Housing improvements are a vital preventative measure keeping elderly people from requiring emergency hospitalisation, writes Andy Chaplin

Winter trees


Almost 2,500 more beds and thousands of extra staff will bolster accident and emergency departments across England to cope with the heightened demand brought about by winter pressures.

‘The government’s move to integrate health and social care as a pivotal moment in how we approach support for vulnerable people’

The additional £250m being spent by government will undoubtedly make the NHS better prepared exactly when it needs to be. As health secretary Jeremy Hunt says, “winter is tough”. But are we making it tougher on ourselves?

A significant proportion of those admitted to A&E will be older, vulnerable people. the Care Quality Commission’s annual State of Care report, published in November, once again highlights the extent of avoidable emergency admissions, with over-65s accounting for more than 500,000 last year.

These are for things such as broken bones and respiratory infections, the kinds of complaints that can be reduced if sufficient support is available in the home. Investment in practical interventions such as better insulation or a falls risk assessment can reduce the chances of hospitalisation, reduce the burden on emergency and acute services, and take some of the pressure off stretched resources.

Scratch the surface

England’s 200 home improvement agencies − among others − are already helping to achieve this across thousands of households every year. But they barely scratch the surface in terms of meeting the huge demand out there. That’s why I view the government’s move to integrate health and social care as a pivotal moment in how we approach support for vulnerable people.

‘The Warm Homes Service had a significant impact on several fronts, from reducing fuel poverty and improving wellbeing’

Backed by the “better care fund”, it offers an opportunity to put prevention at the heart of care. But it will only be effective if health and social care are brought together with the third corner of the triangle − housing.

Home improvement agencies are working hard to prove that very point and have fresh evidence to strengthen their case. Last winter, the Foundations Independent Living Trust coordinated the Warm Homes Service, funded by £500,000 from the Department of Health, which aimed to prevent cold related harm and illness among vulnerable people.

It was delivered by 55 agencies, reached more than 6,000 people within a four-month period − many of whom had long term conditions such as arthritis, heart disease, asthma and dementia − and carried out more than 1,200 jobs ranging from fixing faulty boilers to draughty windows.

Immediate difference

An evaluation of the service by Sheffield Hallam University is due to be published early next year. Its initial findings underline the case for preventative, targeted measures as well as the value of home assessments.

Rather than tackle problems such as poor heating in isolation, visits made by the service were an opportunity to assess a person’s wider needs, offer information, advice and guidance and if necessary refer them to specialist support. Indeed, 41 per cent of clients supported by the scheme were referred to health providers and 40 per cent to agencies such as the Citizens Advice service.

It’s clear the service had a significant impact on several fronts, from reducing fuel poverty and improving wellbeing to lessening the chances of respiratory conditions deteriorating. Clients feel more comfortable, happier and generally much better as a result of interventions. Researchers conclude the scheme delivered “quick, cheap interventions that may be extremely cost effective in terms of cost savings to the NHS and other sectors” and “made a big and immediate difference to clients’ lives”.

End emergency planning

Let’s put those savings into perspective. The average cost of carrying out the Warm Homes Service work at a person’s home was £196. If those improvements prevent the need for just one night in a hospital bed it would save £549. Yet it’s a fraction of the true benefits when you consider the multiple savings achieved through early diagnosis as a result of referrals.

‘The better care fund is an opportunity to finally put the emphasis on prevention’

One of the key findings from the evaluation is the degree to which it enabled home improvement agencies to develop new working relationships with healthcare providers. If we are to build a compelling case for commissioners to invest in practical home support, then strong links between health professionals and those at the frontline of home based support and adaptations will be vital.

We’re reaching a critical phase. Local plans for the better care fund must be submitted by February. I’ve already heard examples of places where housing simply isn’t part of the conversation about how priorities are met on the ground. If that’s the case, how will common outcome framework indicators, such as reducing falls and improvements to dementia care, be achieved if the role of housing isn’t fully recognised?

The fund is an opportunity to finally put the emphasis on prevention and ramp up the provision of practical interventions in the home. It has the potential to deliver better outcomes for vulnerable people and, if we achieve that, perhaps emergency winter planning will become a thing of the past.

Andy Chaplin is director of Foundations, the umbrella body for home improvement agencies and handyperson services