Housing on the Health and Social Care Agenda

The White Paper Our health, our care, our say: a new direction for community services

This White Paper promises that health and social care services will provide better prevention services with earlier intervention. It promises to give people more choice and a louder voice. It promises to do more on tackling inequalities and improving access to community services and ensure that local health and social care commissioners work together. There will be more support for people with long-term needs. Joint health and social care will support people with ongoing conditions who have the most complex needs.

Support For People With Long Term Needs

The four central aims of this White Paper have special force and relevance to those with longer-term problems:

• better health and well-being;
• convenient access to high-quality services;
• support for those in greatest need;
• care in the most appropriate setting, closer to home.

The aim for people with longer term needs is the same as that for all people who use services. Services should support people to take greater control over their own lives and should allow everyone to enjoy a good quality of life, so that they are able to contribute fully to our communities. They should be seamless, proactive and tailored to individual needs. There needs to be a greater focus on prevention and the early use of low-level support services, such as those provided through the Supporting People programme.

The Supporting People programme which covers a broad range of vulnerable groups, including people with disabilities and older people. Through Creating Sustainable Communities: Supporting Independence the Government is consulting on how best to build on and take forward the programme, including co-ordination and integration of care and support services for those receiving both.

We will encourage multi-disciplinary networks and teams will be created at PCT and Local Authority level. They will use a Common Assessment Framework, with prompt and ongoing access to an appropriate level of specialist expertise for diagnosis, treatment and follow-up where necessary. They need to operate on a sufficiently large geographic scale to ensure the involvement of all the key players, including social services, housing, and NHS primary, voluntary, community and secondary care services.

Care Closer To Home

The Chapter on care closer to home includes:

• shifting care within particular specialties into community settings;
• the need over time for growth in health spending to be directed more towards preventative, primary, community and social care services;
• a new generation of community hospitals, to provide a wider range of health and social care services in a community setting;
• accurate and timely information for the public on specialist services available in a community setting.

For some people, residential care may be the best option, but we want to ensure that, wherever possible, people have the option to stay in their own homes. Greater use of community services including extra-care housing, intermediate care services, community equipment, intensive support at home and support for carers, has enabled more people to be cared for closer to home and to continue to live in their own homes for longer.

Over 70 per cent of respondents to the on-line questionnaire felt that being able to get advice and information from a GP, community nurse, social worker or housing or benefits adviser in one place would be an improvement.

The current changes to the health and social care system, as set out recently in Health Reform in England and Independence, Well-being and Choice, are designed to do just that:

• Choice means people will increasingly determine what services they want, and where. Providers that offer these services will thrive; those that do not won't.
• Individual budgets will put far more control in the hands of people who use social care services, affecting the way six different income streams can be spent around their personal needs. Markets will need to be developed to ensure that they have an appropriate range of services to choose from.

People with learning disabilities also want greater choice and control over their own lives, in line with the principles of the Valuing People White Paper. This includes being supported to live in ordinary housing in their local community and to work. Even today, close to 3,000 people with learning disabilities live as inpatients in NHS residential accommodation, or 'NHS campuses'. The White Paper wants to see an end to this type of institutional provision.

Strengthening social care provision

In some areas, Local Authorities are faced with weak and fragile social care and social services providers. This can be a consequence of the size of the Local Authority and associated market, differences in commissioning skills and competencies, or a lack of long-term, co-ordinated, strategic procurement of services. The result, however, is that Local Authorities can end up with poor value for money.

This weakness has a direct impact on the commissioning choices that Local Authorities can make. The fact that over 150 local social services departments are trying to commission services in isolation leads to weak procurement practices, including too many short-term contracts which hinder providers from making the longer-term investments that are required to raise service quality.

Appendix Independence Well Being and Choice - consultation

Our society is based on the belief that everyone has a contribution to make and has the right to control their own lives. This value drives our society and will also drive the way in which we provide social care.

This is a vision for all adults. It includes older people and younger adults who need care and support, people who are frail, people with a disability or mental health problems and people who care for or support other adults. It is also a vision for those who provide care services.

Services should be person centred, seamless and proactive. They should support independence, not dependence and allow everyone to enjoy a good quality of life, including the ability to contribute fully to our communities. They should treat people with respect and dignity and support them in overcoming barriers to inclusion. They should be tailored to the religious, cultural and ethnic needs of individuals. They should focus on positive outcomes and well-being, and work proactively to include the most disadvantaged groups. We want to ensure that everyone, particularly people in the most excluded groups in our society, benefits from improvements in services.

Over the next 10 to 15 years, we want to work with people who use social care to help them transform their lives by:

• ensuring they have more control;
• giving more choices and helping them decide how their needs can best be met;
• giving them the chance to do the things that other people take for granted;
• giving quality of support and protection to those with the highest levels of need.

We will achieve this by:

• changing the ways social care services are designed. We will give people more control over them through self-assessment and through planning and management of their own services;
• developing new and innovative ways of supporting individuals;
• building and harnessing the capacity of the whole community to make sure that everyone has access to the full range of universal services;
• improving the skills and status of the social care workforce.

In summary, the vision we have for social care services is one where:

• services help maintain the independence of the individual by giving them greater choice and control over the way in which their needs are met;
• the Local Authority and Director of Adult Social Services have key strategic and leadership roles and work with a range of partners, including Primary Care Trusts and the independent and voluntary sectors, to provide services which are well planned and integrated, make the most effective use of available resources, and meet the needs of a diverse community;
• Local Authorities give high priority to the inclusion of all sections of the community and other agencies, including the NHS, recognise their own contribution to this agenda;
• services are of high quality and delivered by a well-trained workforce or by informal and family carers who are themselves supported;
• we make better use of technology to support people and provide a wide range of supported housing options;
• we provide services with an emphasis on preventing problems and ensure that social care and the NHS work on a shared agenda to help maintain the
  independence of individuals;
• people with the highest needs receive the support and protection needed to ensure their own wellbeing and the safety of society;
• the risks of independence for individuals are shared with them and balanced openly against benefits.

We do not deliver this vision at the moment. Sadly, the organisation and rovision of our services do not help everyone to meet these goals consistently. We want to use this vision to demonstrate where we need to change and to guide the way we provide care. Our challenge is to make this vision a reality.

Housing Options, Stanelaw House, Sutton Lane, Sutton, Witney, Oxfordshire, OX29 5RY, United Kingdom
Telephone: +44 (0)845 4561497 E-mail: enquiries@housingoptions.org.uk