More affordable, high-quality specialist housing is needed which can provide for different levels of care. Equally important is that this accommodation promotes independence, leading to better health outcomes even as personal care needs progressively increase.
It’s true that many older people without financial means will understandably resist moving from their home, concerned about losing the memories attached to it or a sense of independence. For many there simply aren’t appropriate or affordable alternatives, especially in the rental system.
However, continuing to live in unsuitable accommodation increases an individual’s chance of falling ill or suffering an injury and ending up in hospital – and once they’re in the NHS system, it can be difficult to find a way out.
Extra care housing developments such as those delivered by Preferred Homes bring residents and care provision under one roof, with on-site care specialists who can spot and treat illness quicker. This helps to reduce the number of unplanned hospital stays.
Many residents at Hunslet Moor House, Preferred Homes’ new development in Leeds, moved from poor quality social housing and have already seen physical and mental health improvements within a few months.
Specialist housing can also solve another problem by creating a place for people coming out of hospital. Those unable to return home due to a change in health circumstances can be accommodated in a more appropriate setting without being moved prematurely to costly care homes. It can also act as a ‘step-down’ solution, for patients who no longer have acute medical needs but need time to rehabilitate and regain their independence before they return home.
There is a paramount need to accelerate the delivery of facilities to support discharge planning. These must be cost effective and provide both step-down and step-up care, promoting appropriate use of NHS beds and visits to hospitals. This kind of better integrated, community-focused care has been talked about as a solution to NHS capacity for a long time and was rightly a big focus of Lord Darzi’s review last year.
For stretched local authorities, long-term investment in affordable extra care housing also creates cost savings. Estimates show that a single 80-unit extra care housing development can save around £20m for housing, care and NHS services over a typical 25-year nominations period.
Now is the right time for care and housing authorities to work more closely together – both are under pressure and need to find ways of delivering more without major increases in funding.
From our experience, it is easier to get things done and make smart decisions when care and housing are dealt with under the roof of a single town hall. The government’s devolution mission, including to move England toward unitary authorities, presents an opportunity for local civic leaders to cut across departments and take a more considered view of what their local population needs. Existing combined authorities also have a role to play in providing a strategic and cross-boundary assessment of regional need.
Cross-government collaboration is needed as well, with departments taking a more nuanced approach to expenditure, and how they can collectively deliver the best economic and social value return from investment.
For too long, unaffordable care and unsuitable housing for older people has heaped greater pressure on the NHS. To stop this, we need to reexamine the way we deliver our most important social services – moving from treating sickness to preventing it, and building fit-for-purpose, affordable housing with the necessary support to live independently for as long as possible.
Findlay MacAlpine is chief executive officer at Preferred Homes, a provider of affordable extra care housing for older people.
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