Make a show of it

Act one opens in Joe’s fourth floor flat. ‘Joe is discharged from hospital after major surgery,’ begins the narrator.

Enter Bill, Joe’s neighbour. He asks how he’s feeling. Joe tells him he’s due a visit from a social worker - the first, it turns out, of numerous visits from many agencies who want him to fill out countless forms with the same information. Yet ‘all Joe really wants is a cup of tea’, explains Mike Reynolds (pictured overleaf narrating the play). Mr Reynolds is a resident at Aspire housing association’s Mill Rise extra care scheme, chair of the Staffordshire landlord’s independent living service group and writer of this play.

‘The idea is to get across the frustration older people, disabled people and people with mental health problems feel,’ he says.

Earlier this month, Mr Reynolds and eight other residents performed Joe’s Dilemma at Staffordshire Council’s local strategic partnership away day. Attended by decision makers for health and social care, this was their chance to express why they want the services they receive to be more integrated.

Sue Hailstones, head of independent living at Aspire, argues that a people-centred approach, in which services are built around vulnerable individuals’ needs, is ‘key to how we are going to deliver services in future’.

‘Customers don’t want to be passed from pillar to post having four or five assessments. They get fed up of telling their story,’ she says. Plus, when too many agencies operate separately, they can overlook an individual’s most basic needs - like Joe’s need of a cup of tea.

Housing, health and care teams can work together to make difficult times less stressful for customers. This approach is also a more efficient way of running services, as it avoids duplication of time and resources. And with the previous government’s personalisation agenda continuing to gain momentum, service users are increasingly being given control of the help they receive and now expect to choose services for themselves. If providers, including housing associations and local authorities, can’t offer what they need in an straightforward way, they can take their custom elsewhere.

Integrated services

Aspire’s Ms Hailstones advocated combining services and assessment when she spoke at the Chartered Institute of Housing’s conference and exhibition in Harrogate last month. The session was sponsored by services firm Mears, which began providing social care in 2007 when it bought domiciliary care company Careforce.

The company, which traditionally specialised in repairs, is now restructuring so that care and maintenance workers operate side-by-side.

ntegrating housing and social care services is ‘our fundamental strategy’, explains its executive director Alan Long.

Social landlords including Anchor Trust, Hanover Housing Group and Housing 21, which provide housing, health and care for the elderly, and Look Ahead Housing and Care, which offers supported housing to vulnerable people in London and the south east, have run integrated services for years. The local authorities which provide the lion’s share of such services and commission many of the rest from other providers, on the other hand, are not all so great at this approach.

‘Some are really good at it but they are very few. Most try but don’t get very far. Some aren’t bothered at all,’ states one housing association head.

Now Mears is lobbying the coalition government, pushing the idea that if local authority departments commission services together, they will both give customers what they want and save money.

In the light of changing demographics - official projections show that by 2034, 23 per cent of the UK population will be aged 65 and over - Mears argues that if housing, health and care teams work together, they can prevent serious and expensive health problems and help keep people in their own homes and out of costly residential care.

Financial benefit

From a procurement point of view, jointly commissioning maintenance and care services saves money, says Mr Long. Mears’ personal care at home package, for example, costs an average of £300 per week; residential care typically costs three times more than that, he argues. ‘We have to find ways to save money - that cannot be done by driving down the average cost of care workers’ pay - it’s already low.’

As a service provider, Mears obviously has an interest in pushing its wares, but its argument reflects the government’s own personalisation agenda. Yet councils don’t always welcome the lines between support services being blurred. Moving towards integration often involves overhauling the way public services have always been offered.

‘Local authorities often don’t like to have landlord and care provider as the same organisation,’ says Jane Ashcroft, chief executive of Anchor. ‘Infrastructure issues - funding from different streams, regulators coming from different angles - get in the way.’ Customers in Anchor’s 700 sheltered housing schemes like not having to wonder, ‘is my query a housing query or a care query?’, she says.

In an effort to demonstrate that local authorities can successfully integrate services, Mears is currently working with 12 councils, including Peterborough, Wakefield and Nottingham, on aspects of ‘integrated care’. It’s due to launch a pilot with one local authority later this year to demonstrate how the NHS, social services and housing departments can work together.

Meanwhile, Aspire’s Ms Hailstones recalls how, as community support services manager at Stoke-on-Trent council until January 2009, she managed to create a shared services team with social care, health and housing all working together in one room. Departments pooled funding and commissioned services together, focusing on delivering integrated services centred around individuals’ needs. The approach saved £5.5 million across the two years until summer 2008. For every £1 spent, £6 was saved - accidents that could lead to hospitalisation were prevented and by supporting people to maintain their tenancies, voids were reduced.

Ms Hailstones joined housing association Aspire at the beginning of 2009. Since last September, she and her team have used a similarly co-ordinated approach while working with 220 vulnerable residents.

When an individual - like our fictional Joe - leaves hospital, they conduct a single initial risk assessment and develop a personal support plan, which can include pointing the individual towards outside services, adapting their homes, installing assistive technology or registering them with a GP or dentist. Those at risk of becoming isolated are helped to get out and about. Customers seem to like this approach - 85 of them have contacted their landlord to compliment it.

Social landlords can only do so much on their own though, argues Ms Hailstones - local authorities’ adult social care and health departments need to take control.

New initiative

A new government initiative called Total Place could help. Introduced in March and embraced by the coalition government so far, it represents a new direction for local public services, giving them more freedom from central control. It looks at an area as a whole, rather than at individual public services in isolation. This means overlaps and duplications can be identified, improving efficiency. The result of 13 Total Place pilots were fed back to John Denham, the former communities minister, in February. He concluded that the approach could save £20 billion over 10 years.

‘Housing should be a key partner,’ says Ms Hailstones. ‘We can’t lead on [integration] - we can be part of it.’

At the moment, Ms Hailstones is working with Staffordshire Council to ‘hopefully develop a real culture change’.

Christine Wheeler, service delivery lead for social care and health at Staffordshire Council’s Newcastle-under-Lyme district, confirms: ‘We are at a very early stage - but I think there’s a lot of potential in aligning our services and integrating teams.’

For a start, the adult social care department is reconfiguring its teams so they work along Aspire’s geographical boundaries. This way, housing officers and social workers can ‘form natural relationships’. ‘Sharing systems and processes is where we would like to go - the ultimate vision,’ says Ms Wheeler.

Recent months have seen a surge of information supporting the idea that housing, health and care services need to be further integrated. Last month, the Association of Directors of Adult Social Services released a report called Personalisation - what’s housing got to do with it. It argued: ‘Housing and housing support are integral elements of an individual’s care and support. They can also play a major role both in preventing situations from deteriorating and in delivering speedy and sustainable responses to crises.’

A Care and Quality Commission report called the State of care, published in February, states that ‘if every local area could reduce the number of people admitted repeatedly as emergencies to the low levels seen in the best performing five areas of the country, hospitals could make an annual saving of around £2 billion’.

‘If the home is not properly maintained, then money spent on care is wasted,’ agrees Bruce Moore, chief executive of Hanover. But he worries that as public spending cuts begin, councils will focus on ‘acute provision’ rather than prevention. ‘Intuitively you know [preventing accidents] makes sense but when it comes to the pinch - it’s lost,’ he says.

As the Aspire residents’ play nears the end of the second act, Joe is confused and fed up. Then in flies a good fairy (at which the crowd cheers). She shows the various service providers who have flitted in and out of his flat during the play how to work together.

It’s unlikely that the curtain will fall on the arguments any time soon, but perhaps the cost savings combined with the weight of popular opinion will make this fiction reality one day.

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