“Trust me, I’m a housing professional...”

This week at the Welsh NHS Confederation conference, the menu of topics is interesting and timely. How do we set up our workforce in an integrated way? How do we bring about meaningful change for those we serve? How do we move from rhetoric to reality?

As a policy professional working in the housing association sector in Wales, I’m keenly interested in all of the above. I was recently invited, on behalf of Community Housing Cymru, to contribute to Welsh Government’s “Making Prudent Healthcare Happen” online resource, which is a collection of essays exploring the challenges and opportunities of this new way of working.

The services provided by housing associations, in terms of high quality housing, care and support services, community initiatives, employment and skills, and digital inclusion, are but some examples of the broad work taking place to improve health and work to reduce the number of people requiring the services of their GP or local A&E. The housing association sector and people working within it are able to provide legitimate solutions to the mounting challenges faced by the NHS and, more broadly, public services in Wales.

Housing associations work in some of the most deprived communities in Wales. When we think about how we work as public facing services to combat factors such as unemployment, education, and inactivity which we know have a substantial impact on health and wellbeing, housing associations are a key part of the formula for addressing such issues.

But the carpet is being pulled from underneath us as a housing sector. Salami slicing cuts to vital services such as the Supporting People Programme are threatening to further push people into NHS services who may otherwise have received a preventative, person centred service at a far earlier stage.

The Welsh Government budget for 2015/16 confirmed a £10m cut to Supporting People, reducing it to £124m. In real terms, this means that over 4,000 people will now go without the support they could have accessed if the fund were protected. The £10m cut is the equivalent of annual funding to provide all services for men and women at risk of domestic abuse and young people with support needs in the Vale and Cardiff. In addition, supporting people services provide a well-used referral route for hospital move-on teams, freeing up hospital beds and resources.

At a time when we need a strong “prevention sector” in Wales, we cannot afford an environment of disinvestment that undervalues the key work of organisations delivering Supporting People services.

Although the prudent healthcare work demonstrates the value, the opportunities and the enthusiasm for things to change, these words mean nothing without action from all sides.

If through prudent healthcare we’re entrusting people to look after themselves and to make positive health behaviours part of their regular habits, then it’s also vital to trust the ability of the housing association sector to support and work closely with the NHS in meeting the challenges it faces both now and in the future.

In our recent economic impact report you can see some case studies (p16-18) which demonstrate the prudent nature of the housing associations sector. Taff Housing addressing delayed transfer of care, and Melin Homes working with a collaborative to re-invent Continuing Healthcare packages in Gwent. Consistency is key, however, and we will know we are on the right track once we are able to call projects such as these common practice rather than best.

Matt 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 

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.