The great divide
The NHS has to find savings of £20 billion. Gavriel Hollander reports on the pioneering landlords hoping to come to its aid
‘You would think that health and housing are quite close, but they’re not.’
Kevin Beirne’s assessment of the relationship between the two sectors is fairly typical, but One Housing’s group director of care and support is one of a number of figures trying to change the status quo.
His organisation is one of two landlords, along with Midland Heart, that this year became the first to join the NHS Confederation’s Mental Health Network. Joining the group means they can now provide mental health support services, but the move is not about setting themselves up in competition with health providers so much as about exploring new ways of working together.
It’s a timely attempt to bring the two sectors together. The NHS is undergoing the biggest shake-up in its history, with services that were once the exclusive preserve of health professionals now being opened to new-comers. Health bosses have also been tasked with finding a stomach-churning £20 billion worth of savings by 2015. According to some, a solution lies in housing.
But what can housing providers do to help their healthcare brethren? And why has it taken so long to get the sectors to bang their heads together?
One example in answer to the first question can be found in a recent report undertaken by homelessness charities St Mungo’s and Homeless Link. It found a shocking 70 per cent of the 85 homeless people surveyed were discharged directly back on to the street. The Chartered Institute of Housing has called for social housing providers to become an implicit part of the discharging process and to ensure that housing need is as much a part of a patient’s assessment as their health.
‘There are no formal mechanisms in place at all,’ says Domini Gunn-Peim, director of public health and vulnerable communities at the CIH. ‘It [discharge] has always been about locally agreed practices. In terms of someone picking up their housing needs it’s a postcode lottery.’
At this week’s CIH conference, Ms Gunn-Peim chaired a session examining how housing could contribute to the new health and social care landscape. The CIH is now working with several healthcare organisations, including the Department of Health and the Royal College of Nurses, to come up with examples of good practice and, as Ms Gunn-Peim explains, ‘change the culture’ around discharging patients with housing needs.
It’s just one example of a growing trend that has seen the former mutual distrust between the sectors melt away. Last December, the National Housing Federation issued a joint briefing with the NHS Confederation on mental health and how housing can help aid recovery.
The briefing marked the start of a strategic partnership between the organisations with the aim of getting their members to start working together, not only with mental health patients, but with anyone caught between a hospital bed and a home of their own.
‘I don’t think historically the two sectors have been very good at talking to each other or getting to know each other,’ says Shaun Clee, chair of the Mental Health Network and chief executive of the 2gether NHS foundation trust. His organisation has entered talks with Midland Heart over setting up a formal partnership to provide in-house care to people who might otherwise be left in hospital.
‘Until we create [more of] these dating opportunities, people won’t like doing business with each other in the same way as with a sector they know well,’ adds Mr Clee.
One Housing is in ‘advanced discussions’ with a London-based NHS foundation trust to form a partnership to provide supported housing for former mental health inpatients, using undeveloped NHS land and freeing up much-needed hospital space.
‘It allows the NHS to move people off the ward into a housing situation,’ explains Mr Beirne, who claims that the deal would see the trust spend a fifth of what it would to keep a patient in hospital, estimated at around £3,000 a week.
‘If every foundation trust in the country did the same they would save £500 million,’ he continues. ‘It is only when you get down to brass tacks that you see the eureka moment on the faces of the NHS execs.’
A move into the health sector could also provide a boon for those housing associations whose care and support arms have been hit by the cuts to the £1.6 billion Supporting People programme, which run to as much as 25 per cent in some areas.
Chris Munday, managing director of care and support at Midland Heart, where around 40 per cent of its £150 million turnover comes from its care and support services, says the opportunities from the NHS can alleviate some of the pain of the cuts.
‘The health budget absolutely dwarfs that,’ he says, referring to the SP programme. ‘We need to make the case to the health sector that by investing in housing and care and support it will help them realise savings and achieve targets in terms of bed blocking [the practice of keeping people in hospital beds because of a lack of suitable alternative accommodation].’
A study by NHS West Midlands in 2010 found that home treatment could save £38 million a year.
As well as its partnership with 2gether trust, Midland Heart is in discussion with Acorns Children’s Hospice over providing additional services and has recently completed a study with think tank Demos - due to be published later this month - on how housing can help reintegrate hospital patients into the community.
‘We’ve always done it in a piecemeal way,’ he adds. ‘But this is about [developing] a co-ordinated approach.’
It’s early days yet, but the signs are that using the skills and resources already there in the housing sector could help the NHS meet some difficult targets, while giving social landlords a much-needed new revenue stream.