Learn with us. Improve with us. Influence with us | Integrating Health & Wellbeing through Housing June 2015 Domini Gunn CIH

Learn with us. Improve with us. Influence with us | Housing for Health & Wellbeing 2 Service models that are fit for purpose Meeting changing needs of partners & customers Ensuring strategic fit with public health, social care and health priorities VFM & social value of current provision Understanding current & future demand Making the best use of community based assets

Learn with us. Improve with us. Influence with us | Housing and the numbers 60% of projected increase in households from 2008 to 2033 will be headed by someone 65+; number of over 85’s will increase by 100% To 2029 the population aged 75+ is projected to rise by 47% in urban areas and by 90% in rural areas – major issue for rural old Homelessness has been increasing steadily: in projects closed, bed spaces lost Hidden homeless equates to population of Greater Manchester

Learn with us. Improve with us. Influence with us | Housing as a key social determinant of health & wellbeing Choice, Control & Independence Always more than bricks and mortar Access - homes that can adapt to meet needs Security & safety – affordable & secure Social impact – identity & social isolation Cost benefits - invest to save, social value, VFM Local hubs & community resources Positive outcomes - evidence

Learn with us. Improve with us. Influence with us | Homes Fit for Living

Learn with us. Improve with us. Influence with us | Homes fit for ageing?

Learn with us. Improve with us. Influence with us | Where’s the tipping point? “If nothing is done to change the current housing situation, occupied places in care homes and hospitals would need to rise by 151%, from around 450,000 to around 1,130,000 by 2051, and some estimates project long-term care expenditure as rising by around 325% in real terms between 2002 and 2041.” ‘Lifetime Homes, Lifetime Neighbourhoods: A National Strategy for Housing in an Ageing Society’ 2008

Learn with us. Improve with us. Influence with us | BRE Health costs of poor housing Excess cold £848m Falls on stairs £207m Falls on the level £128m Falls between levels £84M Fire £25m Collision £16m All housing hazards Cost to NHS £1.4bn Falls assoc baths £16m Damp and mould £16m Hot surfaces £15m Lead £14m

Learn with us. Improve with us. Influence with us | Bad housing and the numbers Failed to meet the decent homes standard Overcrowded against bedroom standard Failed Housing Health and Safety Rating System - HHSRS  3.6 million children  8.2 million working age adults  2 million pensioners  4 in 10 private renters – 3.3 million NatCen research for Shelter 2013

Learn with us. Improve with us. Influence with us | Dementia – the facts 800,000 people with dementia in the UK Numbers set to rise to over 1 million by This will soar to 1.7 million by One in three people over 65 will die with dementia – occupy 24% hospital beds. 80 per cent of people in care homes have dementia or severe memory problems. 17,000 people under 65 with dementia in the UK.

Learn with us. Improve with us. Influence with us | 40,000+ needless hospital days = £11.2m A few numbers ….. £12,300 hip replacement. £6,800 av. grant £26k pa residential care Falls & fractures = 4m hospital days 23% non decent housing 870,000 unmet needs

Learn with us. Improve with us. Influence with us | Care Act 2014 INDEPENDENCE – ‘Supporting people to live as independently as possible, for as long as possible, is a guiding principle of the Care Act’ CHOICE – ‘[LA must] put in place a system where people have the information they need to take control of their care and support and choose the options that are right for them’ CONTROL – ‘the local authority should assume that the person themselves knows best their own outcomes, goals and wellbeing’

Learn with us. Improve with us. Influence with us | What does the Care Act do? The Act is built around people: well-being at the heart of every decision that is made; puts carers on the same footing as those they care for; creates a new focus on preventing and delaying needs for care and support, embeds rights to choice, through care plans and personal budgets, The Act makes care and support clearer and fairer: cap on the care costs that people will incur. deferred payments scheme; single national threshold for eligibility information, advice and advocacy ensure continuity of care when people move between areas no one goes without care if their provider fails, The Care Act - reforming care and support

Learn with us. Improve with us. Influence with us | Care Act Guidance A local authority must provide or arrange for the provision of services that contribute towards preventing, reducing or delaying the needs for care and support. The provision of suitable living accommodation can be a way to prevent needs for care and support, or to delay deterioration over time. Getting housing right and helping people to choose the right housing options for them can help to prevent falls, prevent hospital admissions and readmissions, reduce the need for care and support, improve wellbeing, and help maintain independence at home.

Learn with us. Improve with us. Influence with us | Care Act and Housing Suitable Accommodation and support Wellbeing Delaying and reducing need for care Trusted Assessors Integration, cooperation and partnerships Information and advice Safeguarding adults Carers

Learn with us. Improve with us. Influence with us |

Real time example West Leicestershire Clinical Commissioning Group – strategic priorities Early identification and prevention Improved self management Supporting independence Increase planned care Targeting inequalities Reduced hospitalisation Supporting early discharge and reablement Supporting death in usual place of residence 17

Learn with us. Improve with us. Influence with us | Cost benefit: Hospital/Care v. Home C. 66% of general and acute hospital beds are occupied by people 65yrs + 70%+ of hospital bed days = emergency admissions 80% of emergency admissions for 2 weeks or more = over 65yr olds Housing hazards/ poor/ unsuitable homes can contribute to all of above – need to constantly quantify at the individual/household level

Learn with us. Improve with us. Influence with us | The Housing Link: Falls One in three people over 65yrs and one in two of those over 80yrs will suffer a fall each year with home the most common place for falls. Over 75% of deaths due to falls occur at home Quantified link = falls and housing defects (Housing, Health & Safety Rating System Category 1 Hazard) Falls reduction –housing providers can play a key role looking strategically and addressing tri-partite prevention strategy (muscle tone/ drugs/ AND environment)

Learn with us. Improve with us. Influence with us | Building Housing Pathways Falls Prevention & Rehabilitation

Learn with us. Improve with us. Influence with us | Building Housing Pathways Hospital Discharge

Learn with us. Improve with us. Influence with us | Building an impact narrative  Scoping activity impact  Measuring impact against frameworks  Evaluation findings including service quality  VFM & social value  Customer experience/ case studies  Distance travelled  Inputs, outputs & outcomes

Learn with us. Improve with us. Influence with us | Case studies -Individuals’ journeys Housing framework – using information as evidence National outcomes and local commissioning priorities Support contract outcomes -Economic well-being -Enjoy & achieve -Be healthy -Stay safe - Positive contribution -Positive move-on Improving lives -Comfortable & secure homes -Adequate income -Safe neighbourhoods -Getting out and about -Friendships & learning -Keeping active & healthy Ways to well- being (mental well-being) -Connect -Be active -Engage -Keep learning -Give time Resources consumed -Primary/secondary health -Social care Satisfaction with services -Client satisfaction survey Evaluation findings -e.g. Discharge project Organisation Metrics -Finances -Meaningful use of time -Support networks -Physical health and well-being -Housing -Offending behaviour -Safety -Positive contribution Enhancing QOLImproving healthDelay / preventionSafeguardingExperience of care Compliance – reg. standards

Learn with us. Improve with us. Influence with us | Housing supply Housing conditions Affordability & flexibility Place & community Health and Wellbeing ‘ The right home, in the right place, at the right time, at the right cost’ Affordable Connected Accessible Supported Housing’s virtuous circle

Learn with us. Improve with us. Influence with us | June Manchester 2015

Learn with us. Improve with us. Influence with us | Making the case for Housing

Learn with us. Improve with us. Influence with us | Rhetoric to Reality Chartered Institute of Housing: source of information, support and professional membershipwww.cih.org Memorandum of Understanding – Housing, Health & Social Care 2015 Creating housing choices for lifeCreating housing choices for life – CIH briefing CIH Tools: Service Quality (2014), VFM(2013) & Social Value (2015) Developing your local housing offer for health and care - targeting outcomesDeveloping your local housing offer for health and care - targeting outcomes – CIH framework doc Hospital 2 Home resource pack

Learn with us. Improve with us. Influence with us | Thank you for listening, your thoughts and questions.. Domini Gunn 28