Specialist housing is an investment that could save the NHS millions a year and make lives happier, says Jeremy Porteus
Over recent decades, housing has been good for many people’s wealth. But the NHS should be looking at its positive impact on health – and how improvements can save money in health and social care budgets.
There is mounting evidence, accepted in the government’s November housing strategy Laying the Foundations: a housing strategy for England, that providing older people in particular with housing appropriate to their changing need for care and support can reap a dividend for NHS and social care commissioners.
It also helps older people to retain their independence in their own home – possibly through moving from the family home to a “home for life” while still relatively young and fit.
Two documents published last month highlight the potential savings for the NHS and local authorities while improving the health and wellbeing of older people. They emphasise the opportunity presented by the arrival of local health and wellbeing boards, which can forge local partnerships to provide more specialist housing.
An independent evaluation of the Department of Health’s £227m Extra Care Housing Fund studied 19 schemes supported by the project, including several where primary care trusts provided some of the additional capital funding.
That study, together with earlier research involving residents of the schemes, confirmed the potential of specialist housing:
- extra care housing can be cost-effective compared with care homes – with slightly lower costs and residents enjoying higher levels of physical and mental functioning;
- the improved physical and mental health helped reduce demand for health services – including emergency admissions – and delayed or prevented entry into residential care; and
- death rates within 30 months of moving in were lower than for residential care.
This reinforces findings that suggest appropriate housing for older people could save the NHS hundreds of millions of pounds a year through fewer emergency admissions and delayed discharges. In September 2010, Frontier Economics published research suggesting the health and social care costs of an older person in specialist housing were £3,000 less than expected – with the dividend shared almost equally between health and social care.
Extra care housing models are based on self-contained flats owned or rented by people whose care needs are met round the clock, through flexible care and support packages that can be adapted as their needs change. (This allows them to become “homes for life” for some residents.) The flats are intended to promote independence, but they are normally sited within a scheme also offering communal facilities. The range of social and private tenants and owner-occupiers, together with a range of levels of care needs, promotes a sense of community. New schemes have cabling to support telecare and telehealth.
The NHS is increasingly becoming an older people’s service. Falls and resultant fractures in people aged 65 and over account for over four million bed days annually in England alone. Fragility fractures are thought to cost the NHS £2bn a year.
With the incidence of dementia set to double by 2040, there is increasing attention on the scope for providing housing that meets the needs of this group. Until now, the main focus on housing and health has been on the needs of those who are physically frail.
For many NHS commissioners, however, it will be a leap to see the value of working with local authorities to invest in local partnerships to increase the specialist housing older people want to live in.
A resource pack also published last month emphasises that partnership of local government, the NHS, housing associations and third sector bodies, and private sector developers is crucial. Strategic Housing for Older People: planning, designing and delivering housing for older people sets out how health commissioners can work with local authorities – particularly through health and wellbeing boards – to work out the local need for specialist housing.
It says: “The key task here is knowing what level of investment by the local authority and by the health service will deliver a return in terms of reduced hospital admission and/or in terms of reduced admission to care homes as part of their locally agreed quality, innovation, productivity and prevention programme. Only by making that estimate can local health and wellbeing boards determine the level of investment they might wish to make in housing based approaches.”
One way of assessing the financial impact of inappropriate housing on local NHS finances is to study hospital admission and discharge data.
Data about issues such as falls or delayed discharge can boost the case for investment in housing to meet both the prevention and productivity elements of QIPP.
The Strategic Housing document says: “The problem is that housing tends only to be seen in terms of a planning or housing department issue within many local authorities. Therefore, health commissioners may not see the gain to be had from new housing suitable for older people.”
Yet data on hospital admissions can underline to commissioners the value of specialist housing, installing aids and adaptations to an existing home or a move to a new home.
Some of this work can be prepared for joint strategic needs assessments. The resource pack includes a list of the health issues or information that could help in predicting demand. This includes data on chronic obstructive pulmonary disease, dementia and falls.
With the DH fund having helped in the development of 88 extra care housing schemes over the past seven years, there are examples out there for health and wellbeing boards and new health commissioners to explore.
Dabbling in the housing market is not going to make the NHS wealthy, but a coordinated approach could improve the lives of older people and make savings for health budgets.
Find out more
The independent evaluation and strategic housing for older people resource packs are available from www.housinglin.org.uk