Jeremy Porteus Director Housing LIN Changing Demographics among Social Housing Tenants in Wales

About the Housing LIN Previously responsible for managing the DH’s £227m Extra Care Housing Fund and £80m Telecare in England grant 48,000 members across housing, health and social services to help improve partnership working and integration on housing and care Essential online resources on housing with care for older people to support commissioners, funders and providers in market development, innovation and investment Publish papers to brief on latest innovative policy, research and practice developments in housing, care and support for older people 10 regional ‘learning labs’ in England & Wales supporting local information exchange, peer-to- peer shared learning and improvement activities, and exemplar study visits

Ready for Ageing? “The housing market is delivering much less specialist housing for older people than is needed. Central and local government, housing associations and house builders need urgently to plan how to ensure that the housing needs of the older population are better addressed and to give as much priority to promoting an adequate market and social housing for older people as is given to housing for younger people.” Select Committee on Public Service and Demographic Change, Lord Filkin (2013)

A demographic ‘time bomb’? 0.5 million people over 65 in Wales (or 18% of the population) can currently access just over 30,000 units of retirement housing and specialist housing such as extra care housing Over 40% of households in social housing have a disability or are over 65. This equates to c90,000 dwellings in Wales People with dementia over 65 years of age are currently using up to one quarter of hospital beds at one time Total of c23,000 residential care bedspaces in Wales But majority of older people live well at home into older age

Social rented stock for Welsh social landlords by local authority area (March 2014) AreaSheltered HousingExtra Care Housing Isle of Anglesey Gwynedd Conwy 1, Denbighshire 1, Flintshire 2, Wrexham Powys 2,306 0 Ceredigion Pembrokeshire Carmarthenshire 2, Swansea 1, Neath Port Talbot Bridgend The Vale of Glamorgan Cardiff 1, Rhondda Cynon Taff 1,330 0 Merthyr Tydfil Caerphilly 1, Blaenau Gwent Torfaen Monmouthshire 1, Newport 1, TOTAL WALES 27,094 1,812 (Source: Annual social landlord stock returns, Welsh Government, March 2014

APPG - HAPPI2 inquiry: 10 key age- friendly design principles that are ‘care ready’ Wales: Intermediate Care Fund extended Wales: Wellbeing of Future Generations Bill Wales: Planning Bill, Wales: Environment Bill Social Care & Wellbeing (Wales) Act Making best use of NHS Land – NHS estate asset could deliver £6b residential accommodation for supported housing (NHF) At a glance: what’s happening nationally?

Making integration work: building capital Working with NHS England, ADASS and a consortia of housing industry leads on the role of housing in delivering health and wellbeing in a new Memorandum of Understanding The shared statement on the health and social care £5.3b Better Care Fund makes reference to £220m Disabled Facilities Grant and other capital grant funding (£135m) per annum DH Care and Support Specialised Housing Fund, administered by the HCA and GLA. Phase One will see 122 new schemes in England for older and vulnerable people with long term conditions, with Phase Two (£115m) for London and rest of England now out DH Private Finance Initiative, Hull extra care housing schemes

Memorandum of Understanding Key objective “Integrated health, care and support, and housing solutions could make best use of the budgets across the NHS, local authorities and their partners to achieve improved outcomes for less; for example, drawing on the Better Care Fund to support service transformation”. Key actions System leadership: LAs and their role in supporting health & wellbeing Knowledge & analysis: population data and health ‘intelligence’ eg Joint Strategic Needs Assessments (Public Health) Developing solutions: BCF, Care Act, NHS Land, care efficiency/VFM, workforce development, primary care and preventative services, support people with complex needs

Housing - task orientated: outcome focussed Specialist housing - delay move to costly residential or nursing care Housing support - to prevent homelessness, support wellbeing Mainstream housing – design quality and accessibility (such as HAPPI) to offset future health and social care costs Home improvement agencies and handyperson services - deliver aids and adaptations that can reduce hazards, falls, fuel poverty, support hospital discharge, reduce hospital readmissions Environmental health - tackle chronic disrepair and environmental conditions that can lead to a long term condition (mental health), disease (COPD) or increased health inequality Regeneration and renewal – promote sustainable health outcomes via health neighbourhoods/age-friendly communities Spatial planning - support growth and links to strategic needs eg JSNA, better use of NHS (and public) land

The economic case for independence at home? A fall at home that leads to a hip fracture costs the state £28,665 on average – over 100 times the cost of installing hand and grab rails. Cost to NHS Wales is £84m pa Where it is appropriate, postponing entry into residential care for one year saves an average of £28,080 per person. Dementia cost to NHS Wales is £120m pa A hospital discharge service that enables older people to return to a safe and suitable home environment. Link to the Intermediate Care Fund

Where partnerships are working well Windsor & Maidenhead CCG: Strategic Housing for Older People Market Assessment – alternatives to residential and nursing care Camden & Islington NHS Foundation Trust: Reproviding services for people with a mental health problem with One Housing Group Haringey HWB: Homelessness health equity audit to assess needs Staffordshire County Council: working with Accord to develop dementia care centres of excellence North Somerset: HIAs working at Weston-Super-Mare hospital to support transfer or care back home/access aids and adaptations Manchester: local CCG funding housing advice & info with Northwards Peterborough & Cambridge CCG: Better integrated older people’s pathway in out-of-hospital at home care to support frail & older residents Sutton Coalfield: reablement facility, hospital beds managed by Midland Heart HA at Good Hope Hospital

Building homes

The challenges in Wales Increasing demand for ordinary sheltered housing and extra care housing, tenure diversity Number of older people under-occupying 3-4 bedroomed social housing Limited attractive choices to stimulate older people across all tenures to be able to move Welsh Government’s limited budget for all new build (c£40m) programme and existing stock (c£105m) Housing quality standards – accessibility, adaptability, sustainability/energy efficiency Increasing frailty of older residents and impact on other public services, especially pressure on health and social care Impact of Supporting People and LA commissioning adult social care

Delivering solutions that older people want Less dependency on high cost care Developing intermediate care and re-ablement services Make best use of technology and equipment – internet, telecare eg to support continuing health care End of Life Care – avoid hospital admission, hospice at home Preventing costly health interventions eg, as a result of a fall Providing meaningful choices and lifestyle aspirations to meet personalisation objectives Self-care, self management by building effective social capital to enable greater community engagement/informal or family care/volunteering

What’s the evidence?

Building healthy relationships Major shift to services within communities rather than hospital inpatient (planned)/emergency (unplanned) settings. Key barrier is that this transformation landscape means leaders in the short term may be too busy to fully engage. Opportunities though to educate and inform those responsible for this new architecture that good housing can play a major part in improving health and wellbeing. Role of support groups, knowledge transfer and leadership networks

Community chest or chance? Avoid paying a fine: What scope is there for better planning, commissioning and/or access capital and/or revenue funding to promote innovation in lifestyle choices for older people or stimulate a housing with care market as an alternative to institutional provision? Community Chest: Adopt Asset Based Community Development to partner health and social care services support more people in the community, meet growing demands for care and support, any targets / cost-benefits? Chance: Are there other market opportunities ie service, design construction, location, partnerships etc? Going past go. What strategies and policies are in place to engage, involve and listen to the housing with care needs of people, and their carers, and the wider community? Helping you play: Check out the Housing LIN Cymru pages to stay connected with latest ideas on health and housing!

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