From Top Line to Front Line

1
From Top Line to Front Line

• The role of housing in improving health and
  social care outcomes
• Sue Adams
• Director of Care Repair England

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Why Care Repair England?

• Aim to improve the housing and living conditions
  of older and disabled people
• 20 years of the housing, care, health link
  message
• Front line experience of the impact on older
  peoples lives of fragmented services
• Act as catalyst for change policy influence,
  demonstration projects

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Workshop Aims

• Consider scope and mechanisms for targeting
  housing interventions to improve individuals
  health and well being
• Consider how to integrate housing related
  provision into planning and practice eg.
• Top Line The contribution of housing in delivery
  of LAA Performance Indicators
• Front Line changing work practice

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Brief

• Workshop should facilitate
• Exchange of information and ideas
• Networking
• Participation

5
Introductions

• Who you are
• What your experience has been of working with LAs
  (if you are from Health) and Health (if you are
  from an LA)

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Housing, Care and Health Links

• What are the main mechanisms for targeting
  housing interventions in order to improve
  individual health and well being?

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Targeting Interventions

• Area based eg. target geographical area which
  scores high on deprivation indices, correlation
  of key measures (Blackpool example), or
  characteristics (eg. age)
• Target pro-active interventions at individuals at
  greatest risk of
• Admission to Hospital (Kings Fund/PARR)
• Admission to Residential Care (Kings Fund)
• Integration of working practice key to success in
  either case

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Key Health Determinants

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Why do we need to work together?

• 40 of the NHS's budget is spent on caring for
  people over 65 yrs (DH)
• Long term health conditions account for 55 of
  GP appts, 68 of outpatient appts and 77 of bed
  days
• An older person dies approximately every 5 hours
  as a result of a fall (DTI, RoSPA)
• Hip fractures alone cost the NHS est.726 million
  (Parrot)

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A Few Figures

• Over 85s doubles by 2031 admission to
  residential care highest amongst this cohort
• A third of vulnerable people of 75 years live in
  non-decent housing
• People over 65 yrs spend over 80 of their time
  at home on average, for those over 85 yrs this
  rises to 90 (EHCS)
• One in five of 50 , and 2 in 5 of 80 reported
  difficulties with one or more aspects of basic
  self care eg washing and dressing

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Making Connections

• Housing Conditions

• Main Health Impacts

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Making Connections

• Housing Conditions
• Serious disrepair
• Dampness
• Inadequate food preparation facilities
• Inadequate bathing and hand washing facilities
• Inadequate ventilation
• Poor heating
• Unstable structure
• Inadequate drainage.

• Health Impacts
• Respiratory problems
• Bronchitis
• Arthritis
• Depression/ Mental health
• Cardiovascular conditions
• Hypothermia
• Falls and other Accidents Electrocution
• Carbon monoxide poisoning
• Increased risk of infections

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Housing Adding to the Problem
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A Story

• Hospitalised because of housing related problems
• Lack of stairlift
• Decent Homes improvement to home
• Consequences daily social care package, worse
  health, poss earlier admission to residential care

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Integration Top down, bottom up

• Integration of housing related provision into
  planning and practice examples
• Top Line eg LAA Performance Indicators
• Front Line changing working practice

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Should health and care beware?

• Ending of national target to improve housing
  stock
• Reduced regional allocation of funds for private
  sector housing
• Disabled Facilities Grant budget pressure
• Growth in low income owner occupation

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National Targets

• PSA 17 Tackle poverty and promote greater
  independence and well-being in later life
• Housing links to three of the 5 indicators
• Healthy life-expectancy at age 65
• Over 65s satisfied with home and neighbourhood
  (NI138)
• Over 65s supported to live independently

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National Targets

• PSA 18 Promote better health and well-being for
  all
• Housing links to three of the 5 indicators
• All age, all cause mortality rate (AAACM)
• Gap in AAACM mortality rate in disadvantaged
  areas
• Proportion of people supported to live
  independently

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No specific targets for improving housing but

• NI 119 Self-reported measure of peoples overall
  health and wellbeing
• NI 120 All-age all cause mortality rate
• NI 124 People with a long-term condition
  supported to be independent and in control of
  their condition
• NI 125 Achieving independence for older people
  through rehabilitation/ intermediate care
• NI 129 End of life access to palliative care
  enabling people to choose to die at home

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• NI 131 Delayed transfers of care from hospital
• NI 134 The number of emergency bed days per head
  of weighted population
• NI 136 The number of people supported to live
  independently through social services (all ages)
• NI 137 Healthy life expectancy at age 65
• NI 138 Satisfaction of people over 65 with both
  home and neighbourhood

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• NI 139 People over 65 who say that they receive
  the information, assistance and support needed to
  exercise choice and control to live independently
• NI 141 Number of vulnerable people achieving
  independent living CLG DSO
• NI 142 Number of vulnerable people who are
  supported to maintain independent living
• NI 187 Tackling fuel poverty people receiving
  income based benefits living in homes with a low
  energy efficiency rating

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LAA Targets Local Examples

• Bristol still negotiating, but housing
  proposed targets include 141 and 142 Adult SS
  include 128, 129, 136, 137, 138
• HIA SLA already straddles housing, health,
  social care
• Blackpool

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What is happening in your area?

• Discuss
• Examples of current good cross sector practice
  macro or micro
• If none, what hampers this?

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Some Possible Outcomes

• Resources for preventative, integrated help get
  priority eg. home repair and adaptation (DFGs,
  handyhelp) with fast tracking (eg. Home from
  Hospital)
• Joint commissioning of services across housing,
  health and care with agreed shared systems of
  monitoring and evaluation
• Older people get the help they need to maintain
  health and well being

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Front Line Healthy Homes

• Systematic training/ awareness raising programme
• Backed up by easily accessed service good
  handyperson scheme seems to be crucial
• Works best if backed at higher level and part of
  wider strategy

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Service delivery trying to cross the housing,
health, care divide

• Front Line Examples
• Mendip
• Milton Keynes
• Bristol Example of front line link to higher
  level planning

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Impact of Healthy Homes Training
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But

• Problems
• Other issues take priority, especially internal
  re-organisation and conflict
• Medical model prevails
• Staff turnover
• Perceived as added burden
• Not backed up by higher level interest / action

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Contact Details

• info_at_careandrepair-england.org.uk
• www.careandrepair-england.org.uk