Housing and Health Is the glass half-empty or half-full? 8 th October 2009 Robert Cornwall

Northern Housing Consortium Demographics – Cumbria’s growing population of older people (over 65) Percent

Northern Housing Consortium Manchester’s over 65 population remains reasonably stable Percent

Over 50 population – England - the need to plan and prepare now An ageing population mainly affecting rural and coastal areas. Don’t stop me now – Audit Commission (2006)

Cumbria – Net Internal (E&W) Migration,

Creation of Over 65 Households

Resourcing issues Between 58% and 70% of all Health and Social Care resources spent on over 65s Risk Pyramid – those at risk of unplanned hospital admission Bottom pyramid adjusted to reflect costs to Health The top 20% use most of the resources Those at very high risk the top 0.5% use twenty times more resources than the average in the risk population Increasing age is an important risk factor Over 85s – 25% will have dementia plus other limiting conditions.

Demographic distribution of high risk individuals. The Village Scenario. The Village and its surrounding area is located in Eden, a District in Cumbria. The population is about 1000 and 35% are currently Over 65 Over the next 10 years this group is set to double in size due to people growing older and the housing being too expensive for young families to move into the village. This means that by 2020, 700 of the 1000 people are over 65 There 42 people over 85 in the village now; by 2020 that will have risen to 116, nearly 3 times the number. Now there are about 52 people living alone with a long term limiting illness; by 2020 this are now about 150. Today 15 people in the village have some form of dementia and this rises to 45 by In 2009 many of the older people are helped to do jobs by the younger people in the village. But with the school closing they have moved away. The local GP spends 50% of his time looking after the Over 65s in the village now ; by 2020 this is a full time job.

Funding Adaptations – Carlisle

Manchester City and Cumbria – similar size of population 500,000 Cumbria has twice the number of people claiming Attendance Allowance Government allocated £1.8m to Cumbria for Disabled Facilities Grant (£1.9m ) £2.6m to Manchester City (£2.6m 09-10) 70% of all Health/Social Care cost spent on Over 65s Population over 65

Moving Care ‘Closer to Home’ - key issue for Cumbria Choice and control ‘Virtual Ward’ Savings in A & E, discharges, hospital readmissions. Dementia cases End of life Care Telecare and Telehealth Creating Partnerships addressing core issues – cultural differences, funding, risks, responsibility Equalities and Risk issues Joint funding – a new challenge Locality Commissioning ICOs – Integrated Care organisations

Identifying shared goals for Cumbria Meeting the needs of the growing population of older people – a shared problem A shared problem needs a shared solution Mapping the situation Creating a common language Understanding the drivers - People want us to work together Recognising what needs to change Deciding on the mechanisms for change

JSNA Methodology

Cumbria JSNA - Key Challenges

Recommendations for Housing

What people said they want People with Learning Disabilities Older People

Housing and Health - now Nationally – Debate on Care and Support – In Control and Personalisaton – Welfare Reform Bill and Right to Control – Equalities Bill – Closer to Home Housing lies at the heart of our lives – Essentially it’s all about people – Services - there to help at points of transition or crisis – Targeting help and support at those in most need – Collaboration with people and ownership

Housing and Health – the future The Prevention agenda – early intervention Affordable Homes and the demographic shift Sustainable communities – whose responsibility? The Pressure on funding – locality commissioning – The dangers of postcode lotteries – The setting of standards – Meeting expectations Joined up services – one to one assessments, one stop shops. Technology – the paradigm shift? Health Inequalities – to each an equal chance or choice Social Interventions

How does this impact on Rural Communities Rurality for some people is becoming a strand of equal rights policy Universality of public services – eroded with an emphasis placed in Planning on key service centres BUT Health and Care Services are moving into the community Preventing the Health effects of Social exclusion Rural inequalities often are not weighted in policies and services – except often in terms of cost The danger of the health service not making the change to Closer to Home fully – one foot in both camps or buckets

What can you do to help? – filling the half-empty glass The answers will come from users, frontline practitioners, from communities Costs and benefits need to include looking at the affect of a reduction in a service on other public services. A more meaningful partnership between public services and the community – involvement and building trust Making our case both regionally and nationally Become a Community Champion or every little helps – valuing our gifts Leadership and governance – key issue