Paul Gamble comments on the impacts that accessible and adaptable housing can have on health and social care provision
While the National Audit Office’s recent figures on delayed hospital discharge are startling, the fundamental solution lies in the accessibility and adaptability of the homes we live in.
Just 6% of existing homes in England have even basic accessibility features that help older people and carers following a hospital stay.
When you also consider the huge demand on local authorities to make vital household adaptations through the Disabled Facilities Grant (DFG) and the length of time these adaptations take to process, it‘s no surprise households are increasingly unable to support patients leaving hospital.
The NAO report shows clearly that there is a big problem and this is one which will only be exacerbated by the challenges of an ageing population.
A staggering 1.2m hospital bed days were lost due to ‘delayed discharge’ of people from acute hospitals in 2015, up 31% in two years. It is estimated that the problem is costing the NHS £820m a year. This is simply unsustainable for the NHS. But it isn’t a problem they can solve alone. We’re all in this together.
An NHS annual report on delayed transfers of care in 2012/13 suggested that there were 41,789 days delay cause by waits for community equipment/adaptations and also 53,584 days for other ‘housing’ reasons.
So the quality of the home you live in and its accessibility could have a profound effect on your ability to recover in a familiar setting.
So what can the housing sector do to help?
An urgent rethink of our national housing policy is necessary to deliver the accessible homes we need. Such policy will deliver necessary savings to health and social care budgets too.
We need to build more accessible homes. Homes that are easier and more cost-effective to adapt for life's changing needs. And we need a fully funded and more responsive local funding system for household adaptations that can make priority adaptations in a timely way.
The Lifetime Homes Standard provides accessibility and inclusive design with features that make hospital discharge much easier. These 16 design criteria include wider doorways and level thresholds, as well as walls specified to a strength able to accommodate grab rails among other adaptations. All these features make the job of occupational therapists and others more straightforward when making provision for hospital discharge –whether in-home care is to be arranged, or the patient will be looking after themselves.
Health and housing associations - partnerships for the future
It seems like health and housing policy now sit together more comfortably, as a major part of the CIH’s annual conference is devoted to the issues of partnership and best practice. But there is a lot more still to do.
The serious challenges of providing care at home with the financial and human resources pressures identified by the NAO report is a major concern for councils and health bodies. Anything the housing sector can do to alleviate some of the pressure will no doubt be welcome.
Health professionals need robust data on the impact housing solutions can bring and need to trust that housing has the ability and desire to play their part. This is improving with great and innovative examples out there but leadership is required.
Chief Executive of the National Housing Federation, David Orr wrote recently in the Health Service Journal (17 May) that a ‘quiet revolution’ in partnerships between housing, health and social care sectors could help meet the challenges of delayed hospital discharge or ‘bed-blocking’.
This is true and he is right that housing needs to make its case, prove its worth and ultimately deliver what it promises in partnership and integrated services.
But there is something simpler housing associations could do under the guidance of the NHF. Build all their new homes to accessible and adaptable housing standards.
In England there are optional accessible standards in building regulations in the new Part M Category 2 Accessible Standards (broadly equivalent to Lifetime Homes). Many housing associations have a fine tradition of building to accessible standards. The National Housing Federation could make an impact by working to increase members’ focus on inclusion and access in their development plans straight away.
Accessible housing policies in devolved administrations
The Welsh Government plan to build all new social housing to the Lifetime Homes standard with a retrofit programme to build in accessibility so ageing in place is easier. Scotland and Northern Ireland have similar arrangements. While London under successive Mayoral administrations since 2004 has committed to build ALL new homes to Lifetime Homes standard with 10% to wheelchair housing standards. The new Mayor, Sadiq Khan, has pledged to maintain these progressive targets in his London Plan as part of his priority focus on building the homes Londoners need to meet the demands of everyone in the capital.
The links between health and housing seem obvious but can be overlooked. The Greater Manchester Combined Authority will now have control over their devolved health and social care system and £6bn budget. Finding efficiencies and systems that will stand the test of time will be a challenge. At the head of the GM Health and Social Care Partnership is newly appointed Chief Officer, John Rouse. His experience at the coalface of health and housing policy will be vital.
We hope that accessible, adaptable Lifetime Homes will form part of the Manchester mix and await announcements on the future direction of health and housing across the Northern Powerhouse as a template for the rest of the country. The success of devolution in this country will demand no less.
So we don’t advocate a radical change or a leap of faith but a relevant, practical and achievable focus on housing quality that will give a legacy to the partnership of health and housing. A new focus on housebuilding that helps meet current demand but also future housing need in an inclusive way.
We need an integrated approach to the challenges highlighted in the NAO report. A solution is within our grasp, we just need to reach for it together with housing quality and accessibility central to the mission.