Housing is fundamental to the delivery of the NHS’ Five-Year Forward View for mental health, says Claire Murdoch of NHS England
We know that housing plays an intrinsic role in the health of our communities. Poor housing is estimated to cost the NHS on average £1.4bn per annum. So it doesn’t take a big leap in our thinking to see the positive impact that good housing can make, particularly in mental health.
Housing is fundamental in the NHS’ Five-Year Forward View deliverables. And that goes way beyond giving somebody a roof over their head in a safe and fit-for-purpose home. It covers everything from support with maintaining a tenancy when a person is living with a relapsing and challenging condition, to crisis and respite accommodation to support people who need to leave hospital but who are not quite ready for complete independence.
So there are a range of patient journey points that housing can play a big role in. And these absolutely need to be person-centered and holistic. The challenge is setting out the housing pathway with a little more clarity and evidencing its success.
There are great examples of housing solutions in mental health across the country, but what is crucial to increasing these health and housing services is the ability to plainly see the financial return and patient outcomes.
Some good work has been done by HACT and the London School of Economics to show the benefits housing services can contribute to mental health pathways. However, we need to ask housing providers to work with NHS partners to monitor and evaluate these outcomes from the outset. What is the problem that the partnership is trying to solve, and how has it solved it?
And this goes far beyond a straightforward comparison of costs in supported housing with costs of a night in hospital. We need to know that the individuals accessing these services are making progress on their journey to independence. Managing bed flow in hospitals is as much about prevention as it is delayed discharge. As the Crisp Report says, housing needs to be part of the pathway.
“Housing cannot be an add-on; it needs to be fully immersed into strategic plans.”
So how and when should these conversations take place? In my view, they need to begin long before a service is being designed. Housing providers need to be around the table as sustainable transformation plans take shape.
Housing cannot be an add-on; it needs to be fully immersed into the strategic plans alongside primary and acute care; justice services; and education, employment and public health campaigns. How can all of these organisations and services come together to find solutions? How can land be used to enable pathway redesign? It needs to be a collaborative journey, not a series of off-the-shelf products that work in isolation.
Accountable care partnerships provide an opportunity for providers to come together to deliver better outcomes for a group of patients. Housing associations could be a key to the success of these initiatives. This is certainly happening in some cases, but it needs to become standard practice.
To make things a little less complex from the NHS perspective, I can state some of the key areas in which I believe housing can play a significant role regarding the Five-Year Forward View mental health priorities specifically. Our commitment to end inappropriate out-of-area placements by 2021. Our efforts to reduce delayed transfers of care. Our ambition to develop crisis or respite houses for child and adolescent mental health services as an alternative to hospital admission.
We are moving in the right direction, but we could certainly accelerate our success in these areas.
I’ve spent some time recently discussing such challenges and solutions with several housing providers that already have a number of health partnerships across the UK, as well as integrated commissioning projects in vanguard areas. I’ve seen great examples of step-down services, alternatives to out-of-county placements and more.
What is key in services such as these is the understanding of how commissioners need to evaluate. A common
framework and language need to be used and there is an opportunity to develop some standard models of care and procurement frameworks, which is precisely why conversations need to take place as early as possible. Outcomes need to be agreed at the start.
It might be that you don’t currently run a specific type of supported accommodation service, or cater for a specific demographic, but as long as housing providers have the dedication, rounded expertise and robust infrastructure to take things forward as a strategic partner to the NHS, great outcomes can be achieved. They just need to be around the table.
I’ll certainly help to bang that drum for the housing sector, but providers must be ready to evidence clear value and commitment to their local commissioners.
Claire Murdoch, national mental health director, NHS England
This article was written independently and was commissioned as part of a package sponsored by HACT