Andrew Dilnot’s recommendations on funding older people’s care make sense - all but the poorest older people must pay for their care. But let’s not forget about interventions that prevent older people going into residential care in the first place. When the causal links between poor housing and health problems are so strong we need to focus on pre-emptive solutions that postpone when someone needs intensive care.
Gone is the local government mentality that a stitch in time really does save nine. With housing support under severe pressure, any attempt to convince commissioners that spending today will save for the next 10 years is an uphill struggle.
Yet evidence about the potential of preventative interventions to save money from health and social care budgets has never been stronger.
Last year, the Communities and Local Government department developed a financial benefits toolkit to measure the value of low-level home repairs and adaptations. Providers can input the service they offer and the benefits are calculated, such as data on the number of burglaries or falls prevented, the volume of hospital beds ‘unblocked’ and how much local budgets are likely to save.
We know that postponing entry into residential care by building a £5,000 downstairs toilet saves on average £28,080 per person per year.
reventing a fall leading to a hip fracture by fitting a grab rail for £100 saves £28,665. Installing a wheelchair ramp for £400 to speed up release from hospital saves at least £120 a day.
This is low-cost, high-impact stuff. The business case is plain to see and some local authorities are making the links. Liverpool Council understands that healthy homes equal healthy people. Their healthy homes programme, which featured in Inside Housing’s House Proud campaign last year, aims to reduce health inequalities caused by poor quality housing conditions. By removing health hazards from local homes, the programme estimates that it will save the NHS £4.4 million over 10 years, with wider savings to the public purse of £11 million. The total cost of the project was £1.07 million.
Tackling fuel poverty is central to Liverpool Healthy Homes’ preventative strategy. More than 7 per cent of households in the city lack central heating and there are an average of 242 excess winter deaths per year. For each death there are eight emergency admissions.
Every year, the government spends money on dealing with the health impact of poorly heated and insulated homes, but only a handful of councils are investing in a targeted approach to fuel poverty - joining up energy efficiency measures, fuel costs and household incomes - to make greater savings down the line.
The realism of Mr Dilnot’s report is welcome, but let’s look at the cause as well as the symptoms. There needs to be a shift from the ‘inevitability’ of residential care towards low-cost ways of maintaining independence. Quite simply, local authorities must invest now to reap the benefits later.
Andy Chaplin is director of Foundations, the national body for home improvement agencies