Last month, I spoke at the Recover, Reset and Regenerate virtual event run by the ADASS Housing Policy Network, Foundations and the Housing LIN which attracted over 900 online delegates. This blog for the Housing LIN provides an overview of the main points I set out in my presentation.
In ADASS our vision is for a compassionate and respectful society that enables independence, wellbeing and participation in community life and one of our key beliefs is that people should be supported to live in their own home and community unless their needs can only be met elsewhere.
Our priorities include increasing social justice. When we talk about social justice we really mean greater equality, power and control of those people who experience disadvantage and discrimination in our care, health and housing system. The fundamental importance of housing and home is equally applicable regardless of age (older people and people of working age) or disability. It is an essential element of all of our lives.
COVID-19 has had a devasting impact on adult social care and the people who rely upon it every day to live the best life possible. People have died prematurely, and families have grieved in isolation. People have been quickly discharged from hospital without assessment, or been unable to access community-based services. People have isolated or shielded, sometimes alone. This led to safeguarding, family crises, in mental health, domestic violence or addiction crises.
Coronavirus has exposed the underlying inequalities in our society relating to age, disability and Black Asian and Minority Ethic (BAME) people. COVID-19 will be with older and disabled people for a very long time even as we restore care and support, assessing needs, preparing for the inevitable surge in demand for care and enabling us all to live our lives again.
The focus on protecting the NHS with rapid discharge from hospital (some 25,000) without taking account of the needs of the whole health and care system has had tragic consequences which are now well publicised.
Most people went home in line with the Discharge to Assess Guidance – but many could not, and for some this was because their housing was not suitable, or flexible housing was not available, or there was a lack of capacity in reablement or support at home. This then limits choice, reduces the ability to support people home, and may lead some people into homes they wouldn’t have chosen.
Every decision about care is also a decision about housing. Recent events really bring it home, that things like housing adaptations, equipment and technology are incredibly important in people, and help to avoid having to go into residential or institutional settings.
As a signatory to the national Health and Housing Memorandum of Understanding (opens new window) (MoU), ADASS considers that COVID-19 presents an opportunity to reaffirm that integration includes housing, as well as health and the wider public sector. To state the obvious housing has played an increasingly important role in achieving the protection we sought - people staying at home in small numbers prevented an even greater spread of the virus.
"Every decision about care is also a decision about housing. Recent events really bring it home, that things like housing adaptations, equipment and technology are incredibly important in people, and help to avoid having to go into residential or institutional settings"We should not shy away from the number of people who have died in our residential care homes recently. We should not seek to blame our care providers or their staff who have continued to work in conditions where they themselves have made personal sacrifices, the ultimate sacrifice in a number of tragic circumstances.
We should though ask ourselves how we can make every place where people are living as safe as it can be and this includes changing the mix of options for people so that our care homes are better able to cope with lower occupancy, with infection control and with stable staffing.
We need to focus on what people would choose, and moving to a care home may not be a positive or aspirational choice. People tell us they would rather continue to live at home, or if not, in an alternative ‘new’ home with care on site, such as Extra Care housing.
In 2017, the LGA called for a ‘Residential Revolution’ in their report on housing and ageing population (opens new window). Written by the Housing LIN, it estimated that we had a shortfall of 400,000 units of housing for older people by 2030. This has not significantly improved since that research. Outside of London, by 2030 only 22% new homes are planned to meet a minimum accessible, adaptable standard (M4(2)/LTH) and only 1% will be wheelchair accessible.
Across all tenures we need people to be living in accommodation that meets their changing needs. It takes time and evidence to influence Local Plans but if we could have a better offer for older people this could have a significant impact across all tenures, social housing or privately owned.
Local Authorities cannot achieve this alone and we must work with partners to understand the specialist housing which is required to support those of us with the most complex of needs. Whether that be learning disability, dementia, autism, mental health or people with a drug or alcohol dependency which is often prominent in those who are homeless.
On the back of our recent experience, should our legacy now be a major expansion of accessible housing and of extra care housing for older people? Not only would this meet needs better, but it would help us with our economic challenges.
We should seek to protect our care services during any changes but not preserve care models that the public do not prefer. So, if there is a shift in use of residential or nursing care we should support the change, but protect people from disruption, and we should reflect on housing rights.
How right is it that someone who has a dementia and or behaviour issues should have to leave their home? If care providers are forced to close or ‘hand back’ care is that acceptable? I call that an eviction because it's an involuntary act on behalf of the person receiving care. It can't be right, that people are forced to move home when they could have a right to stay where they are if they have the right care. So, I wonder whether part of our reset going forward, we need to strengthen people's housing rights?
Councils, the NHS and local voluntary groups have worked together during COVID-19 on homelessness, and rough sleeping and have done an incredible job. For many the increased numbers of people identified as homeless or rough sleeping has come as a surprise.
"On the back of our recent experience, should our legacy now be a major expansion of accessible housing and of extra care housing for older people? Not only would this meet needs better, but it would help us with our economic challenges"These new local partnerships have rapidly come together to provide wraparound services which has reminded us of some of the arrangements that we have had in the past, particularly around the Supporting People Programme and whilst we can’t go back to the past surely we need to see properly funded partnership approaches?
The principles of proper, user controlled, wraparound support can equally be applied to supporting people with learning disabilities and autism. People with learning disabilities and autism have been dreadfully exposed to COVID-19. It feels as though the Transforming Care programme has suffered from a series of delays and false dawns over time and although much progress has been achieved it hasn’t been to the levels we all would have hoped for, or expected often because of housing.
Nationally, adult social care needs be the focus of a new people defined approach and an ‘industrial strategy’. Too often it has been accepted as in ‘crisis’ and successive Governments have made the right noises but then not delivered solutions. Social care offers huge employment opportunities and through housing can offer great redevelopment and regeneration opportunities. It can be part of 'build back better'.
The conditions are there for housing and social care to flourish together. Health has learned that you can't just think about NHS services without thinking about the wider system of social care and housing, and we should never again put ourselves in a position where we have to discharge 25,000 people without having sufficient planning and reform to get them into a home of their choice.
So, in the light of the MoU, we need to move away from an “understanding” to a memorandum of “action”. That’s why I’ve also suggested that together we should make a number of asks of Government as follows:
- A major expansion of accessible housing and of extra care housing for older people
- A strengthening of people's housing rights.
- A properly funded partnership approach to Housing as part of the Transforming Care programme
- Develop partnership and funding approaches to wraparound housing support services for vulnerable groups
I’d be interested in the views of people on these asks and how best to action to improve the housing rights in a just way.
If you would like to talk through any of the issues raised in this guest blog and/or find out how the Housing LIN can assist your organisation, email us at: email@example.com