around personalisation Jan linking personalisation and key themes of social care vision
a sector-wide partnership committed to transforming adult social care.
examples of good practice in delivering and commissioning fully personalised care and support. TLAP Provider Blueprint, an interactive web-based resource designed to share learning and best practice about personalised support. Deadline 20 December 2011.
greater differentiation of housing options for vulnerable people
better integration of housing, support, care and health, mixing and matching of services, integrated packages, such as supported and extra-care housing, as a choice
assisting vulnerable young people to make informed housing and support choices on their route to independence
Social care vision: right to personalised service, involving carers. Prevention important – housing cited as a key partner, and central to achieving personalised services and Healthier, happy communities.
As personal budgets are rolled out, tenants will have opps to buy shopping and gardening services inc older people

7. Health & social care Reducing delayed transfers of care
Independence for older and vulnerable people
Health improvement in deprived areas
Adults in contact with secondary mental health services in settled accommodation
Unscheduled hospital admissions in people aged 75 and over per 100,000 population inc falls prevention
Significant opportunities Housing and support deliver on major health priorities, not just around the edges. Range of current PCT local targets that housing and support can contribute to.
Life changing
- HRS preventative and intervenes early: effective and helps avoid acute services.
- Specialist services reaching out to the most vulnerable groups, to reduce health inequalities, and providing housing and support packages which help people living chaotic lives to stabilise and access services.
NHS trusts using housing related care and support to improve MH care pathways can achieve 30% plus savings South Yorks HA 911 Project 24 hr supported accommodation –people with MH & complex needs..
NHS outcomes framework – hospitals should discharge in 28 days, our Invest in Housing Invest in Health publication has a great case study on Black Country housing group’s home improvement and adaptation service can help enable this and thus deliver massive savings to health service and local authorities.
Articulate our value in a ways that demonstrate quick cash savings to health trusts, not just long term value
JSNA – time to link it to housing market assessments. Will need to be specific enough to drill down
Healthwatch to collate information on performance. National and local. Patients will have more choice and control, helped by easy access to the information they need about the best GPs and Hospitals, Patients will be in charge of making decisions about their care. Economic regulator or driver of collaboration?
NICE quality standards – these will look at clinical pathways – there are 150 of them to be developed - examples exist around dementia, there will be some that are relevant for housing to be involved in and should look out for these. NICE also published guidance on spatial planning and health.
Linking to health outcomes – quite btoad but opportunities here:
Match with social care vision - Prevention important – housing cited as a key partner. And outcomes at the community level.
QIPP – quality, innovation, productivity and prevention – NHS approach delivering quality and efficiency commitments
A successful model for home ownership
Equity release
Charging for low-level support
Providing affordable home care to the wider community
Older people’s strategies

8. Case Study: Saving NHS funds through transitional housing
Havebury Housing Association in partnership with NHS
Transformed an unused managers flat – to transitional flat
Charge £155 per week inc service charge v hospital bed c£400 a day saving NHS £2,800 pw
Saves social services avoids likely registered care
Articulate value in quick cash savings, not only long-term value
Transitional flat: hospital discharge or wait for adaptations
Articulate our value in a ways that demonstrate quick cash savings to health trusts, not just long term value
Quality, Innovation, Productivity and Prevention (QIPP) is a massive agenda. More productivity and no reduction in quality: re-designing care pathways, both avoiding people coming into system and helping people through care and speedily out the other end of the system.

9. Case Study: Extra care promoting community integration
Moorlands Court, a joint venture: Local Council Community Services & CHS Group.
A big move: from move from residential care to 35 unit extra care facility.
Big changes for residents & their relatives, CHS staff & organisation.
Big gains: increased physical function, increased independence & increased integration.
Focus for community activities: luncheon clubs, meeting rooms
Cambridge Community Services & South Cambs District Council & CHS Group (Cambridge Housing Society Ltd Group
A unique move
Excellent 3* care home – could this be reproduced, how would people cope physically, mentally, financially?
Staff: from residential care standards to domiciliary care in a community setting, changes in terms & conditions
Organisation: CHS registered social landlord to domiciliary care agency.
Big gains: Since April 2008, staff monitored tenants’ functional independence (34 tenants) using a modified Functional Independence Measure and a quality of life measure. Over a six-month period, 20 people showed improved function or increased independence in activities of daily living, 12 remained stable and two deteriorated owing to progressive dementia rather than environmental factors.

10. Case Study: MHA extending services to the community
Each scheme manager offers a menu of services to residents, as well as personal care provided through MHA’s domiciliary care service.
Through surpluses & charitable income MHA funds national network of 50 Live at Home services: community services and neighbourhood activities
MHA funds managers for the groups, plus local committee & volunteers
Increased independence & integration of services
MHA specialist provider of care and support for older people
50 retirement and extra care schemes, 70 care homes, 50 community care services
Each scheme managers...
Peer support
Attacts charitable funding

11. Case Study: Providing Portable Care
Housing 21 Portable Care Pilot in Bristol, with Bristol City Council & North Bristol NHS Trust.
Impact on patients & staff when care is transferred from the extra care setting to hospital.
Care workers supported 4 residents through 17 formal care visits.
Shared information on care needs, family circumstances, medication, eating & drinking
Improved communications
Discharge home instead of to residential care.
Specialist reablement service
Included this eg because small scale
Integration on the frontline
Big impact on individuals
Savings to NHS
In the pipeline
Phase 1 information
Phase 2: key workers undertaking practical tasks, bathing and feeding
Do contact Housing 21 for more info

12. Housing central to health & social care Communicate & Participate
The Key?
Housing central to health & social care
Communicate & Participate
Health & Wellbeing Boards
Evidence for JSNAs
Healthwatch
Directors of Public Health 12

13. Contacts & Information
Telephone: