1. Adaptations
The National Picture and Good Practise

2. Robin Alldred
Commercial Manager Wales & West Housing

4. We work across 15 of the 22 local authorities in Wales
This gives us an understanding of the practises and challenges in different local authority areas
Has influenced our approach to adaptations

5. The National Picture
Why are adaptations important?

6. Adaptations to people’s homes improve people’s independence and quality of life, enabling them to do the things that matter, restoring confidence and promoting improvements in health and well-being. They are also an important part of falls prevention, which is the subject of action by the NHS and other agencies, and campaigns such as “Steady On…Stay Safe by Public Health Wales and Ageing Well in Wales.

7. “Steady On…Stay Safe” emphasises the need to stay active and stay strong, the importance of telling someone if you fall, and to watch your step by being aware of trip hazards.

8. As part of action to prevent falls, effective and appropriate adaptations to homes reduce risk and can therefore help to prevent emergency or unplanned admissions to hospital or residential care. They can also facilitate earlier discharge from hospital.

9. More than £50 million is spent each year on adapting people’s homes by local authorities, housing associations and the Welsh Government itself, delivering a significant amount of help. For example, in a typical year, around 4,500 people receive Disabled Facilities Grants, more than 1500 people benefit from Physical Adaptation Grant, over 17,000 people are helped by the Rapid Response Adaptations Programme and some 30,000 people receive help from care & repair agencies.

10. Relatively simple adaptations such as a stair or grab rail, which cost comparatively little, can not only help ensure people can do the things that matter to them but also prevent falls and other serious injuries. Helping maintain independence and avoiding the expense of treating injuries represents great value for money. For example, the £28,000 or so it costs the NHS in Wales to treat a hip fracture. Injuries like this are a significant factor in people having to move into long-term residential care.

11. Enable
In 2015 a delivery group was established by WG with practitioners from:
Local Authorities
Housing Associations
Older Persons’ Commissioner for Wales
College of Occupational Therapists
Care and Repair Cymru

12. To look at…
The provision of adaptations across all tenure types throughout Wales.
Homeowners
Tenants

13. Funding routes Homeowners – DFGs from local authorities
Traditional Housing Associations – PAGs
LSVT Housing Associations – own funds
Council Housing Stock – own funds
Private Tenants -?

14. A mixed picture… Homeowners – means tested DFG
HA tenants – fairly straightforward PAG
Council tenants – LA budget
LSVT tenants – business plan
Private tenants -?

15. Several different systems…
Widely varying timescales
Varying outcomes

16. Data?
What data?

17. Performance
WG’s annual published results placed this local authority among the “poorest” performing authorities.

18. The human story… 92% of council’s DFGs to people over 50
Which is 57% of the LA population
56% (some 30,000 people) of over 50s have some sort of long term limiting illness
Evidence suggesting more to do with age than disability…

19. Further study showed
Where a DFG was received the average age of admittance to residential care was 84
Those that did not receive a DFG (because of the waiting time) were admitted at an average age of 80
Therefore, adaptations sustain people in their own homes for longer
Considerable emotional and community benefit to users

20. Of those referred for DFG in the five years leading up to the study (1,060 people)
234 died while waiting
193 dropped out owing to concern about the means test
115 did the work themselves
45 went into residential care
271 dropped out for unknown reasons

21. Systems thinking Clear need to redesign system
“If we focus on delivering service to citizens…we also become more efficient”
Find out “what matters” to customers
Systems thinking intervention

22. Neath Port Talbot County Borough Council Case Study 2009
DFG Measure
Old System
Redesigned System
Comments
Average end-to-end time
675 days
64 days
675 made up of 435 wait, 240 install
Flow steps (end-to-end)
291 steps
34 steps
Every step from first contact to completion
Preventable demand
71%
40%
See above
Costs of delivery (average per grant)
£499
£319
Staffing activity costs (36% improvement)
Cost of physical works (average per case)
£7000
£6300
Procurement savings and reduction in re-work
DFG drop outs
33% of cases
Nil
Early intervention prevents drop-outs

23. As a result
WG is now monitoring data from all local authorities and housing associations in Wales
Common data collected from all providers irrespective of funding streams
Resident satisfaction

24. Wales & West Housing WWH is a registered social landlord (RSL)
Traditional housing association – recently enjoyed our 50th birthday
Last year we spent £20,870,670 building 253 homes
Have access to Welsh Government grant funding (PAG) for adaptations
Fund smaller adaptations ourselves

25. In 2010/11 We carried out our own systems thinking intervention
Viewed the process from our residents’ perspective
Realised that we could do much better

26. This house is marvellous. It has given me back my independence
This house is marvellous. It has given me back my independence. Before we moved here I felt like a prisoner in my bedroom. We now have everything we need to make our lives easier. The extra wide corridors and doors mean I am able to move about without help. I can go into the kitchen and make myself a cup of tea or go out into the garden.
Resident, Mr Parsons

27. In 2017 WWH spent £1.4 million adapting residents’ homes
We claimed £1.2 million in grant funding
Adapted 400 homes
From handrails to extensions…
Helped over 400 people (possibly more)

28. A good picture – however…
There are challenges.

29. Things that get in the way of us doing a good job
Waiting times for OT assessments
Tendering process for grant claim

30. A different picture across Wales
OT waiting times – from days to aeons…
Differs from LA to LA
Accessible homes registers – or not
Limited number of contractors in some areas
Homes that are difficult to adapt – not able to sustain tenancies
From tendering to commencement – 12 weeks

31. Questions