By linking disabled facilities grants activity and social care data, home adaptations can delay entry into residential care, writes Paul Smith

Paul Smith

Paul Smith

Paul Smith

Hospitals are again facing record levels of delays in discharging patients. Figures from NHS England show that during September 2016 there were nearly 200,000 days of delays – a 33 per cent increase from September 2015.

Much has been written about the delays attributed to a lack of available care in the community, but if you delve deeper into the figures you find further delays due to waits for adaptations or other housing issues. These two factors account for just 4 per cent of the total but this still equates to 8,280 days and a cost to the NHS in England of £2.5m.

However, this average masks some significant variations across the country, with up to 26 per cent of all delay days attributed to adaptations and housing for some local authorities.

It’s also worth remembering that unsafe housing can be the reason why people are admitted to hospital in the first place, particularly through cold and trip hazards.

These dangers have been estimated to cost the NHS over £600m every year in England.

Compared to the total annual NHS budget of £120bn this could still be seen as a drop in the ocean but, as we’ve learnt from our success in the Olympics, there is a lot that can be achieved from the cumulative effect of marginal gains. Particularly when there’s a whole group of people willing and able to help.

Warm, safe, secure

Foundations is the national body for home improvement agencies (HIAs) – locally based organisations who work with people to carry out repairs and adaptations to their homes so they can continue to live there: warm, safe and secure.

Much of the work carried out by HIAs is funded by disabled facilities grants (DFGs), traditionally paying for home adaptations like ramps, level access showers and stairlifts.

By linking DFG activity to social care data, our analysis of this work found that such adaptations can delay entry into residential care by four years and significantly reduce the burden on family carers.

This combination of increased funding and collaborative working means that innovative new approaches are starting to emerge

For 25 years the DFG was often a stand-alone intervention, working in isolation from health and social care. Then, in 2014 the DFG was incorporated into the Better Care Fund, which requires health and social care commissioners to plan services alongside their colleagues in the housing departments.

In many areas this is the first time these conversations have taken place and the potential of housing to support health and care services has been properly considered.

In our recent report – The disabled facilities grant, before and after the introduction of the Better Care Fund – we highlight how professionals are increasingly being brought together into multidisciplinary teams and providing a more responsive service for customers.

In Warwickshire, a countywide Home Environment Assessment & Response Team (HEART) has been established to deliver the right practitioner at the right time with the right solution. This will enable the customer choice and control to manage their own lives.

The whole journey

For the first time, there’s a clear focus on health and care outcomes for service users, including statutory outcomes and targets, rather than just delivering a service (eg providing an adapted bathroom).

The government recognised the value of this approach and announced significant funding increases in last year’s autumn statement – up by 127 per cent by the end of the decade compared with 2015-16.

This combination of increased funding and collaborative working means that innovative new approaches are starting to emerge. For example, in Ealing a range of adaptations are being fast-tracked for people admitted to hospital so that their home is ready for them when they’re fit to be discharged.

But this opportunity to maximise the extra investment in prevention via DFGs – and ensure it continues to be resourced – will only be fully realised if there’s a common link that tracks a person’s journey from beginning to end.

For the first time, there’s a clear focus on health and care outcomes for service users, including statutory outcomes and targets, rather than just delivering a service

That means the sharing and use of the NHS number for all case files – something that’s often missing. Otherwise, it will be harder to gauge the full impact of these preventative interventions, embed them and maintain the case for future funding.

If the NHS number can be used consistently for these services then it will become possible to evaluate what really works to keep people out of hospital and which approaches help to limit delays in discharging from hospital.

Home improvement agencies are willing and able to play their part, the DFG budget has been increased and Foundations is available to advise and support commissioner and providers across England to make the most of the opportunities to innovate and collaborate.

Paul Smith is director of Foundations, the DCLG-funded national body for home improvement agencies and disabled facilities grants (DFGs)