Taking care

An ageing population and growing demand for services means we should expect to see increased pressure on the health system.

Indeed, the recent King’s Fund report, which suggests NHS trusts may be £2.3bn in the red this year, makes sober reading, and my sympathies lie with hard-pressed trust CEO’s who day in, day out have to square the tricky circle of coping with providing more services in these very challenging times.

While the country’s population is projected to rise 25% by 2033, the numbers of those aged 65-74 will increase by 54% and those aged 75 or over will soar by 97%. Given it is estimated that more than two-fifths of national health spending is committed to those over 65, that makes for a somewhat worrying future for the NHS, especially when large numbers of older people fill hospital wards and are then accused of blocking available beds due to the lack of suitable social care being in place for when they are ready to leave. The beleaguered NHS CEO must - in those rare moments of thinking time - muse about how that demand can be reduced. 

Early intervention

So it is a no-brainer that early intervention, prevention and an emphasis on well-being for older people is vital to avoid unnecessary hospital admissions and enable people to remain in their own homes. In my 25 years in the charity and housing sector, a genuinely joined-up service provision has been a long-held aspiration. There is growing awareness between local professional partners that joint thinking must be the way forward and there are excellent examples being provided across the housing, social care and health sectors. 

This thinking chimes with the tenets of the prime minister’s ‘Smarter Government’ speech last September. He emphasised the importance of early intervention: “We have got to stop picking up the pieces when things have already reached crisis point - with all the misery, and extra costs, that brings.”

The smarter state can deliver local services people want, but more importantly hold the key to cutting the deficit. With a smarter state we can spend less and deliver more. 

Even now, one in five emergency hospital admissions are for known conditions which could be managed by better primary, community and social care. The clear lesson is to encourage departments, local authorities and other providers to work collaboratively - to ensure a more holistic and systems-led approach to local planning and services. It’s also about greater efficiency with the moral imperative not to squander taxpayers’ money. 

The proposed capping of housing benefit to Local Housing Allowance (LHA) rates may only be a small saving line in the Spending Review, but it has very significant potential consequences. It jars with the aspiration of better local integration and the notion of a smarter state.

Unchecked, this could have a devastating impact on people who rely on supported housing. For many, the relatively low level and preventative support provided will become unaffordable, putting pressure on more expensive statutory services further down the line when a crisis happens.

This applies also to the other side of a crisis. For example, extra care and supported housing schemes are being used increasingly to reduce delays in discharge from hospitals, and this saves the NHS money and supports recovery and well-being.

We all know how notoriously difficult it is for policymakers to think across the wider system and work collaboratively to optimise resources across it. The announcement of the LHA cap is a perfect example of this. The £225m savings promised by 2020 as a consequence of the changes look significant and will reduce welfare spending in the short-term. The increased demand on other budgets - health, social care and criminal justice - will in the longer-term eclipse this saving, however, and it will not be easy to replace services that have been closed or decommissioned. 

The revenue funding of housing for what we used to call intensive housing management needs to be reformed. The scoping exercise that is underway will be invaluable in sizing the sector. The work of understanding how to shape and fund the work that we do can then begin, informed by wider value-for-money principles as argued above.

Many people have talked about the unintended consequences of the proposed changes. What must now happen is the creation of intended consequences - a transparent, credible and sustainable system of funding people to live semi-independently with support. Now that’s a prize worth going for.

Dame Clare Tickell, chief executive, Hanover Housing Association