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Insight: For better, for worse


3 June 2014

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Social prescribing can help commissioners to effectively deliver preventative healthcare
Norman Lamb recently described the Better Care Fund (BCF) as “the biggest ever shift towards preventive healthcare”. But for that to happen, the care and support minister said BCF plans would need to deliver care centred on individual needs and which integrate health and social care. Crucially, they must ensure early action so people can stay healthy and independent at home and avoid going into hospital or to accident and emergency.
Let’s consider that final point. Early intervention will clearly have to play a central role if we are to move away from our reactive, hospital-centred healthcare system and relieve pressure on overstretched acute services. 
Future pressures on health and social care that will come as a result of an ageing population mean prevention must come to the fore. That means investing in activities that not only enable people to manage long-term conditions but in some cases prevent them from ever developing. A big part of that will be a much greater emphasis on home-based intervention such as adaptations – including grab rails and bathroom modifications alongside technical based solutions like telecare – and advice and guidance on a broad range of issues. Housing support can also have many broader benefits, not least in reducing isolation and tackling loneliness. Research published by the University of Chicago in February found loneliness could increase the risk of premature death by 14%.
After a frantic few months for clinical commissioning groups, health and wellbeing boards and local authorities, BCF plans have been submitted. It appears housing support – one of the key determinants of our health and wellbeing, according to Michael Marmot – has not got as high a profile as we would like.
My own organisation, Foundations – the national body for nearly 200 home improvement agencies (HIAs) in England – has been tracking the progress of BCF discussions and the formulation of plans. Hull’s submission, for example, places strong emphasis on care and support in the home. But in some cases, references to housing support are implied rather than made explicit. 
Indeed, a number of our members report finding it challenging to engage with CCGs and local authorities on this agenda. To help build bridges between these different stakeholders, Foundations has developed a Housing, Health & Care Integration Toolkit which aligns home improvement agency interventions to specific outcomes in Adult Social Care, Public Health and NHS England frameworks. Our hope is that housing support providers use this toolkit to build a compelling case for the inclusion of their services into HWBBs’ and CCGs’ commissioning.
HIAs are right on the frontline of prevention, supporting vulnerable people to live independently by assessing their needs, carrying out home adaptations, providing advice and enabling them to access support for everything from dementia to debt problems. They are also one of the main participants overseeing work carried out through disabled facilities grants (DFG) – now part of the Better Care Fund. 
Yet it’s difficult to see how we will achieve a shift towards prevention if housing support isn’t part of the integration picture. Safe, warm homes mean vulnerable people are less likely to be hospitalised as a result of falls or suffer from deteriorating health conditions that necessitate repeat GP visits. And as much as home support prevents hospital admissions it also has a role to play in facilitating safe, swift and sustainable discharges. Helping people to choose the right changes to their home environment presents a tremendous opportunity to help individuals enjoy a better later life. 
The April 4 deadline for final BCF plans may have passed but efforts to highlight the need for housing to be reflected in strategies and spending priorities will continue. There seems to be a paradox in many of the plans that have been submitted. On the one hand, housing appears to be conspicuous by its absence. On the other, it’s there implicitly because the ambitions and objectives these plans describe can only be achieved if support in the home is prioritised. But for that to happen, providers of housing support must continue engaging with healthcare professionals, embracing the sector’s language and presenting arguments backed up with evidence. 
Fortunately we have plenty of examples of areas where housing support’s role is already being recognised. 
For example, Lincolnshire HIA has just been successfully mandated to deliver a countywide wellbeing service that will include trusted assessment, minor adaptations, daily living aids, telecare, a rapid response service to support vulnerable people in their homes and generic provision such as help to apply for grants and benefits. It will run the service with fellow members of Lincs Independent Living Partnership (LILP), a consortium comprising the HIA, two social landlords, a hospice, a community support provider and an Age UK partner. 
By joining forces they have made life easier for commissioners, bringing together a range of support to provide a seamless service. Three members of LILP already run the Prevention and Avoidance Community Team in Lincolnshire on behalf of an NHS trust, providing transport and support for vulnerable people when they are discharged from hospital.
In places such as Warrington and Sheffield housing support providers are already working with GPs to help them use social prescribing to enable their patients to live independently. These areas will undoubtedly reap the rewards in terms of better outcomes. Ultimately, efforts at a local level to integrate health and social care will be judged on results, whether it’s a reduction in avoidable admissions thanks to fewer falls or improvements in the proportion of people who remain at home for more than 91 days after discharge.
With so many competing priorities and a diminishing pot of public funding, it’s increasingly important that commissioners are presented with robust cases for investment. Researchers at the London School of Economics have calculated adaptations could reduce demand for health and social care by £1,079 per recipient per year – on top of the annual £1,500 quality of life gains (using Department of Health criteria) – at an average yearly investment of £1,000. They cite one London borough reporting annual savings of £30,000 per client for two wheelchair users who were able to leave residential care due to the provision of adaptations in their homes.
Enabling people to live in their own properties, often managing long-term conditions, will become ever more important as we grapple with the impact of demographic change. There are endless statistics available to hammer that message home but here are a couple: between 2010 and 2030 the number of over 85s will double, according to the Office for National Statistics, and the proportion of older 
people with care needs is expected to increase by 60% over the same period. Importantly, ‘older age’ is increasingly recognised as a progression through phases, with different needs and circumstances presenting at each phase. 
If we’re to move towards individualised care, characterised by prevention, then the only way that can be achieved is through greater choice at each phase of older age. Health, social care and housing support services must adapt as the changing demographic flows through. Support in 
the community, such as that provided by HIAs, is key to this. Local services that 
really listen to individuals will have much more success in helping clients live independently and healthily through their changing life stages. 
 
Andy Chaplin is director of Foundations.
 
 

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