Neil Revely, Executive Director People Services (Sunderland City Council)
Neil explained that integrating health, housing and social care was a longstanding personal quest and one that was moving up the policy agenda. He identified a number of national policy drivers that were supporting a greater role for housing in the integrated care agenda including the Marmot Review (2010) with the report’s emphasis on the social determinants of health, and the Health and Social Act (2012). The 2012 Act was driving forward local integration, including the establishment of multi-agency Health and Wellbeing Boards and placing a greater emphasis on the role of housing as an important component of integrated care. He also referenced the Better Care Fund as a new mechanism for funding integration and service transformation.
Having outlined the policy context, Neil described the challenges facing agencies in implementing major transformation and service integration. They included: the current economic difficulties with major cuts to public expenditure, population ageing, rising demand and consumer expectations, and the impact of the welfare reform agenda on agencies and local communities. However, he suggested that we had to turn crises into new opportunities to innovate and deliver better outcomes for individuals and more cost-effective community-based models of housing, care and support. The shift towards personalisation and personal-budgets confirmed that individuals wanted different models of care and support to enable them to live at home in the community. Reflecting this, Neil challenged delegates to work together to achieve a shared ambition to eradicate institutional models of care in the twenty-first century, in favour of home-based care.
Neil drew attention to the importance of good design and the development of a range of housing options to meet the changing needs of an older population. He mentioned two recent extra-care developments in Sunderland that had been developed in a partnership between the local authority and housing associations. One of these schemes had utilised local authority land by converting a former orphanage into extra-care housing. Neither had required public sector finance and this highlighted the fact the alternative forms of funding housing and support could be found if there was a will to do so. With imaginative design and innovative funding models, housing can support independence for people with dementia as their needs change. Drawing health funding into extra-care housing was important to support the seamless delivery of primary healthcare services as well as care and support.
Neil was clear that these were not isolated examples of good practice, but they were examples of integrated approaches to dementia care and independent living that needed to be replicated. He drew attention to the National Housing Federation’s ‘Alternative Pathways’ report that provided detailed case-studies with costed examples of the outcomes that could be achieved by including housing solutions in integrated care pathways. The message was therefore ‘we can do this if we want to’, often .the only thing preventing progress was the limits of organisational willingness to innovate and work in partnership.
In concluding his presentation Neil delivered the following key messages:
- There is a need to develop a robust evidence-base in order to understand and share information about ‘what works’ and to demonstrate the impact of integrated models of care on individual health and wellbeing and demands for healthcare. We need to build links with academic partners to develop this.
- We need to look at the potential to draw new assets into our planning for integrated care, including the use of land, assets, access to capital and revenue funding, and include the experience of service users and examples of best practice from elsewhere. We cannot rely on public sector funding alone to deliver this.
- Good design and the offer of range of housing options are essential to meet varied consumer needs and expectations and changing needs in retirement.
- We can innovate and integrate if we want to. Developing good personal relationships across traditional sector boundaries was essential if progress is to be made. The future is in our hands and it is ultimately people who make the difference.