Creating Pro-Social Places – The Importance of Urban Design

To support the collective social wellbeing set out in the Marmot Review, Fair Society Healthy Lives (2010), we need to foster a culture that regards and manages places as essential infrastructure. We have entered a critical era where greater thought leadership in our place-making culture is essential.

Dubbed “Toxic Assets” by CABE, Britain’s poorly performing urban places and communities continue to absorb much of our GDP, where land, places and people are exploited and treated like commodities. In his book Collapse: How Societies Choose to Fail or Survive, Jarred Diamond discusses the dangers of continued exploitation and the outcomes for societies that could not change their behaviour patterns: certain extinction.

With expenditure outstripping income, we have entered a long period of economic depression with high levels of ‘welfare’ costs signifying a nation under stress. Whilst the government’s economic austerity measures may rebalance the budget on paper, their short-term nature does not address the fundamental health and wellbeing issues that impact individuals, communities and the wider stability of the nation.

The Marmot Review emphasises the impact of urban quality on matters of equity, health and wellbeing giving urban designers an important role to play, but not through the technocratic fixes that they are typically trained to deliver. So, where do we start when thinking about the relationship between place-making, health and wellbeing?

Please visit CREW Regeneration Wales' website to read the post in its entirety.

Graham Marshall BA(Hons) PGDipLA MAUD CMLI
Professor Rhiannon Corcoran

Five golden rules of being a Policy Officer

When I started at CHC in 2012, I had no real idea what a Policy Officer did. Two and a half years later, it’s fair to say that I sort of know. That’s hopefully no reflection on my ability to do the job, but more a reflection of a distinct benefit of the role. Policy Officer roles are like snowflakes - no two are exactly the same. I’ve been fortunate enough to be involved in working on current policy development, particularly around the Supporting People programme in Wales, whilst also providing some contemporary thought on links with the health service in Wales. Queue shameless plug for CHCs contribution to “Making Prudent Healthcare Happen”.


1. Ctrl-f is your best friend
The length of consultation documents, the complexity of legislation, the sheer volume of research and briefings was a daunting prospect when I initially started. Part of the Policy Officer art is in being able to understand something complex or lengthy pretty quickly and, more importantly, understand the impact and opportunities on the sector.

2. At events, the real work begins when you arrive at the coffee station or go to the buffet
You’re inundated with events to attend… both for your own organisation and being a representative at others. I’ve learned quickly that the buffet queue or coffee station is where the real value of most events lie. Particularly if you’re trying to put across some complex points about how the sector works, stuff around more than bricks and mortar to someone with a basic understanding of what housing associations do… it’s far tougher for them to walk away whilst scoffing down a slice of quiche.

3. Decide on a one liner to describe what you do, and stick to it…
I’ve tried not to worry too much about the fact that my Nan thinks I work for a Local Authority, my Mum thinks I build homes and my partner has given up trying to explain what I do altogether. My one liner has always been “I work for a housing charity”… most people are happy enough to take that and leave it there. Anyone who has probed further has, no doubt, after I’ve finished my 30 minute explanation, learnt their lesson.

4. Carry a food bag
As someone who can’t function when hungry I’ve made constant use of a food bag to enhance my ability to eat well between meetings, event and the office. Policy, if it were a sport, would be an endurance sport with a few sprints added in for good measure. For me, bananas, fig rolls, seeds and nuts, apples, jaffa cakes, dark chocolate, peanut butter have all made regular or guest appearances.

5. Be passionate and believe in the work
When most people think Policy Officer they don’t think excitement, explosions etc. It’s true that you’re more Q than you are 007 - equipping the sector for the challenges ahead. But it can be dry, so being passionate about what you’re helping to achieve, and believing that it’s genuinely the answer to complex socio-economic challenges, is vital.

I’ll still, where beneficial and appropriate, highlight the role of housing associations in improving health, tackling poverty and working with communities. Not because of any feeling of obligation to do so, but because seeing the impact of housing associations, and being part of developing the thinking around improving health through housing, has had a permanent impact on my own belief system.


So those are my 5 (not so) Golden Rules for being a Policy Officer.

In the words of one of my idols, and role models - Stay classy CHC. 

Matthew Kennedy
Policy Officer

Matt will be starting his new role as Policy Officer at Macmillan Cymru next week. Pob lwc, Matt!

Positive ageing - bucking the trend?

This week is Positive Ageing Week, which also includes Older People’s Day today, (1 October). The narrative around ageing and particularly around the substantial increase in the number of older people in the coming decades is often focused on the challenges of increasing demand for services and the fact that, across public services, we aren’t ready to accommodate this need.

At Care & Repair’s recent Annual Conference, a consultant from Powys Teaching Health Board (Prof. Bim Bhowmick) spoke about caring for older people with more acute needs in the community. One of his main points, which really resonated with me, was in saying that an increase in the older population doesn’t have to mean greater demand… more need… pressure on hospital services. He’d been leading on a consultant led “virtual ward” service aimed at keeping older people out of hospital. Through this he demonstrated a few things, namely:

• Consultant-led community services for older people will reduce attendance at A&E and instances of delayed transfer of care.
• Services configured to intervene at the time, before someone is admitted to hospital for further checks etc., is by far the most important time to intervene. 
• Ensuring that there's an understanding of what can be provided in the community by NHS staff and other stakeholders is key for General Practitioners. 
• The home is often an appropriate place to provide interventions for people with acute needs. 
• If we make these changes on an all-Wales level, we can realise a future where even though there’s a large population of older people, better service focus along with changes in lifestyle and behaviour can combine to offset the type of demand being predicted at present. 

The way we understand housing in the context of positive ageing is also very important. All too often this is a bit one dimensional – along the lines of poor housing leads to poor health. Clearly this is a really important part of understanding the impact housing can have, and the implications of poor housing. But an over-focus on the physical environment may lead us to overlook much of what it means to age positively. Housing certainly underpins this, but (for example) opportunities to socialise, learn new skills, inform and participate in local and national debate, spend more time with family, work or volunteer and travel the world can all have a huge bearing on how 'positively' we age. 

For the housing sector, it’s about understanding how we can best support this shift in emphasis and if there’s capacity to provide staff, share expertise or facilitate patient, carer or family engagement in building a shared understanding of how we support people in truly holistic way. 

Matthew Kennedy
Policy Officer: Care, Support and Health

Prudent healthcare - a new approach

On a sunny afternoon in July 2013 we held our first Health & Housing conference – celebrating the 65th Birthday of the NHS. Housing associations have and continue to be vital partners of the health service. This year we broaden the scope and equally the message - health, housing and social care - doing the right thing at the right time.

It’s fair to say the last year has been a trying time for the NHS with high profile inquiries into standards of care, ambulances queuing outside hospital doors, and difficulties for most local health boards in balancing their books. On the flip side we've also seen an NHS that has taken action to change how services are delivered, engaged with political scrutiny on various areas of work and continued to deliver excellent levels of care to people in Wales.

That's not to paint over the cracks; there are clearly challenges around increasing demand and dwindling resources. Housing associations can and many are already helping to reduce this demand. The good news is that the links are simple, worryingly simple in fact, and as housing associations we need our health board colleagues to sit up and take notice when we say we can help with respite care, reducing delayed transfer of care and providing preventative services - which means people not turning up at their GP surgery, or their hospital A&E service.

At CHC we’ve worked with members to highlight the massive impact housing associations have on the health and wellbeing of the individuals and communities they work with. It really is about more than bricks and mortar. Housing associations have become experts at working closely with tenants, community regeneration and providing innovative care services.

Local health boards in Wales have taken advantage of these links in some areas as we highlight in the briefing launched at today's conference - Partnerships to deliver the NHS required now and in the future.

This publication doesn't pull any punches; it rightly doesn’t water down messages but highlights that there is highly positive work and projects taking place – but we can and must do more. As organisations and sectors, we serve people with multiple needs through a wide range of services and there are clearly opportunities to better coordinate how services are delivered by the right person at the right time.

Prudent Healthcare ushers in a new approach to providing healthcare which places the individual at the heart of service delivery, with responsibility on services to do only what is necessary and for individuals to take responsibility for their own health behaviours. In terms of the future of how health and housing work together, there should be no mistake that we are central to this approach - prudency is after all at the heart of what housing associations do.

Matt Kennedy
Policy Officer: Care, Support and Health 

Who says health, housing and social care can't work together?

I heard about The King's Fund ‘Innovations in the delivery of care for older people’ conference through Twitter. The King's Fund wanted to showcase different innovative projects at the event and were inviting submissions. I immediately thought of the Rapid Response Adaptations Programme (RRAP). While it's not a traditional ‘care’ project, it is an excellent example of a successful partnership between housing, health and social care sectors, which are usually more 'fragmented'.

The majority of referrals to the RRAP programme are received through social care and health practitioners such as occupational therapists, social workers, physiotherapists and discharge nurses, who are happy to place their trust in our voluntary sector organisation to support their work. It is a real achievement that each Care & Repair agency, across all of the 22 local authority areas in Wales, has been able to develop such positive relationships with their health and social care teams.

The Rapid Response Adaptations Programme is funded by the Welsh Government and allows Care & Repair agencies to carry out minor adaptations, such as ramps and handrails, to enable people to return safely to their own homes following hospital discharge. These adaptations can also prevent the need for admission to hospital or residential care. The programme requires these adaptations to be completed within 15 working days, although jobs can be carried out immediately in response to a crisis.

For health professionals, not only are ‘hospital beds unblocked’, allowing clinical scheduling and prioritisation to improve, there are clear indications of cost savings through the programme. It has been estimated that £7.50 is saved in Health and Social Care costs for every £1 of public funding invested in RRAP.

A recent report found that, by 2017, demand for unpaid care will begin to exceed supply, and the ‘care gap’ will grow sharply from then onwards. In turn, pressures on A&E departments and hospitals are likely to increase, as fewer older people receive the care they need and more are likely to slip into crisis (IPPR 2014).

Care & Repair Cymru carried out a survey of stakeholders in 2011. One hundred per cent of respondents felt that RRAP had helped to delay or prevent the need for social care services.


Stakeholders told us:

• RRAP promotes independence in the home and therefore reduces long term dependency on care. 'People are able to remain in their own homes for longer and it reduces the demand for more costly support from social services.'

• 'There is benefit (from RRAP) to the quality of service users’ lives which is greatly overlooked but of great significance.'


It is recognised that most people, as they grow older, would like to remain living in their own homes (Wanless, 2006). The demand for services such as RRAP which contribute to enabling older people to remain living independently in their own homes is likely to increase as the ageing demographic increases. The programme has proved to be extremely cost effective and yet the service remains unique to Wales.

The benefits of the RRAP programme were recognised by The King's Fund panel and were presented to the audience at the conference on 18 June.

Whilst attending the conference, it was clear that most of the innovations showcased, all immensely exciting and inspiring, were mostly carried out within the confines of one local health area. Care & Repair, however, supported by Welsh Government funding, work across the whole of Wales, ensuring equity of service for older homeowners and not confined by boundaries. Hopefully, by sharing good practice through such events, older people across the UK will gain greater access to excellent services such as those showcased at the conference.

NB. In the previous year, Care & Repair agencies carried out almost 15,500 works through the Rapid Response Adaptations Programme.


Rachel Gingell, Policy and Research Officer
Care & Repair Cymru 

Care & Repair did my forward thinking for me!

In September 2013 I slipped and badly tore the ligaments in my ankle. An X-ray showed no fracture and I was given crutches and codeine by A&E!

No thought was given as to how I would cope at home. I live alone in a house with an upstairs bathroom and it was ENORMOUSLY difficult. I was in pain++ and trying to manage stairs on my bottom!

I felt very vulnerable. Not a good feeling for a fiercely independent 69 year old!

Care & Repair came to my aid quickly and fitted rails up my stairs and in my bathroom so I could access my shower. However, my injury was so bad that in spite of rails etc, my daughter whisked me off to London for 5 weeks. Whilst there, Dafydd (C&R) emailed me to check if I needed any more help, and on returning home he convinced me to have a step and rails at my front door. Little did I know that I would really need them soon.

January 2014, in the wars again! An acute knee problem necessitated another two nights in hospital. You cannot believe how grateful I was that all the aids to help my mobility at home were already in place. With a painful and stiff knee, I was still able to cope at home on my discharge from hospital with my C&R rails.

Care & Repair did my forward thinking for me! I am so grateful to them and have recommended them to friends, and retweeted their posts on Twitter. Perhaps we could all try to prepare for the worst that could happen, whilst hoping that the need will not arise.

THANK YOU Care & Repair!


Penny Murfin 
Client of Gofal a Thrwsio Ceredigion 


This is the first in a series of five blog posts published during Care & Repair Week. Pop back tomorrow to read the next post!

In One Place

Last week saw the signing of the In One Place collaboration agreement between Aneurin Bevan University Health Board (ABUHB), 5 local authorities and 9 housing associations.

In One Place is the name of our new programme of work to deliver high quality accommodation and care to those with Continuing Health Care (CHC) needs.

Continuing Health Care is a package of care and support provided to those with complex health care needs, and due to a lack of local accommodation solutions many individuals are housed far away from their families in high cost ‘all inclusive’ packages of care, averaging £200,000 per year.

Supported by a Regional Collaboration Fund Grant, the partners will strategically plan, co-ordinate and deliver housing and care solutions and will engage the individuals to be accommodated and their families and carers.

Researchers will be appointed to track, measure and monitor the progress we make, with specific emphasis on quality of care, satisfaction with the solutions provided, organisational change, and cost.

This is new, it’s exciting, it carries high expectation and responsibility, but most importantly we expect the In One Place programme to make a real difference.

 
Mark Gardner
Chief Executive, Melin Homes
Mark.gardner@melinhomes.co.uk

Why we need to make every visit count

During such difficult economic times, with public service budgets under severe pressure, there are many reasons why we must make every visit count. First and foremost, for our clients. Care & Repair in Wales visit around 30,000 clients every year and this is the opportunity for our caseworkers and technical officers to discuss what their concerns are and take action, either directly through Care & Repair’s services or in partnership with others who can help. We need to make visits count by comprehensively tackling the range of problems and concerns identified. These include: 'I’m worried about paying my gas and electricity bill'; 'what will I do this winter when it’s freezing again?'; 'how am I going to get my leaking roof seen to?'; 'I can’t use my bath anymore' and 'who can help me repair my broken steps?' For the sake of our clients, we aim to efficiently resolve as many of these problems as we can, either directly or making sure that we refer to other third sector organisations, local authority and health professionals if we can't.

Making every visit count is also about making it count in financial terms. Our services prevent or reduce admissions to hospital and residential care by making the home environment accessible, warm, safe and secure. What counts here is the way in which helping older people to live independently in their own homes can take pressure off Health and Social Care services by preventing falls, preventing cold-related respiratory and circulatory illness, or by preventing the need for residential care by making the home safe and accessible. This makes every visit count for public finances.

Making every visit count is about providing comprehensive solutions to older people who need our help. It’s about being efficient and about working in partnership with others. And finally, it’s about providing solutions to help older people to live independently and reduce demand for Health and Social Services who find themselves under increasing pressure.


Chris Jones
Chief Executive, Care & Repair Cymru

Care & Repair Cymru's conference, Every Visit Counts, took place on 18/19 September in Wrexham. Did you attend? Look out for a blog post on issues discussed at the conference!

Is service integration the cure for an ailing NHS?

This year marks the 65^th anniversary of the NHS in Wales and, despite being a hallmark of ‘Great Britain’, it is possibly facing the most challenging time in its entire history. With increasing demand for services, higher expectations and pressure to cut spending, finances couldn’t be any tighter. Or could they?    

Unscheduled care, in particular, is under extreme pressure as more and more people present a t A and E and choose to bypass GP out of hours surgeries.  Hospitals are also struggling to meet existing targets and delayed transfers of care and waiting list times continue to rise.  

Reconfiguration is one solution that’s being offered; however, it’s not just secondary care which is under pressure.  Patients in Wales come into contact with the NHS some 20 million times each year, with 80% of contacts taking place outside of a hospital. On average, people visit their GP seven times a year and we expect this to rise rapidly as welfare reform impacts on wellbeing with more people suffering from depression.  

So, put simply, finances could be and are likely to get tighter!  The good news is that housing associations and Care & Repair agencies can help.  Housing associations and Care & Repair agencies already work closely with social care partners to deliver critical services that contribute to prevention and re-enablement. They are also key players in supporting better community health and staff can be a key contact for older people living alone.    

The Older Persons Commissioner is passionate about ‘Older people wanting to stay safe, healthy and secure’ and that the key requirement for those returning home form hospital is ‘food in the refrigerator, a warm home and continuity of care.’ Housing associations already fulfil this role and they can and want to do more.  

Some housing associations also have their own dementia and extra care homes and provide specialist care and support throughout Welsh communities.  Others employ staff in hospices to reduce pressure on A and E by providing support to homeless people who are often repeat presenters at A and E. Despite this work, the role of housing associations is barely recognised in the new Health, Social Care and Wellbeing bill.
 

As the NHS grapples with how best to simultaneously cut costs, meet demand and improve services, more Local Health Boards have been developing projects with housing associations to provide more integrated/holistic services focused on the needs of the individual. While this might not be a total cure, results so far show that it certainly drives improvement.

We will be celebrating some of these projects during Health & Housing week from 15-19 July and we’re inviting you to engage in this week. Tell us your story, either as a service provide or as a customer, about how integrated services across housing and health have helped you! 

Amanda Oliver
Head of Policy and Research, CHC 

What are the current challenges for the new Health Minister?

I have taken on the role of Health Minister at a time when there is no choice but change for the health service. The NHS has changed every single year since it was founded in 1948 and this is still the case.

My aim is to bring the process of NHS configuration in Wales to a conclusion and to provide people with certainty about the shape of healthcare to come.

The process is already underway. I understand that when decisions are made not everybody will be happy. Not everybody will get the decision that they would prefer, but we need to make changes and finish the process so people can get on with delivering important services.

The changes come at a time when the whole of the Welsh Government faces stringent cuts in the revenue provided to all the vital services that Wales needs. My job as Health Minister is to speak up as loudly and persuasively as I can to make sure that we have the money we need to provide a health service that meets people’s needs.

An important part of my role is to meet people and I’m keen to talk to people and explain why things are being done in the way that they are.

What I can promise people is that I’ll consider everything as thoroughly as I possibly can, I will weigh up the arguments, I will look at the evidence, and then I will give them a decision.

Dr Mark Drakeford
Health Minister


Dr Mark Drakeford will be speaking at CHC's Health and Housing Conference in Cardiff City Stadium on 18 July. For further information, please see CHC's website.