Not a week passes without media reports describing the range of pressures on the NHS and care sectors. In the lead up to Winter this coverage is likely to intensify with messages including not going to Accident and Emergency departments unless absolutely necessary and keeping a watchful eye on older family members and neighbours to ensure they stay warm and safe.
The flip side is that clearly older people themselves would prefer not to have accidents in the home but if that does happen they prefer to return from hospital as quickly as possible with appropriate support if necessary. As the majority of older people live in mainstream housing rather than within specialist accommodation I am reminded about the key messages from speakers at an event held in Manchester earlier this year (organised by Care & Repair England and co-funded by BSG and MICRA) setting out how housing led interventions, operating in partnership with health and care services, can help maintain independence, health and wellbeing in the home.
The event entitled “Health at Home – The Right Prescription” attracted 91 individuals including academics, policy makers, commissioners and service providers interested in ageing, health, social care, housing and integrated provision. What follows is a succinct outline of the event but click here for full presentations.
Sue Adams Care & Repair England –highlighted the challenges of demonstrating what works for older people in achieving/maintaining positive health and wellbeing at home and to reduce or defer expenditure in the health and care sectors especially in addressing delayed transfers of care. The key challenge is to provide genuinely integrated housing interventions with a robust evidence base that demonstrates positive health and economic outcomes.
Sarah Cromwell Department of Health – described the contribution that housing can make to health and care integration. Key NHS drivers include the prevention agenda and delayed transfers of care. The key challenges are the need for an improved evidence base and mechanisms to influence policy makers and local decision takers in the NHS, local government and the housing sectors in particular. There is a growing recognition at government level that housing had a valuable part to play especially via Integration and the Better Care Fund.
Gill Leng Public Health England – focused on evidence for integration specifically standards and types of evidence and how they fit into the current and probable post 2020 policy and practice landscapes. The challenge of proving value and efficacy to commissioners in the health, care and housing sectors was illustrated with some examples of how housing interventions can help maintain the independence of older people in their own homes for as long as possible.
Helen Garrett Building Research Establishment (BRE) –detailed how the BRE has used national housing data and evidence to model health outcomes. The health cost calculator was described with the estimated costs to the NHS of poor housing occupied by older people being £624m first year treatment costs (with risks from excess cold and falls associated with 91% of that cost).
Dr Emma Stanmore University of Manchester – the presentation majored on applying the evidence in falls prevention. Data was provided on the occurrence of falls and fractures in older people and the range of negative health outcomes arising from them. A number of risk factors were listed. A key message was that there was good evidence that falls can be prevented but there is an implementation gap in achieving that ambition.
Anees Mank Wigan Council – the CCG funded Home Adaptations Programme was one of the products of aligning local health, care, public health and housing strategies. Approximately £2m was allocated to pilot a rapid adaptations process which has successfully reduced unplanned hospital admissions arising from falls and/or facilitated a safe hospital discharge to home.
Janette Linacre Manchester Care and Repair – a number of high volume no cost services are provided for older people including
- Discharge Support Service – directly escorting people get home from hospital and checking the property is safe and warm
- Home from Hospital – check-up post discharge to home
- Handyperson – home assessment relating to safety, security, energy efficiency, disrepair and installing falls prevention equipment
- Technical Support –arranging and helping to deliver necessary major repairs and adaptations
- Caseworker Support – home visits with advice on benefit/income maximisation, bereavement support, housing options and sign posting to other services
Lee Norman St Helens Council – described the local Home from Hospital scheme. The handyperson service provides a range of home repairs, adaptations and telecare to improve property condition, security, accessibility and to reduce the risk of falls which has prevented accidents in the home or speeding up a safe discharge from hospital. An Enhanced Hospital Discharge and Community Care Initiative has been evaluated and revealed a significant reduction in medically fit people occupying hospital beds equivalent to freeing up a ward in the local hospital and generating savings to the NHS.
Geri Kiddle Warrington Home Improvement Agency – described the aims of the local partnership agreement including improving independence, health and quality of life, reducing falls and supporting carers. This was illustrated by a number of case studies which identified problems experienced by older people in their homes, how the problems were addressed and the outcomes that flowed from those interventions.
Helen Simpson Bolton Council – Set out the commissioner perspective on service integration and standards of evidence with a focus on the challenges using housing evidence which currently is not considered strong compared to that generated in the health sector. However a managed risk approach should be adopted in service development by “taking a chance” in supporting a service. Local data sets help in case finding and targeting housing resources to achieve notable health outcomes.
Key Messages from the Presentations, Question/Answer Sessions and Panel Discussions
- Housing led interventions help in securing/maintaining the independence and health and wellbeing of older people in their own homes but without good quality evidence the future of many services is insecure.
- Gaps in evidence will require further research and will work most effectively if practitioners are linked to interested academics.
- Effective service partnerships need to understand respective priorities in housing, health, care and public health sectors so that strategies can be aligned and complementary to each other.
- Effective partnership development requires an embedded way of thinking and operating but all too often is dependent on motivated individuals who may leave their respective organisations and take the enthusiasm and momentum with them.
- Generation and sharing of meaningful data and monitoring outcomes facilitates effective commissioning. It can help if the problem or desired service outcome is defined so that appropriate data collection can be designed and managed.
- At a time of austerity it is important that services are not unnecessarily duplicated and that a business case to validate their existence is increasingly important.
- Do not forget the views and experience of older people and their carers in developing and evaluating services
- There is a challenge in understanding the “language” used in health and housing.
- For those older people willing to self-fund improvement/modifications of their existing homes or to consider other housing options it is advantageous to access independent advice and information and for all necessary services to exist in one place.
|The aim of Care & Repair England’s Catch 22 project is to forge new partnerships and stimulate fresh research in the health/ housing/ ageing field by bringing together leading researchers. If you have any good ideas, good practice and issues to raise in this field or want to join our virtual network to receive occasional e-mail alerts please contact Martin Hodges firstname.lastname@example.org or telephone 0751 654 5586.