Poor housing undermines care reforms

A suitable home is vital for maintaining independence, so housing must be part of the debate around integrating health and social care

Larger numbers of older and disabled people are living at home and the quality of housing can affect their health and care.

When last month’s social care white paper announced it would “set out new duties to … ensure that adult social care and housing departments work together”, some were excited that housing had been given a look in, so long had the integration conversation been dominated by health and social care. Others were more cynical, wondering whether the utopian housing vision of strategies, toolkits and capital funds was too little, too late.

The fact is, a holy trinity of demographic change, medical advances and an inexorable policy shift from institutional to community-based care has meant one thing: significantly larger numbers of older and disabled people living at home, needing services, adaptations and equipment to keep them there.

In this context, the suitability of a person’s home is critical. It can mean the difference between independence and institutionalisation; continued wellbeing and hospitalisation. We have come full circle from Victorian times – just as then, adequate housing is now key to public health.

Yet for years, housing has been the spare wheel as the integration of health and care moved forward. Several attempts to raise its profile, including the excellent HAPPI review, have had little impact. Housing providers still do not have a guaranteed place on health and wellbeing boards, even though a health and wellbeing strategy – which these boards are charged with producing – could clearly never be designed, let alone implemented effectively, without housing providers at the table.

It is also symptomatic of the government’s limited and belated recognition of the importance of housing that the actions announced in the white paper aren’t fully evidence-based. We face a dearth of quantitative evidence when it comes to the affect of a lack of suitable housing on older and disabled people, but the government has made little attempt to better understand the scale and nature of the problem.

Qualitative research suggests something must be done – Demos’s own research included following the parents of a disabled girl over two years as they fought to have her bedroom properly adapted. But we can hardly build national policy on such individual cases. Without robust quantitative evidence, do we know for sure that the balance of funding between new build and adaptations for existing homes outlined in the white paper is correct? Or that the planned investment for either is sufficient?

Some care providers are trying to fill the void by carrying out their own research. Charity Papworth Trust, for example, is about to use its networks to circulate a survey designed to quantify the impact on the older and disabled people they support of unsuitable housing and delays in securing adaptations. Such endeavours may only be pieces of the whole picture, but these can still be invaluable – something Andrew Dilnot found when he was drafting his report on care funding and was faced with a lack of comprehensive data regarding unmet need in the care system. He asked care providers for as much data as they had on this issue, and piecing their responses together enabled him to get a grip of the challenge he faced.

Before it implements its housing policy solutions, the government could do well to follow suit. Until it has a better grasp of the extent to which poor housing is undermining health and care, any planned investments could turn out to be a drop in the ocean.



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