The time has come to offer more medical treatment in homes rather than hospitals
There’s no place like home, especially when we are unwell. This is a simple truth that has eluded the separate evolution of health, housing and social care services since 1948.
We associate healthcare with hospitals, clinics and GP surgeries, yet in the future many of these needs could be met in our own homes. Innovative providers are showing how clinical interventions such as intravenous antibiotics once available only in hospital can now be offered at home; and people’s vital signs can be monitored remotely. The home as the hub of care is no longer a Tomorrow’s World fantasy. Research clearly shows that whatever their illness or care needs, people want to live in their own homes for as long as possible. But at the most basic level we have a long way to go. For example, 71 per cent of people wish to die at home yet only 21 per cent actually do.
Current service models assume that we get ill, are treated in hospital and go home; yet 70 per cent of health and care spend is on people with chronic conditions requiring long-term support, not one-off episodes of care. Their needs defy traditional demarcations between ‘health’ and ‘social care’ - as providers of housing with care will know only too well.
Our ‘time to think differently’ programme aims to stimulate ideas about how we can transform the delivery of health and care. Housing commissioners and providers need to join this debate because the location in which services are provided will shoot up the agenda. Some of the challenges are familiar. For our burgeoning older population, there isn’t enough specialist housing in terms of tenure type, location, size and affordability. Older owner-occupiers with emerging care needs are falling outside the publicly funded care system. The changing housing needs of growing numbers of younger people with chronic illness and disability will expose our creaking, dysfunctional approach to home adaptations, while information and advice about housing and care options remains fragmented.
There are big challenges here for housing investment priorities, remodelling of existing provision, and the co-ordination of practical support for individuals. There’s no shortage of small-scale practical solutions - as last week’s National Housing Federation report, Providing an alternative pathway, illustrates - but the challenge is massive. If ‘the home as the hub’ of care is to become a reality, do we need to be even more radical in our thinking?
Richard Humphries is a senior fellow at The King’s Fund