We already have the blueprints: the 2009 Housing our Ageing Population: Panel for Innovation (HAPPI) report set out design criteria for new 'care ready' housing that would meet the needs of our ageing population, allowing them to retain their independence for longer, match the aspirations of the baby boomer generation and promote good health.
Now we need to get on with implementing the HAPPI proposals, something the All Party Parliamentary Group on Housing and Care for Older People recently sought to encourage with its report calling for a more coherent strategy across housing, health and social care.
This will require stronger leadership, radical new policies and financial incentives to inspire innovation and stimulate growth. The importance of coherence and integration is also emphasised in the Health and Social Care Act 2012. Health and wellbeing boards will have a critical role to play here, and it is promising to see that executive councillors or directors with responsibility for housing will join colleagues from children’s services, adult social care and public health on these boards.
Housing providers and commissioners must also ensure that those around the table are well informed about the role that housing can play in improving older people’s health and producing savings across an increasingly stretched health and social care system. For example, extra care housing, which is designed to meet the needs of residents by offering care and support on site and on call, has been shown to improve health and wellbeing for older people, while delivering cost-effective support outside of residential care.
At this time of year, we also need these boards and clinical commissioning groups to recognise that providing winter fuel allowance for older people and others with long-term conditions will produce savings by avoiding A&E visits and emergency hospital admissions.
What else can be done? Health commissioning strategies must take account of the return on investment that services – such as handyman services and aids and adaptation – can provide. Last month saw some festive cheer on this front with the Department of Health announcing an additional £40 million for Disabled Facilities Grants. This comes on top of the announcement in September of an increase of £100 million – to £300 million – in the Department of Health capital grant to stimulate the building of new specialist housing with care ‘hubs’ for older and disabled people over the next five years.
On the ground, we also need to see housing input into hospital discharge plans. Each local health system should have pooled or dedicated budgets to allow housing adaptations to be put in place swiftly to support recovery and rehabilitation at home, reducing the cost of delayed discharges or readmission.
This is true for the growing number of people with dementia too: relying purely on hospital provision to meet their needs is not only bad for those affected, it’s also frankly impossible for the taxpayer. Virtual ‘hubs’, telehealth, assistive technology and low-level interventions could all help people with dementia stay in their own homes.
Perhaps we can learn something from the progress made in end-of-life care? A national strategy with a key target of helping more people to die in the familiar surroundings and security of their own homes has had some success, though it has taken a lot of work at both national and local levels to get there. Increasingly, people can be discharged home to die in dignity because the multidisciplinary team has assessed and responded to their needs for specialised beds and equipment, such as drips to provide intravenous pain relief.
Investment in housing needs to be more than just bricks and mortar; it must be part of an integrated architecture of building healthier communities and care hubs tailored around someone at home. At a strategic level, this means that housing must be aligned with Joint strategic needs assessments. Operationally, services must be better networked within local health and social care economies. In this way, we can really begin to plan and deliver the health, social care and support that people aspire to in their own homes and neighbourhoods.