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 

Why the Care & Repair Service is essential to Occupational Therapy intervention

Being discharged home from hospital can be an anxious and worrying time for some individuals. At times people are concerned that they may be unable to get around their home and care for themselves as they did previously, and individuals are often concerned about how they are going to meet the financial burden of not only maintaining their home but also for funding essential care services. The Care & Repair service has played an integral role in enabling occupational therapists to discharge people home from hospital efficiently and safely and in alleviating some of these concerns.

Care & Repair is a reliable and efficient service that, through the installation of small adaptations such as handrails and stair rails or through major building work such as adapted bathrooms, allows people to live in their own homes independently. The comprehensive service that Care & Repair provides enables smooth transition from hospital to home, reducing their length of stay in hospital and preventing readmissions.

Work is consistently completed to a high standard and in a timely manner by qualified technicians who understand the needs of the patient.

As well as providing practical assistance with repairs and adaptations, Care & Repair also provides advice and information regarding benefits, home safety and security.

Without the Care & Repair service, occupational therapists would be unable to address many of the concerns and needs of their client group.


Rachael Gdesis
Advanced Practitioner Occupational Therapist
Princess of Wales Hospital

We can help you

During Care & Repair Week, we want to get a simple message out to the many thousands of older homeowners in Wales who live in poor housing. That message is: 'We can help you'.

If you are having difficulty getting up the stairs, if you can’t get in and out of the bath, if you are cold but afraid to turn on your heating because it costs so much, if your roof leaks, if your walls are damp, if your house is in disrepair, if you’re scared of falling on the steep steps to your house… whatever your housing problem, we can help you.

Last year, we helped 30,000 older people with their housing problems, 12,000 of whom lived alone. Most of the people we help are aged over 60 and their average age is 75. 10% of the people we help are over 90. Last year, 20 of our 22 Agencies helped people aged 100 years old or more.

We provide our services across the whole of Wales so wherever you live, we can get out to you, assess your housing problem, make sure you are claiming everything you are entitled to, talk to you about what you want, find out what grants or other funding is available to help you, find you a reliable builder, supervise the work, or do the work ourselves with one of our in-house handy-persons.

Our services are important. Not only do they help improve older people’s quality of life by keeping them safe, warm and independent in their own home, but they also keep them out of places they don’t want to be - ambulances, hospitals, GP surgeries and residential care homes. And we work with others to get it right, such as important partners like Welsh Government, occupational therapists, local authority housing staff, housing associations and health professionals.

But for older people, our biggest message for Care & Repair week is… We can help you! If you would like to contact us, you can call 0300 111 3333 anywhere in Wales and be connected to your local Care & Repair Agency.


Chris Jones
Chief Executive, Care & Repair Cymru 


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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!

Older People's Commissioner for Wales: Listening to HA residents across Wales

For the last two months, I have been travelling across Wales meeting and speaking with people who are tenants of housing associations. I would like to thank everyone who took the time to find out about the work of the Older People’s Commissioner and let me know what matters most to them.

The role of the Older People's Commissioner for Wales, Sarah Rochira, is to stand up and speak out for older people across Wales. That is why it is so important that we meet with people and talk with them about what matters most to them.

Older people across Wales have told us that they want their lives to have value, meaning and purpose. The people I have met as part of this series of visits have echoed this.

Public transport, especially buses, has come up time and time again. There is huge concern about the cuts to routes, but also the location of bus stops and the need for benches and bus shelters. Public transport helps people to get out and about and maintain their independence, allowing them to stay in touch with friends and do things they enjoy, as well as getting to doctors and hospitals. People have told me that they are really struggling to get to health appointments and visit loved ones in hospital.

Tenants have also told me how much they value the people who work on site for housing associations, particularly those who support activities and social events. Tenants had also clearly built strong friendships with their neighbours, which has resulted in strong communities. The link to having a good quality of life is clear – people who are not isolated are less likely to be lonely and suffer from depression. Many people were worried that this support may be cut and told me that staff were a lifeline; “I don’t know where I’d be without them” has been a common refrain. It is a testament to the hard work of housing association staff that their services are so valued. It has been inspiring to meet people who show that individuals really can make a difference.

I am looking forward to meeting many more housing association residents and staff over the next few months.

If you would like someone from the Older People's Commissioner for Wales to visit your scheme to let tenants know about our work and listen to their views, please contact Kate Hughes, Engagement Coordinator on kate.hughes@olderpeoplewales.com or 08442 640670.


Kate Hughes
Engagement Coordinator

Hospital to Home

Living independently is a reality if homes are secure, safe and warm and people over 60 have enough resources to maintain a healthy lifestyle. While in hospital, it seems issues of concern surrounding housing are magnified.

With this in mind, the purpose of our Hospital to Home scheme is to ensure that Care & Repair services are targeted at the most vulnerable in our society, especially those who are high on the falls agenda.

The scheme is aimed at not only clients but the professionals working with the most vulnerable and those at risk of falls such as Nursing staff, Occupational Therapists, Physiotherapists and Hospital Social Workers. The scheme enables these professionals to understand the services the agency can offer to clients to assist them with ensuring that a safe discharge is paramount.

On wards that cater for the over 60s, our caseworkers undertake monthly 'ward Rounds' during visiting periods, enabling engagement with patients and their families to introduce them to the services of Care & Repair.

The ‘Hospital to Home’ scheme is limited in its current form and funding is required to sustain the scheme further. The scheme is not just the 'packs' that are distributed containing information on housing options but the whole 'package' of Care & Repair, encompassing the ability of the staff delivering the scheme, the Caseworker service offered to patients in hospital to discuss concerns regarding housing and the network of organisations supporting the agency to deliver a holistic service post hospital discharge.

Many patients admitted to hospital are there due to falls within the home. The agency services such as the ‘Healthy Homes Check’ and Benefit Checks offered as standard can address housing issues that are of concern to clients and could be preventing a safe discharge from hospital. These can be undertaken whilst the patient is in hospital, thus cutting down time spent in hospital and consequently bed blocking.

Health needs to recognise the scheme’s benefits and allocate sufficient funding to support it. The scheme needs a dedicated Hospital Caseworker who will work alongside a multi disciplinary team of health staff and other organisations to ensure that housing is placed on the safe discharge agenda.

If this is facilitated by a strong financial commitment by government and rolled out throughout Wales, results would be a drastic cut in the amount of re-admissions to hospital and making an impact on reducing over-stretched Health Board budgets.


Nicola Eccles
Agency Manager
Conwy Care & Repair