Published on 15 November, 2013 in the Health Service Journal
'As the foundations of the NHS are dug up once more, we should not miss the opportunity to integrate better housing into care provision', says Jeremy Porteus.
The integration transformation fund and the Care Bill signal that the health and care landscape is being redesigned yet again. This time, let's make sure the concrete is smoothed over before it sets.
That means the NHS and its social care partners must include housing as they strive to move from a medical model to a preventive approach that supports the delivery of care at home.
Indeed, the NHS and social care should already be building relationships with housing through health and wellbeing boards.
The Care Bill recognises housing's preventive role and the contribution it can make to wellbeing. The bill includes a requirement on local authorities to consider the suitability of a person's home when reviewing their wellbeing.
Councils will be required to provide care and support with the aim of integrating social care with NHS services or "other health related services such as housing".
NHS England expects the £3.8bn integration fund will incorporate disabled facilities grants but housing involvement in integrated care services goes well beyond such vital but small-scale capital grants.
To build healthy homes and communities on a much larger scale, we must achieve greater alignment through new procurement and commissioning approaches.
Counting the cost
There is already evidence that integration and partnership working that includes housing interventions can make a real difference to people's lives, as well as health and social care budgets.
In particular, this means helping to facilitate the transition to care back at home after a hospital stay or developing specialist housing for older people and those with long term conditions to prevent more costly care.
For example, Sandwell Council's approach shows that integration of health, social care and housing really is "investing to save" in action.
In Sandwell, research shows investment in various housing initiatives saves the NHS money. For example, £25,000 invested in a home improvement agency is estimated to save the NHS £56,000 annually; investment of £100,000 is estimated to save the health service £132,000.
But it is not just about the money. Genuine integration must focus on outcomes for older people and those with long term conditions. This will require genuine partnership working and assessments that can only be achieved through a new leadership culture.
Sector leaders must recognise the need for greater shared responsibility and improved joint training and networking across professional and sector boundaries. In this way, integration can deliver the social and capital infrastructure that people want.
Housing Learning and Improvement Network (LIN)