Facilitating better integration between health and social care services
In March 2017 the Department for Communities and Local Government (DCLG) and the Department of Health (DH) published a policy framework for integration and the use of the Better Care Fund throughout two consecutive financial years from 2017 to 2019.
This mandatory policy is designed to facilitate improved integration between health and social care services by combining the budgets from both areas in a single programme.
NHS England, the Ministry of Housing, Communities and Local Government (MHCLG), the Department of Health and Social Care (DHSC) and the Local Government Association ...
... recognises that local authorities must be more appropriately prepared for the inevitable increase in the England’s elderly population. These four governing bodies are therefore working in partnership to help local areas plan and implement integrated health and social care services across the country.
In order to achieve the desired integration between services, a Better Care Fund (BCF) of £5.617 billion will be distributed to local authorities in England between April 2018 and April 2019, following the £5.128 billion which was allocated in the previous financial year. The BCF for 2018-19 is pooled from the £468 million Disability Funding Grant (DFG), a new £1.499 billion grant for adult social care services and a £3.65 billion contribution from NHS clinical commissioning groups.
BCF funds are paid directly from the Government to local authorities, provided that the following four national conditions are met:
1. Plans to be jointly agreed
2. NHS contribution to adult social care is maintained in line with inflation
3. Agreement to invest in NHS commissioned out-of-hospital services, which may include 7 day services and adult social care
4. Managing transfers of care (a new condition to ensure people’s care transfers smoothly between services and settings).
Beyond this, areas have flexibility in deciding how the fund is spent over health, care and housing schemes or services. Although they must agree how this will improve performance in:
• Delayed transfer of care;
• Non-elective admissions (general and acute);
• Admissions to residential and care homes; and
• Effectiveness of reablement.
The funding from NHS clinical commissioning groups, the Disability Funding Grant and the grant for adult social care can be withheld, recovered or directed elsewhere if it is believed that the conditions of the BCF policy framework are not being adhered to.
Provided that local authorities can demonstrate that they are meeting the Government’s key criteria for the BCF, they will then have the opportunity to graduate from the programme, which no longer requires them to submit plans and quarterly reports.
Institute of Mechanical Engineers makes recommendations in 'Healthy Homes' report
In their recent report on accommodating for the increasing ageing population in the UK, the Institute of Mechanical Engineers examines the lack of housing that is available to support the changing needs of individuals.
The research highlights the financial impact poor housing can have on the NHS, with £2.5 billion being spent on care as a result of poor housing in 2015.
Further investigations reveal that individuals who remain independent in their own homes ...
... with an appropriate level of additional support, require far less funding. In 2015 the cost of providing a hospital bed for a week was £1,925, compared to the £357 it cost to provide care at home.
The Institute of Mechanical Engineers suggests that new homes should be appropriately built to include assistive technology and adaptations that will reduce demands on healthcare services.
Elderly people are often encouraged to downscale their homes, with the assumption that they will have reduced mobility with increased age. However physical inactivity is costing the NHS £10 billion a year, with only approximately 30% of people aged 55-64 achieving the recommended 30 minutes of activity a day, at least 5 days a week.
It is similarly often assumed that elderly residents would prefer to be located at ground level, to remove the requirement of travelling to upper floors. However it has been suggested by the Institute of Mechanical Engineers that many elderly residents prefer to reside on upper floors for the provision of varied views, natural light, reduced noise and greater privacy.
Therefore, new homes need to be designed to encourage a more active lifestyle, with different levels of adaptations and assistive technology used to support an individual depending on their health, and not their age.
In order to provide appropriate housing, the Institute of Mechanical Engineers recommends:
• Providing financial incentives for construction companies to builder houses for elderly living;
• Committing to modernising UK housing design and construction to include technology;
• Encouraging product suppliers and manufacturers to provide new technology that allows people to live in their own homes for longer and;
• Focusing on technology that prevents ill health
Changing UK construction regulations could motivate companies to build intergenerational houses, and educate older people about physical activity and technology that can assist in maintaining a healthy lifestyle.
Lifetime Homes Standard (LHS)
Non-statutory policies such as the Lifetime Homes Standard (LHS) are already recognised by the Government, and IME believes these could be incorporated into Government policy to address the current lack of housing for older people.
Local authorities can choose to implement LHS in the design and build of new houses, by applying the 16 criteria that aim to ensure a home is equipped to support the varying needs of an individual throughout their lifetime. These criteria include specifications for the dimensions of rooms and entrances to fore plan for wheelchair access, providing access to upper floors, and ensuring utilities such as window handles, sockets and switches are at an accessible height for all potential users.
Although LHS can provide an additional cost to building design, ranging from £545 to £1,615 depending on the modifications required; it has the potential to save long-term costs in both the construction and healthcare sectors.
The additional costs saved by making new homes accessible and inclusive could be invested in technology which aims to support individual needs by adding convenience and reducing the risk of accident or injury.
It is already predicted that by 2020 the average home will have more than 500 connected devices ranging from washing machines to lightbulbs, with over 130 million smart home devices having been shipped in 2017.
A smart home utilises the internet of things to adapt the home environment to meet an individual’s needs or requirements. Connected intelligent systems can be installed within a home environment to fully integrate control over dimming and switching of lighting, audio visual systems, energy efficiency, home automation, security and door entry, and even next generation assisted living and Technology Enabled Care devices.
Consumers in the UK are only currently showing a 66% interest in smart homes, and the Institute of Mechanical Engineers has identified factors that could be affecting the percentage of those adopting smart home technology including:
• Security and privacy
Although cost is a factor, with the aim of adapting homes being to save costs in the long-term, it is not suggested that every new home needs to be fully automated. Small adaptations to homes could reduce the cost of healthcare by reducing the risk of falls or injuries, possibly with a view to use these savings to develop new, cost-effective solutions.
The risk of privacy being compromised by smart home technology could also be neutralised by the Government working with stakeholders and customers to define new legislation for smart home technology regarding the transfer, storage and use of personal information.
The Institute of Mechanical Engineers have regarded the barrier of appeal as the usability and aesthetics of smart home products. Some users may be concerned with the stigma which can be associated with assistive technology, whereas others may require products that are designed to be user-friendly. Creating technology that is flexible across generations is a simple solution to concerns regarding the appeal of smart home technology for different demographics.
Government will launch new funding model in April 2020
In their policy statement for Funding Supported Housing, the Department for Communities and Local Government and the Department for Work and Pensions stated that a new funding regime is being introduced for supported housing in April 2020.
The document confirms there are approximately 651,000 supported homes in Great Britain, and with the overall number expected to rise to 845,000 by 2030, suggests that changes are required to the existing funding model to support the significant increase.
The requirement for a 30% increase in supported homes is largely due to the predicated increase of 35% in the current demand ...
... for elderly individuals, in addition to a 53% increase for individuals with disabilities.
As supported housing is essential for the most vulnerable in society, this puts pressure on Housing Associations and Local Councils as the main providers of these types of housing. Housing Associations provide 465,000 (71%) of the supported homes in Great Britain, and Local Authorities provide a further 117,000 (18%).
The Government recognises that funding is needed to support those delivering the new and much needed supply of supported homes, as well as make the best use of existing ones.
Their policy statement makes it clear that the current ‘one-size-fits-all approach’ is not sustainable, and they have therefore tailored a new model which is divided into three main types of supported housing; Sheltered & Extra Care Housing, Long-Term Supported Housing and Short-Term Supported Housing.
Sheltered & Extra Care Housing
Sheltered & Extra Care Housing is identified as accommodation that is designed for elderly individuals with care and support needs, and aims to help them remain independent in their own homes for as long as possible.
Although this type of housing will continue to be funded by the welfare system, the Government will be introducing a ‘Sheltered Rent’ in 2020, which sets an overall cap on the amount providers can charge in gross eligible rent.
The policy statement acknowledges the higher cost of Sheltered & Extra Care Housing, and recognises that better cost control is needed in order to make it affordable for elderly and vulnerable individuals.
In order to facilitate this new social rent, Local Authorities and housing providers are being asked to:
• Submit data on their gross eligible rents;
• Publish breakdowns of their service charges;
• Work in partnership with other local partners to produce a local strategic plan for supported housing and;
• Undertake an assessment of provision and need for all supported housing groups
Long-Term Supported Housing
The Government defines Long-Term Supported Housing as highly specialised housing for individuals with learning disabilities, physical disabilities or mental ill health.
All long-term housing costs, including rent which is inclusive of eligible service charges, will continue to be funded by the welfare system as it is presently.
In order to support the continued provision of long-term housing, which incurs medium to high costs, Local Authorities and housing providers are being asked to:
• Begin developing an understanding of long-term housing provision in their areas and;
• Think about ways to ensure better cost control
As outlined in the policy statement, the new funding model will be introduced to support housing in April 2020. However prior to its implementation, the Government will be working with providers to:
• Plan and facilitate new supply;
• Provide support which keeps people independent, offers a real alternative to residential care, and enables efficient use of stock and;
• Provide transparency in reporting against delivery
In addition to the new funding model, a number of funding schemes will also be launched to facilitate the success of the Government’s policy.
The Department for Communities and Local Government’s Affordable Housing Programme has committed £400 million which will be used to build 8,000 new supported homes by 2020, the Department of Health’s Care and Supported Specialised Housing (CASSH) fund is investing £200 million to build a further 6,000 supported homes, and the Department of Technology has launched a £25 million fund for housing and technology, which aims to support people with a learning disability to live as independently as possible.