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 

Cardiff's Healthy @ Home Service - doing the right thing at the right time

Housing and health are closely linked and health related work has become a key part of what we in Care & Repair do, both to improve people’s overall health and to make them safer in their home by preventing accidents and potential hospital admission. Because we visit older people in their own homes, we have the ideal opportunity to discuss a range of healthy issues as well as their housing needs.

The Healthy @ Home Casework service is a partnership project, funded by the Welsh Government’s Intermediate Care Fund, which works with GP surgeries across Cardiff to offer the Care & Repair service to their patients on their 75th birthday. During the home visit to the client, we can offer a range of services that may be of interest to them now or in the future. Our aim is to support the client to stay safely living at home for longer, thus having a long term positive impact on their health and wellbeing.

We all know the saying: prevention is better than cure. Our service gives us access to older people who may benefit from our services and those of other organisations at an early stage to support them living independently and to prevent them from reaching a crisis situation in their home.

As well as discussing home repairs, maintenance and adaptations, we provide assistance with welfare benefits, home safety and fire safety checks and information on health and well being. If relevant, people are assessed for falls and referred back to their GP for a follow up appointment. Our project is unique in Cardiff and of real benefit and help to older people.

During our home visit, the Healthy @ Home Caseworker will listen to what the client wants and needs, will make suggestions and offer solutions to address these issues. By addressing the needs of clients, we undertake and organise a variety of direct interventions or make referrals to existing voluntary and statutory agencies to draw in and co-ordinate with other services as appropriate. Through partnership working with other voluntary and statutory agencies, we can provide the right assistance at the right time.

There is so much information available, much of which is, or seen by our clients as, complex. Many clients are not accessing schemes due to a misunderstanding of the referral process.

It is our experience that our clients still prefer a home visit where someone speaks to them face to face, someone who is willing to understand and discuss their needs. That someone is a Care & Repair Healthy @ Home caseworker.

Julie Swain
Senior Caseworker, Care & Repair Cardiff

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 

Rural Week - 'The cheapest home available in the village is £450k'...

At the moment my life revolves around Zoopla and Rightmove. Then back to Zoopla again. I change the price bracket, hoping that something may just pop up that needs a bit of work….we could negotiate the price down? Negative. Each morning I reach for my phone, click open the app, adjust the price bracket and….yes it’s become an obsession!

Back in February this obsession had not begun, instead my day consisted of filling in reams of paperwork, calculating our monthly spend, printing evidence of our savings accounts and, most importantly, proving our links to the local area. I was getting excited, we were applying for a low cost home ownership property in Cowbridge. However, I soon found out that managing expectation was key. I knew many many people would be applying for this single property. So 6 weeks later we found out… negative.

My boyfriend works on the family farm but earns very little. On the other hand, I earn a decent wage but despite working for a housing association, promoting affordable homes in the Vale of Glamorgan, we just can’t seem to purchase an affordable home ourselves anywhere near the farm.

We have been together for 2 years and privately rent a home…but it's 5 miles away from the farm. Depending on the time of year, my boyfriend moves in with his parents during lambing, harvest or when the horses are foaling. Not a prospect that fills me with excitement. I would like to add that we also have a decent deposit, but we still can’t find an affordable home within 5 miles of the farm. The cheapest home available in the nearest village is £450,000. Totally out of our reach. This makes our house search the most frustrating activity of the day.

So what is the solution? There isn’t one at the moment… a farm can’t be moved. I continue to hope that low cost affordable homes will be built near the farm. Likelihood? Negative. There was recent talk of a new housing development in the neighbouring village, but looks like these will be executive homes. The frustration continues.


Mared Elenid Williams @maredelenid
Marketing Coordinator, Newydd Housing Association 

Reducing the risk of falling

As we grow older, gradual changes to our health and the medications we take can contribute to an increased risk of falling.

Every year, around one in three over-65s living in the community and one in two people aged over 85 will have a fall.

There are many reasons why the risk of falls and fractures increases with age, including weaker bones and muscles and being less mobile. However, many falls can be prevented and are often due to hazards that are easy to overlook but equally easy to fix.

Falls Awareness Week 2014 is about helping to reduce the risk of falls among older people by identifying some of those fixes.

There are many simple changes you can make around your home to reduce the risk of falls – indoors and out.

Checking for hazards which can cause a slip, trip or fall on floors, steps and stairs in the bathroom, bedroom, kitchen and garden can help you to reduce the risk of falling.

It is also important to look at and address the fear of falling that some people may have. This anxiety may stem from having already had a fall and can lead to older people losing confidence and becoming isolated and depressed.

We also need to consider the role that medication can play in falls. Some medications including sedatives or strong painkillers can cause drowsiness, while others may alter your vision, hearing or concentration.

If you are worried about falls, Age Cymru has produced a guide called ‘Avoiding slips, trips and falls’. It gives tips on how to reduce the risk of falling at home and includes a self-assessment form about your general wellbeing.

‘Avoiding slips, trips and falls’ is available for free from Age Cymru’s Healthy Ageing Team by contacting them on 029 2043 1555, or emailing ageingwell@agecymru.org.uk. You can also download it from the Age Cymru website – www.agecymru.org.uk.


Rosalyn Williams
Health Initiatives Officer, Age Cymru

Stepping stones to falls prevention

Older people have a right to expect the highest possible quality of life. Sadly a lot of older people have slips, trips or falls and falling can badly damage a person’s quality of life and level of independence.

Falls are not necessarily a natural consequence of ageing and many can be prevented through simple lifestyle changes.

A fall is often the trigger to make people look at their life and take the opportunity to improve their health and fitness and hopefully prevent themselves falling again.

In Bridgend, as part of a falls prevention project, a folder of information has been developed. The aim of the information is to enable people to get the help they need in the Bridgend County Borough Council area as well as good advice e.g. how to adapt their home environment, how to get up if they fall, strength and balance exercises for healthy ageing.

Here are some top tips on preventing slips, trips and falls:

• Remove or tape down loose rugs to avoid slips and trips
• Wipe up floor spills straight away 
• Minimise bending/climbing  
• If you must climb, use proper steps 
• Get up from chairs/bed slowly 
• Have a regular eye test/wear your spectacles and make sure they are clean 
• Avoid trailing clothes which may trip you up 
• Don’t wear sloppy slippers, buy a new pair that fit well 
• Keep stairs free from clutter 
• Keep stairways and halls well lit 
• If prescribed medication is making you feel dizzy, keep taking it, but consult your GP 
• Be aware of pets. Dogs and cats can cause trips and fall if they are around your feet

If you do have a fall:

• Don’t panic – you will probably feel a little shocked and shaken but try and stay calm
• If unhurt look for something to look onto 
• Hold onto a firm object for support, place one foot flat on the floor with the knee bent in front of the body 
• Lean forward putting weight on hands and foot until it is possible to place other foot beside the one on the floor and stand up slowly 
• Sit down and rest for a short time

In Bridgend the Bridgelink Telecare service is a home and personal alarm service which, in the event of an emergency/fall, can automatically contact a 24hour control centre to call assistance. A mobile response team is also available to assist. This service has prevented many hospital admissions and ambulance call outs as the mobile response team, following an assessment, have equipment that enables them to pick a client up from the floor, if they have fallen, to a bed or chair. This service is administered, installed and maintained by Bridgend County Care and Repair.

Health, social care and voluntary agencies are now all actively involved in falls prevention campaigns across Bridgend County Borough Council, the aim being to develop a robust Integrated Falls Pathway for the people of Bridgend.


Anita Williams
Agency Occupational Therapist/Falls Coordinator
Bridgend County Care and Repair

1 in 8 adults in Wales are carers... did you know?

Carers Week is a celebration of the contribution the 370,000 unpaid family carers in Wales make to society on a daily basis. They provide hours of personal care, physical and emotional support, help with finances, checking on medication and a whole range of other practical support, which saves the state millions of pounds every year. 100s of local events are being held across Wales throughout the week.

Wales is a caring nation but there are big challenges ahead. A Carers Week/You Gov poll this week found that the majority of adults in Wales vastly underestimate the number of carers there are in Wales (most said 1 in 25 when in fact 1 in 8 of us are carers). The same poll showed that most adults in Wales do not think that they will ever become a carer, when in reality over 60% of us will at some point.

The IPPR Generation Strain report 2014 highlighted recently that many more adult children caring for elderly parents will have to provide more care for longer, carers of working age will increasingly struggle to balance care and more older people themselves will be carers.

All of which highlights the need for carers to be 'Prepared to Care' so that we can all make decisions in a planned and considered way rather than in a crisis.

Caring has always been a mixture of caring 'for' and 'about' someone but carers need to be prepared for the emotional, practical and financial implications caring can have. Unfortunately the Carers Week/You Gov poll also found that over half of current carers in Wales say that they do not receive enough support to do the role well. Carers’ biggest worries were money matters, the emotional strain of caring and not having the right skills for their role. They also said that the most important thing for them would be to know exactly what help is available right from the start.

Health and Local Authorities have a huge role to play, of course, but the third sector also plays a big part in supporting carers across Wales. Organisations such as Carers Wales, Carers Trust, MS Society, Macmillan, Marie Curie, Parkinsons UK, Stroke Association, Age Cymru, Alzheimer’s Society, Care & Repair Cymru and others all provide vital services to carers.

We all have two years to plan for the implementation of the Social Services and Wellbeing (Wales) Act 2014, which will bring major changes to social care in Wales, and the third sector will be keen to contribute fully. Although fundamental questions still remain about how, as a society, we invest in social care to meet the needs of carers and those they care for.

Keith Bowen

Director

Carers Wales