The role of housing and health is not new.
Huge advances in healthcare came 200 years ago with the arrival of vital public services, sanitation and drainage. These essential services were driven by social housing providers and had an enormous impact on people’s health.
The joined up role of health care and social housing is still being talked about; more recently how they can truly join up to deliver good reablement - the vital support services which are designed to speed an individual’s discharge from hospital and reduce the need for ongoing care and support.
Housing and care organisation Midland Heart joined Demos to commission a report: ‘The Home Cure’. The report shows the important role that housing and care has in supporting reablement services. It calls for social care, health and housing teams to partner to help them deliver more holistic reablement services.
The problem is that current reablement activity has a limited impact on hospital resources. The Department of Health’s most recent estimate stated that delayed hospital discharges cost the NHS around £170 million a year (or around £500,000 for every day of the year).
A further symptom of these delays is bed-blocking which accounts for 1.7 million lost bed days annually. Behind these figures are vulnerable individuals in poor health that are stuck in the system waiting to be admitted into hospital or to go home.
The Demos report stresses a need for greater scrutiny over the ability to reduce readmissions to hospital as this remains an overlooked, but critical, element of the cost savings that reablement might achieve in addition to delayed discharges.
Weaknesses are highlighted in the existing system, such as a narrow focus on home care tasks, a ‘cliff edge’ of support at the end of the intervention and a lack of personalisation.
It argues that we need a broader focus than simply home care - it is time for a much more holistic approach that will help people to integrate back into their communities.
Social landlords, who excel in encouraging community engagement, can create a more gradual reduction in support through the integration of their services with home care; they provide a vital link between home and active parts in the community- such as local GPs, community networks and local facilities. Together these can ultimately support a vulnerable individual to lead the life they choose with confidence and independence.
Today there are 2,000 registered social housing providers, making them the main providers of affordable and social housing in the UK. Housing associations provide 2.5 million homes for 5 million people.
With 21 per cent of all over 65s living in social housing and 24 per cent of over 75s living in social housing it is reasonable to assume that together they make up an even greater number of individuals that are in need of reablement services. Health care professionals already recognise that reablement is about wider community activity, and not just about services in hospital.
Housing can add real value to reablement and there is a clear business and skill fit: housing providers engage in relationships, promote independence and share similar missions to health. As the eyes and ears in many communities housing organisations already have a strong relationship with vulnerable people and have easier access than other community professionals.
The focus on reablement is strong; the government has chosen to not only honour the previous government’s commitment of £70m for reablement services but to add a further £162m from Department of Health efficiency savings.
The future prospect of combining the best of housing and health together to develop new and innovative ways of working would mean encouraging providers to bid for reablement contracts themselves. This would mean ending the local authority monopoly on reablement services and create a more diverse market too.
So what next? The launch of ‘The Home Cure’ brought together some critical thinkers in housing and healthcare; Stephen Dorrell, chair of the Health Select Committee and David David Croisdale-Appleby, chair of Skills for Care, Ruth Cooke, CEO, Midland Heart and Claudia Wood, deputy director of Demos.
It agreed that there was an urgent requirement to decide what “good reablement” looks like from the perspective of the service user and not an organisational chart and clear recognition that services must join up.
Looking ahead, further systematic research is needed sooner rather than later on broader reablement and then followed up by a framework on which this can be delivered.
Some housing providers are already providing housing, care and support. This is through floating support and social care teams working with older customers. So for some, it could seem a relatively small leap into the reablement field. We are now working with health providers to establish what practical steps are needed to make it a reality.
The challenge is making the joint aspiration work. It’s not going to be easy - many housing and health services don’t even share each others phone numbers, let alone run a shared system.
‘The Home Cure’ by Claudia Wood and Jo Salter is available to download for free from demos.co.uk/publications/thehomecure
Chris Munday is director for care and support, Midland Heart