1. Improving Health Through the Home 9th November 2015 Health & Housing MoU - A North East Commitment
Neil Revely
Executive Director People Services, Sunderland City Council
Chair, Association of Directors of Adult Social Services, Housing Policy Network

2. Memorandum of Understanding
NHS England initiated discussions with the Housing and Care sector
ADASS hosted the process supported by DH and PHE
Live action plan
Regional/Local action and implementation

3. Housing – not new in supporting Health & Care!
Public health in the mid-19th century established to tackle the cause of infectious diseases – poor housing & sanitation
Much of what the social housing sector does was born out of the public health movement
Better designed and better housing standards fundamental to improvements in health and daily living since early 20th century
Modern planning and design fundamental in supporting independent living
Home adaptations and disabled facilities grants long established
Innovative new models of housing supporting current and future generations to live independently

4. The Policy Context
Marmot Review - to improve Health and Wellbeing, need to improve the social determinants of health
Health and Social Care Act - Reforming health services and creating Health & Well Being Boards
Care Act - An overarching vision for adult social care including an emphasis on housing solutions
Better Care Fund – requires integration and needs to drive significant efficiencies
Five Year Forward View – Healthy New Towns
Memorandum of Understanding – Improving Health through the home
Create and develop healthy and sustainable places and communities.
Duties on the local authorities to
Set up Health and Wellbeing Boards
Establish and have authorised our Clinical Commissioning Group(s)
Put in place a Joint Strategic Needs Assessment
Establish HealthWatch
Transfer Public Health including the Director of Public Health
Develop a Health and Wellbeing Strategy
BUILD AND STRENGTHEN RELATIONSHIPS ACROSS THE WHOLE SYSTEM
Caring for our Future White Paper and the Care & Support Bill
Housing Strategy – not specific enough about specialist housing
Cross Government – not joined up enough DH (Health/Social Care)/DCLG/DWP etc DFGs/Telecare/adaptations/equipment etc

5. The Challenges – Growing Demand
Life expectancy is rising
Over 65s % increase between 2010 and 2014
Over 65s in need of care will increase by 40% between 2005 and 2020
Pupils with a Learning Disability will increase by 26% between 2014 to 2023 (2x the overall pupil increase)
Without changes this equates to a 150% increase in care costs
95% older households want to live at home
Life expectancy is rising, as is the absolute size of the older population, and the size in proportion to the population as a whole, will grow
An aging population both in absolute terms and relative to country-wide trends and left unchecked will see decreasing numbers in the family forming age groups
In Sunderland, it is forecast that by 2030 the number of older people above 65 years of age will rise by 46%, with those over 85 increasing by 50%.
In 2010 the numbers of people with Dementia are estimated at 3100, by 2025 we are likely to have 4600 people aged 65 years and over with a diagnosis
37% of older people in Sunderland have problems with some aspects of daily living which is projected to increase by 28% between 2008 and 2025
Even if no improvements to public health, this would increase care costs by 150% by 2025
Over 95% of vulnerable residents told the City they wanted help to live in their own homes currently and/or in the future

6. The Challenges The Economy Reductions in public resources
Increasing demand and expectations
Strategic shift to personalisation, early intervention, prevention, re-enablement, care at home
Welfare reforms
Changing the way agencies work with residents and communities
Unlocking untapped assets and potential within communities

7. The Challenges – Housing
Housing supply (all tenures)
Provision of affordable homes (all tenures)
Registered Providers – rent reductions, right to buy, and housing related care costs
Improving the housing offer for older households (all tenures) including supporting downsizing through attractive accommodation options
Enabling people with housing and care needs to live at home independently – including new developments, links with welfare reform and capital

8. Bad housing and the numbers
Homes that:
Failed to meet the decent homes standard
Overcrowded against bedroom standard
Failed Housing Health and Safety Rating System – HHSRS
Impacted on:
3.6 million children
8.2 million working age adults
2 million pensioners
4 in 10 private renters – 3.3 million people
NatCenresearch for Shelter 2013

9. Making Housing Count – the opportunities
Provide a real choice for independent living – bungalows, extra care apartments, downsizer homes and retirement housing
Older households in future proofed modern housing – choice of tenure, affordable to heat, level access
Well designed to maximise ‘home for life’ aspiration
Evolve the housing offer to meet new and emerging demand and aspirations
Keeping people central to their communities
Improved outcome for people, carers, families
Improved property conditions
Willing partner supporting integrated working and substantial health and social care efficiencies
- A consortia of housing providers have been meeting with the NHS Commissioning Board to formulate a Partnership Agreement that recognises the role of housing
- Joint select committee report on Care and Support Bill recommended extending the scope of what constitutes wellbeing to include, safe and settled accommodation
- Department of Health £300m Care and Support Specialised Housing Fund higher quality thresholds to deliver care ready housing for disabled and older people that can improve health and wellbeing
- Forthcoming government statement on integration, will include reference to housing
NHS Confederation briefing, Stronger Together, HWBs need closer engagement with providers, including housing
Reduce costs of pathways – eg S’land Drug & Alcohol services

10. Why Integration Matters & Making Housing Count
Reduce Demand & Avoid Cost
Prevent or reduce levels of demand; acute (inpatient, A&E and outpatient care), primary (community health) and social care (residential, intensive home care)
Reduce Costs
Reduce unit costs e.g., tariffs for condition specific interventions
Reduce costs of pathways
Reduce staffing costs/overheads
Outcomes for People
Most importantly much better for people and families
- A consortia of housing providers have been meeting with the NHS Commissioning Board to formulate a Partnership Agreement that recognises the role of housing
- Joint select committee report on Care and Support Bill recommended extending the scope of what constitutes wellbeing to include, safe and settled accommodation
- Department of Health £300m Care and Support Specialised Housing Fund higher quality thresholds to deliver care ready housing for disabled and older people that can improve health and wellbeing
- Forthcoming government statement on integration, will include reference to housing
NHS Confederation briefing, Stronger Together, HWBs need closer engagement with providers, including housing
Reduce costs of pathways – eg S’land Drug & Alcohol services

11. Final Thoughts
The legislation and policy helps – but locally its about people and whether we want to do it!
We need to use the burning platform of rising demand and reducing resources
The Sectors need to act more coherently
Government needs to join up better
A better evidence base is required
Relationships are the key
The Memorandum of Understanding is a real opportunity – let’s use it!
legislation and policy helps – it supports joined up working
We need to use the burning platform of rising demand and reducing resources – necessity the mother of invention
The Sector needs to get its act together – easier to be understood and its offer simply expressed
Government needs to join up better – too silo’d in its approcah
A better evidence base is required – it will convince the NHS
Relationships are the key – its all about the people

12. Contact Details Neil Revely Executive Director People Services
Sunderland City Council
Civic Centre
Burdon Road
Sunderland SR2 7DN
Tel: