I may not be the first to say this but partnerships between health and housing are key to reducing bed blocking, writes David Orr
One figure from the recent Lord Carter review on productivity in the NHS stopped me in my tracks. On any given day as many as 8,500 beds in acute care are occupied by someone medically fit to be released.
To put that in context, about one in 10 of all of our hospital beds is taken up by someone who has no medical reason to be there.
These delays could cost £900m per year. And it’s so well known we have a phrase for it – bed blocking.
About one in 10 of all of our hospital beds is taken up by someone who has no medical reason to be there
I dislike this phrase as it suggests people are in some way deliberately staying in hospital, blocking beds of those who really need them. The truth, of course, is almost everyone wants to get out of hospital as soon as possible but they don’t have somewhere suitable to go.
Just this week the Parliamentary and Health Service Ombudsman highlighted serious concerns about patients being discharged with no home care plan in place or being kept in hospital due to poor co-ordination across services.
Housing associations and their partners provide good quality, affordable homes for people who for a huge variety of reasons need support to live independently
In a different part of the forest, housing associations and their partners provide good quality, affordable homes for people who for a huge variety of reasons need support to live independently. This work depends on housing benefit and help with support costs through Supporting People and other funding.
Over 400,000 people are supported in this way. It is very cost effective and ensures people can enjoy a high quality of life in the community.
And yet, between 2010-11 and 2014-15, SP funding reduced by 45 per cent and now the government has a proposal to cap housing benefit for supported housing in a way which would be catastrophic and would, according to our research, reduce existing provision by 40 per cent. If that happens, the queues at hospital will increase, more people will be admitted and more will stay in beds even when the clinical need is met.
Add to the mix the fact of the housing crisis. More children are living in temporary accommodation today than 50 years ago when Ken Loach made Cathy Come Home.
Health service staff in many parts of the country can’t afford to live anywhere near their work. Thousands of families move time after time as their short term private tenancies run out and are not renewed.
On top of all that there is the growing challenge of funding the health and care requirements of an aging population. We are not emotionally prepared for the reality that it will soon be unremarkable to meet people in their 70s caring for their parents.
It’s all interconnected
In our policy response, we fail to see how entirely connected it all is. We think hospitals alone are responsible for freeing up their beds and housing associations have to find alternative ways to fund housing with support.
The frustrating thing is we know we could make a huge difference if only we built different partnerships, not just of money and resource but of knowledge and expertise
We think the market should take care of our housing requirements and social care as we get old and frail will be paid for by insurance. We believe the systems, structures and approaches that have delivered this series of intractable problems will be the way to resolve them.
The frustrating thing is we know we could make a huge difference if only we built different partnerships, not just of money and resource but of knowledge and expertise. Housing associations are good at land and property management, are experienced in providing supported housing and are excellent at raising investment for new homes.
They are not good at delivering acute health care. Hospitals are fantastic at delivering acute health care but have no real expertise in land and property management.
It shouldn’t be difficult to join these particular dots.
We all know land and property owned by the NHS is not often put to best use. Trusts don’t really want to sell their assets as a capital receipt is not much use to them.
But what if they leased these assets to a housing association, delivering a much needed income stream? A leasing deal could be the start of a strategic partnership built on the objectives of both parties and a long term plan for maximum delivery.
I can easily imagine a joint venture where a foundation trust provides the land on a long lease, the housing association builds a facility where people can leave hospital safely until they are ready to return home, where some homes are built for shared ownership for health service staff and some homes are built for affordable rent to help meet the housing association’s objectives. The finance for the development could come from capital markets or social investors with the repayment cost met from rents and licences.
The trust might even be able to close a ward and use the savings to buy other services to help reduce demand for hospital admissions.
I’m entirely clear I’m not the first person to think this. A small number in health and housing have tried heroically to make partnerships like this work.
But it will only happen at scale if we understand the connections and plan strategically together. No need to make a fuss – just get on with the quiet revolution of doing it.
David Orr is the chief executive of the National Housing Federation