Blog 24/01/2018 Housing

Systemic approach needed

Each week Inside Housing publishes the thoughts of industry leaders around the big issues that matter most to the housing world. In one of its latest blogs, regular contributor Dame Clare Tickell asked how we can ease pressure on health and social care while increasing housing supply.

Who would have thought that we would find ourselves in 2018 with Secretaries of State with Housing and Social Care in their job titles? This is real progress and the Prime Minister is to be congratulated for this and the signal that it sends.

It is unlikely that either has begun to make any connection between these two changes, or to realise quite how much they might be able to help each other out and, further, model a real example of a systemic approach to tackling three of the most high profile issues facing them by joining them up.

Jeremy Hunt, the Secretary of State for Health and Social Care, will get to this earlier because of the acute NHS pressures this winter. Indeed, it has been reported that he asked for this change to happen and we know he is already fully sighted on the significance of the relationship between health and social care (and of course social care is delivered by councils). Now we need to provide the evidence of the fundamental part that housing can play in this as it can so easily slip out of view.

For Sajid Javid, the Housing, Communities and Local Government Secretary, it may take longer, although the importance of supported housing is now well understood. The issue here is a more subtle one - that ambitious plans to build more housing of whatever tenure type need to include housing for older people, many of whom can live independently and well, with low levels of support, if the design and infrastructure are right. Further, that by doing so there is the potential to release under-occupied housing for families because the offer is an attractive and realistic one.

To both, then, I would like to offer the following thoughts and ideas on what might be done to ease the pressure on health and social care whilst increasing housing supply, for older people and consequently more widely:

Above all, there is a need for a systems approach to be taken, focusing on the wellbeing of individuals and communities. History tells us that structural changes won’t by themselves work, in part because they are crafted in isolation and don’t start from the realities of how citizens live their lives. Everyone needs decent, appropriate and secure housing. It is both an enabler and a connector to much else. Conversely, its absence or being inappropriate, disproportionately impacts on the wider system, slowing it down, costing money and creating unhappiness.

A systemic approach demands a hard look at the interconnections between services within health and across to social care and housing. It is important, as part of this, to recognise the impact of different cultures within the health, housing and social care worlds and think of how these might be overcome.

  • Examine the wider determinants of health and social care - housing, employment, exercise, loneliness, air quality, diet and nutrition. Think about following the lead of Wales, assessing policies in terms of their health impact.
  •  Take a renewed look at the benefits of prevention and early intervention. It is a false economy not to re-invigorate local authority public health budgets and assess relative costs between prevention and expensive treatments and what steps might be taken to move the dial on this. Require and support stakeholders and providers to get better at providing evidence of the positive outcomes and impact of their preventative work so it can be shared and inform commissioning practice in the future.
  • Revisit the findings and recommendations of the Barker Commission and, in particular, look at the balance of private and public funding and model different scenarios of these to understand what might be possible. This will also show how significant these choices have been, and could be, in determining wider outcomes including the role of housing.
  • And one for the future. Whilst the government’s track record on digital transformation has been fraught with difficulty, the successful delivery of a joined up citizen led system which links housing, health and social care could be significantly assisted by integrated, secure technology. With the necessary safeguards in place, there is real potential for the right information to be shared so that services could be delivered compassionately, intelligently and appropriately at the right times, thereby achieving not only better services for citizens but better value for money too.

The pressures of the day job and the immediate may make all this sound utopian and impractical. Consider, though, the size of the prize if this join up could happen. Think of the impact that devising positive, long lasting improvements to this wider system would have, not only to the quality of people’s lives and the public purse but to confidence in our ability to identifying solutions to these stickiest of issues. It really is a bit of a no brainer.

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