Update on Housing and Social Care

Purpose of report

For information.

Summary

This report summarises current policy and improvement work to address the housing and social care priorities in the Community Wellbeing Board’s 2019/20 work programme. Much of this work is steered jointly with the Environment, Economy, Housing and Transport (EEHT) Board and in close collaboration with the Association of Directors of Adult Social Services (ADASS) Housing Policy Network. As we look ahead to the 2020 Comprehensive Spending Review, this discussion is also an opportunity for Members to identify potential issues to reflect in our submission.

Recommendations Members are invited to note the update offer any further steer on the Board’s current work programme, particularly the actions outlined in paragraphs 9 and 16. Actions Officers to continue to progress the work outlined in the report and to take forward any further Member steer.

Contact officer:	Laura Caton

Position:	Senior Adviser

Phone no:	07775706087

Email:	laura.caton@local.gov.uk

Update on Housing and Social Care

Background

Following the housing and social care sessions at the 2019 National Adult and Children’s Services Conference, Members requested an update on the Community Wellbeing Board’s housing and social care work. As such, this report does not cover the role of housing in improving public health outcomes or tackling inequalities.

Housing is a key component of health and care and the foundation upon which people can achieve a positive quality of life. Affordable, suitably designed and accessible homes in the right places, with supporting infrastructure, can extend independent and safe living for older people, people with a disability and/or other long-term health needs. It can also help to reduce demand on social care and health services by supporting greater levels of independence in the community, preventing admissions to residential care and hospital and aiding discharges. For people in vulnerable circumstances, a safe home with personalised support to address practical and care needs, can help people to regain their independence.

Nationally, there is greater recognition about the role of housing in health and care as part of a wider focus on prevention. Health and wellbeing boards are increasingly integrating housing into their work. How this is achieved varies between places, not least to reflect district councils’ responsibility for housing in two-tier areas, and the extent to which health partners are fully engaged.

In September 2019, Members agreed to work with the EEHT Board to:

Support councils to provide high quality supported or adapted housing for vulnerable adults, people with a disability and older people.

Make the case for a sustainably funded local oversight regime for supported housing.

Support housing and social care directors to respond to Social Housing Regulator concerns about specialised supported housing.

The following government priorities will also shape the Board’s work in 2020:

The December 2019 Queen’s Speech committed the government to publish a National Disability Strategy in 2020 that will set out plans to transform the lives of disabled people, covering housing, transport and education.

The Conservative Party’s 2019 General Election Manifesto pledged to encourage innovative design and technology to make housing more affordable, accessible, and suitable for disabled people and an ageing population.

The 2020 Budget included funding to increase the number of affordable homes, funding for homelessness services and proposals to simplify the planning system.

This report updates on specific housing and care work streams, but it is integrated throughout the Board’s policy and improvement work. For example, our work on the future funding of adult social care makes the case for the importance of housing in supporting people to live the lives they want to lead. The role of health and wellbeing boards in relation to housing features in our political leadership offer. Housing and care is also reflected in our work on loneliness, mental health and the Armed Forces.

Supported Housing

Supported housing brings together good quality build in the right locations with support for the needs of the individual, alongside help and care so they can live a fulfilling life with positive outcomes. There are different types of supported housing offering different levels of assistance across all tenures. This includes sheltered housing and extra care mainly for older people, specialised supported housing mainly for working age adults with learning disabilities, long-term mental health and/or other complex needs, hostels supporting homeless people and refuges for people who have experienced domestic abuse.

The supported housing sector has a mix of registered and unregistered providers and multiple finance arrangements and governance models. This can present challenges around quality and value for money. Difficulties defining housing and support costs have prompted numerous government supported housing reviews. In August 2018 the government announced that Housing Benefit would be kept in place for all types of supported housing. The government also pledged to develop a more robust oversight regime to improve quality and achieve better value for money.

Community Wellbeing Board work focusses on the following areas and Members are invited to give any further steer:

Making the case for a sustainable supported housing funding model to ensure that councils can reduce homelessness and help older and other vulnerable people to live well. Housing costs and care costs must both be adequately funded. This links to wider concerns about the sufficiency of Housing Benefit, welfare reform (led by the Resources Board) and social care funding.

Positioning councils to have the lead role in overseeing and ensuring supported housing is good quality, value for money and fits in with the wider local services offered in places. This should be appropriately resourced and not overly prescriptive for councils or providers. We are also influencing the development of the government’s national statement of expectation which well set out voluntary minimum standards for providers.

Supporting councils to respond to the Social Housing Regulator’s concerns about the long-term financial viability of specialised supported housing funded through the lease-based model. With ADASS and NHSE/I, we have commissioned Housing LIN to produce an advice note for commissioners that aims to support decision-making, share good practice and inform our advocacy work going forward. The note will be published next month.

There is close alignment to the EEHT Board’s work supporting councils to develop new approaches to working with developers and securing investment in housing supply. Demand for the different types of supported housing will vary between local areas and reflect local need. In particular, there is unmet demand in the extra care market from the growing older population and a need to encourage housing associations and other established providers back into the specialised supported housing market.

Accessible Housing

Timely home adaptations help to support older people and disabled people, their families and carers to manage wellbeing in the home, extending safe and independent living. Improving the accessibility of existing housing is a priority because over 80 per cent of the homes we will be living in by 2050 are already built. 72 per cent of existing homes could be adapted to meet the four features of ‘visitable’ accessibility for people with a disability or accessibility needs. Public Health England estimate a social return on investment in adaptations of £7.23 for every £1 spent.

Growth in the Private Rental Sector (PRS) means that more people are living in homes with less secure tenure and it can be difficult to secure the landlord’s agreement to adaptations. One-third of disabled people in rented accommodation are living in unsuitable properties. It is estimated that the number of households in the private rental sector (PRS) headed by someone aged over 64 will more than treble over next 25 – 30 years (from around 450,000 now to over 1.5 million in 2046.) The EEHT Board has commissioned research into activity being undertaken to improve the quality of the private rented sector and to understand the key challenges, including changing demographics. The final report and a practical toolkit for councils will be published this month.

The Disabled Facilities Grant (DFG) funds adapting existing stock in the private and rental sectors. It is allocated via the BCF Policy Framework and requires close working between housing authorities and social care authorities in two-tier areas. Government funding for the DFG has more than doubled, from £220 million in 2013/14 to over £500 million in 2020/21. In December 2018, a government commissioned independent review recommended simplifying the DFG process. We expect the government to publish its response to the review in due course.

Adapting existing housing stock sits alongside a council’s wider housing and planning role. New homes should be accessible or easily adaptable for people of all ages and needs. It is vital that national rules incentivise the building of accessible homes. The EEHT Board leads on work to support the increase in supply of new build accessible homes.

Community Wellbeing Board work focusses on the following areas and Members are invited to give any further steer:

Making the case for a significant scaling-up of funding for home adaptions so that councils can upgrade existing housing and give people timely advice and access to funding where needed to adapt and repair their homes.

With Age UK and Care and Repair England, we will shortly launch a new publication on accessible housing which shares steps councils can take to improve local approaches to home adaptations and support a more strategic use of DFG aligned to local integration outcomes.

Influencing the future of the DFG so that it meets increased demand and is easier to access for people in the PRS. We continue to press government to adopt the DFG review’s recommendations about simplifying the DFG process.

Sharing examples about how councils are putting in place personalised interventions that enable older and disabled people to live in their homes for longer, often in partnership with the voluntary and community sector. We will continue to do this working closely with Care and Repair England and Age UK.

Supporting the Housing Made for Everyone coalition. Organisations including Age UK, Centre for Ageing Better, Disability Rights UK and RIBA are calling for action to build homes fit for an ageing population and people with disabilities.

Safeguarding and Homelessness

Drawing upon feedback from four workshops, the LGA and ADASS are developing a briefing for councils about supporting people who experience multiple exclusion homelessness. For many of those who are street sleeping, homelessness is a long-term experience and associated with tri-morbidity (challenges arising from a combination of mental ill-health, physical ill-health and drug and/or alcohol misuse) and premature mortality.

A key message from the briefing is that multiple exclusion homelessness refers quite probably to people with care and support needs, who may well also be experiencing abuse and neglect (including self-neglect). Adult safeguarding responsibilities are therefore also engaged. The briefing will assist senior leaders, such as members of Adult Safeguarding Boards, as well as commissioners, practitioners and operational managers to support people who are at risk of experiencing abuse and neglect. This is a complex area of safeguarding adults’ practice which requires an integrated whole system response around the person. The briefing will be published in March.

Economy, Environment, Housing and Transport (EEHT) Board

In addition to references already made to EEHT work, the Board is refreshing the 2016 Housing Commission report. This includes a chapter on ‘putting housing at the heart of integrating health and care’, which currently focusses on older people and reflects many of the issues covered in this report. The outcome of Members’ discussion will inform updating the Housing Commission report, including to better reflect the housing needs of working age adults in vulnerable circumstances and/or with complex needs.

The EEHT Board also leads the Housing Adviser Programme. The 2019/20 programme is funding 19 projects, supporting more than 80 councils to meet their local housing need via direct grant funding through which councils can secure specialist expertise. A series of case studies from the 2018/19 projects are available on the LGA website and some of these explore the links between housing, care and health.

LGA / ADASS Care and Health Improvement Programme (CHIP)

In addition to providing direct advice and insight to councils on housing and social care, which in turn helps to shape the Board’s policy work, housing is embedding across CHIP programmes, including:

Developing a supported housing self-assessment framework that will help councils to better understand local needs and market in order to strengthen commissioning.

Updating the High Impact Change Model so that it now includes a new change on the role of housing and related services in supporting timely hospital discharge and quality outcomes for people. This addition was promoted at four regional events alongside research on homelessness and discharge by the Institute for Health Research at King’s College London.

Enabling councils to access additional expertise to develop and share innovative approaches to supported housing.

Developing ‘top tips’ for Directors of Social Services and Heads of Planning in relation to mutually beneficial ways of working to see sufficient appropriate housing development.

The support provided to councils and NHS partners around implementing the Better Care Fund includes discharge of the Disabled Facilities Grant.

In preparing to support local health and care systems to respond to Covid-19, the BCF support programme, delivered by CHIP, is mobilising expert peers to advise on the best use of housing and related services, as well as social care and community services, to support more people to be discharged from hospital safely and quickly and so free capacity in the acute sector to respond to the virus.

This includes new case studies on aspects of suicide prevention that councils identified as areas for further support which will shortly be available on the LGA’s website.

Implications for Wales

Housing and social care are devolved policy matters.

Financial Implications

The LGA activities highlighted in this report can be delivered within existing resources.

Next steps

Members’ steer will inform the continued work of the Community Wellbeing and EEHT Boards on shared policy priorities.

Boardman, B et al (2005) ‘40% House’, Environmental Change Institute, University of Oxford, UK

https://www.gov.uk/government/statistics/english-housing-survey-2014-to-2015-adaptations-and-accessibility-of-homes-report

Public Health England (2018) Falls prevention: cost effective commissioning https://gov.uk/government/publications/falls-prevention-cost-effective-commissioning

https://www.equalityhumanrights.com/en/publication-download/housing-and-disabled-people-britains-hidden-crisis

https://www.housinglin.org.uk/_assets/Resources/Housing/Support_materials/Other_reports_and_guidance/HAPPI-5-Rental-Housing.pdf

https://www.foundations.uk.com/dfg-adaptations/dfg-review/