improving health through housing how to meet...
TRANSCRIPT
About Health
National Housing Federation Conference
2nd February 2013
Professor Mike Cooke, CBE
Chief Executive
IMPROVING HEALTH THROUGH
HOUSING – HOW TO MEET THE
CHALLENGES?
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2
WELCOME AND INTRODUCTION Roger and myself
Housing and Health
Patients and People
NHS Constitution
Commissioning and Provision [National and Local]
Implications for the NHS going forward
An example No Health Without Mental Health’
Homelessness and Mental Health
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4
NOTTINGHAMSHIRE HEALTHCARE Positive about Integrated Healthcare
Approx 390,000 service user contacts
8810 staff
£423m turnover
8490 Public Members
FT Standard – 1/11/10
IMRoC National Demonstration site
MIND Award – Sectioned documentary
Research – Institute of Mental Health
4th in 2013 Stonewall Index
Forensic Services
Local Services
County Health Services
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Invest to Lead 4
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About Health
PATIENTS AND PEOPLE
• Clinicallyeffective care
• Cleanliness
• Responsive services
• Dignity
• Respect
• Involvement
• Communication
• Clear role
• Real teams
• Clear goals
• Approachable Management
• Feedback
• Chance to develop [job]
• Chance to develop [career]
What Patients want? What Staff want?
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Innovation
Rampton Centenary Flag Raising
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“The NHS belongs to the people.
It is there to improve our health and well-being, supporting
us to keep mentally and physically well, to get better when
we are ill and, when we cannot fully recover, to stay as
well as we can to the end of our lives. It works at the limits
of science – bringing the highest levels of human
knowledge and skill to save lives and improve health. It
touches our lives at times of basic human need, when care
and compassion are what matter most.”
NHS Constitution
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Nottingham Panthers –
Anti Stigma campaign 10
IS THE NHS LISTENING?/NHS FUTURE
FORUM 2
We need to listen to patients and public
There are new clinical conversations happening
“Field Report” and “Nicholson Challenge” + Francis Inquiry
Collaboration + Integration
Future Forum[2]-
The Nation’s Public Health
Information
Integrated Care
Education and Training
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About Health
Rampton Centenary
– Tree Planting
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Summary of
NHS and Social
Care Bill [2012]
COMMISSIONING AND PROVISION
13
About Health
Mentoring Scheme
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NHS GOING FORWARD [1] The Commissioning Side
• SHA’s out 2012 [but 4 Clusters]
• PCT’s out 2013 [151-25 areas now]
• GP Commissioning Consortia
• Commissioning support
• National Commissioning Board
[for designated services]
• Health/Wellbeing Boards
• Personal Commissioning
The Provider Side
• 144 FTs 110 NHS Trusts + Private +
Third Sector
• Regulation- Quality, Economic
• Any Qualified Provider
• NHS Trust Development Authority
• Failure Regime
• Clinical Engagement through outcomes
• PbR/tariff based market
• Patient Revolution and choice
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About Health
NEW APPRENTICES 16
NHS GOING FORWARD [2]
Coalition Government – above inflation commitment to fund NHS
New CEO NHS Commissioning Board – Sir David Nicholson
Public Health England – integration with L.A.s
CMO – Dame Sally Davies
Personalisation and statutory thresholds for Local Government
Welfare, Social Care, Housing, CJS “Rehab Revolution”, HEI reforms
Big challenges – quality and finance delivery
- understanding/tackling variation
- Evidence-based decision-making/delivery/transparency
- Routine outcomes monitoring
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GETTING GRAINIER [1] Nuffield Trust - ‘A Decade of Austerity/Funding
Pressures Facing the NHS 2010/11-2021/2’
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Describes a rising triple pressure on the NHS
- demography
- healthcare activity
- healthcare costs
2014/15 Hits the Buffers?
During period to 2021/2 - £13-16bn funding gap on current DH
estimates versus department expenditure limit
If funding held flat £44 -54bn gap by 2021/2 based on
current trends
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GETTING GRAINIER [2] Nuffield [cont]
Pressures [triple – population, activity, costs] = 4% per year
NHS will have to achieve unprecedented sustained [4%] productivity
Pay restraint, research evidence, productivity +, impact of policy changes
all need to be better used/understood
Gives a scenario of 2% productivity [UK average] + 2.4% GDP
contribution
Assumes £20bn QIPP initial challenge will be met
Kings Fund, National Commentaries
- 2015 Election?
- Coalition cracks appearing
- Elderly care, people with disability – policy + LA cuts
- NHS not recycling savings, handing money back to
prop up deficit 21
Anti Stigma -Young
Person event 22
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IMPLICATIONS – THE 2014/15 BUFFERS? Francis - ‘a game changer’? before, during, after
- focus on values
- focus on professional and industry regulation
- transparency of information on quality
- patients, public
- purchasers
Finances/Rationing – denial, selection, delay, deterrence, handed
off or dilution of services
Regulators – failure regime on clinical or financial viability
Provider [and commissioner] consolidation – ‘design of whole
system around patient pathway[s]’
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NO MENTAL HEALTH WITHOUT MENTAL
HEALTH [February 2011]
1. More People will have good mental health
2. More People with mental health problems will recover
3. More People with mental health problems will have good physical health
4. More People will have a positive experience of care and support
5. Fewer People will suffer avoidable harm
6. Fewer People will experience stigma and discrimination
Links to Outcomes
Framework - Domain 3
Links to Outcomes
Framework -Domain 5
Links to Outcomes
Framework -Domain 4
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HOMELESSNESS AND MENTAL HEALTH Homelessness is a key negative factor in wider ‘determinants of health’
Housing issues are recurrent themes in GP mental health consultations
[30-40%]
Dual diagnosis [mental health/alcohol or drug issues] a particular problem
Poor health care worsens their adverse life style and risk
70% people accessing homelessness services have mental health issues
[9 x National average suicide rate]
Life expectancy of long-term homelessness = 47 43
[should be 77 and 81 respectively]
80% of all homeless have dependant children
50% of all significant mental health problems start before
age of 14
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QUESTIONS & ANSWERS
www.nottinghamshirehealthcare.nhs.uk
Nottinghamshire Healthcare NHS Trust
Duncan Macmillan House
Porchester Road
Nottingham
NG3 6AA
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building communities
Roger Powell
2 February 2013
building communities
Yarlington at a glance
• Based in Yeovil, Somerset
• 8 District Council areas
• 9,000 properties
• Range of tenures:
– General needs
– Sheltered
– Extra-care
– Leasehold
– Shared ownership
• 17,000 residents
• 31% over 65
• 17% with a disability
Yeovil
building communities
Our three year strategy
building communities
Some housing statistics (South West)
• 16,100 new homes were built in the South West in 2011/12, but more than 27,000 new households formed
• Less than 60% of the homes the South West needs each year are being built
• House prices in the South West have increased 3 times faster than incomes over the past 10 years
• The cost of an average home in rural parts of the South West is now nearly 13 times the local average income
• Private sector rents are expected to rise by 62% in the South West in the next 10 years
• The number of families on social housing waiting lists in 2011 rose by over 25% to 186,305, the biggest increase in the country
• One in 12 households in the region is now waiting for a social home
[Source: NHF Home Truths 2012: The Housing Market in South West England]
building communities
Some health statistics (Somerset)
• 21% of Somerset’s population is aged 65 or over
• Number of those aged 90+ expected to increase by 267% in the next 20 years
• Number of those over 65 years with limiting long-term illness will increase by almost 9% by 2015
• Proportion of children (under 16) living in poverty in Somerset has increased to 15.6%
• On average men live 4.3 years less and women 3.3 years less in the most deprived compared to the least deprived areas
• 18% of adults smoke and 18% of pregnant women, one of the highest rates in the country. Estimated that smoking costs the NHS in Somerset £26 million pounds a year
• Over three-quarters of adults do not do enough physical activity to benefit their health, the worst rate in the South West
• 41% of adults are overweight and 26% obese. Estimated that conditions associated with overweight and obesity cost the local NHS £138 million a year
[Source: Somerset Joint Strategic Needs Assessment and Health & Wellbeing Strategy 2012]
building communities
Projected increase in health conditions
building communities
Somerset Health & Wellbeing Strategy
Vision:
People live healthy and independent lives, supported by thriving and connected communities with timely and easy access to high-quality and efficient public services when they need them
Strategic priorities:
1. People, families and communities take responsibility for their own health and wellbeing
2. Families and communities are thriving and resilient
3. Somerset people are able to live independently for as long as possible
building communities
The health & care system from April 2013
Somerset:
Commissioners:
• National Commissioning Board
• Clinical Commissioning Group
• Social care (County Council)
• Public Health (County Council)
NHS Providers
• GP Federations
• Taunton & Somerset NHS FT
• Yeovil District Hospital NHS FT
• Somerset Partnership NHS FT
building communities
Somerset health services commissioning map
building communities
Somerset GP Federations
building communities
Governance comparison
Housing Association NHS Foundation Trust
NEDs only on Boards (but exceptions) EDs and NEDs on Board
Relatively few members (M&As) Large number of members (1,000s)
Resident involvement Governors (hold NEDs to account)
Light touch co-regulation (HCA) Heavy regulation (Monitor, CQC, etc.)
Not commissioned Commissioned
Able to raise private investment Limited opportunity for private investment
Staff vs operational costs less than 25% Staff vs operational costs up to 75%
Hence cultural differences
building communities
Integrating housing, care and support
Joint working between housing, health and social care can:
• avoid or delay a move to residential care
• reduce admittance to hospital and avoid readmission
• reduce the demand for assessment and treatment centres
• prevent the need for domiciliary care
• prevent health emergencies and reduce demands on A&E
• prevent mental health deterioration and overall deterioration in health and wellbeing
building communities
Integrating housing, care and support
Opportunities for housing associations:
• Understand the new architecture of the health and care system
• Engage with Health and Wellbeing Boards
• Build on what you know already
• Get involved locally
• Collaborate to improve impact on the ground
• Resident engagement – HealthWatch
• Exploit the new NHS commissioning landscape
• Take the lead:
– Set up a referral system
– Talk to tenants
– Keep staff healthy
– Train staff
– Link services to public health outcomes
– Optimise services to maximise health gain
– Measure the impact of these services
building communities
So what does this all mean?
Risks:
• Austerity
• Changing demographics
• Few organisational links between housing and health
• NHS uncertainty and CCG immaturity
• Wither social care?
• Organisational retrenchment
• Reductions in Supporting People funding
• Raising of the bar on access to health and social care services due to economic pressures
• Skills base in housing more geared to support not care
Opportunities:
• Health and Wellbeing Boards: Joint Strategic Needs Assessment
• NHS commissioning: Any Qualified Provider
• Local Authority commissioning: aspects of social care
• Public Health objectives: community investment
• Resident involvement in HealthWatch
• Integrated care pathways
• Reducing delayed discharge
• Independent living
• Partnered services and projects
• Asset management: land and shared resources
building communities
So what are we already doing?
Some examples:
• Mind Wellbeing Project – signposting people to services which help improve their mental health
• Surviving Winter Fund – in partnership with the Somerset Community Foundation giving out grants to help older people with rising fuel bills
• Healthy Communities – increasing active lifestyles through affordable classes and heath checks
• Mandala – providing support to families who have suffered a traumatic event
• Working All Together in Chard (WATCH) – a community run organisation with over 70 members who have mental health problems and are isolated from their community
• Symphony project – working in partnership with the NHS to deliver integrated care pathways for frail elderly people
• Yarlington community fund – includes health and wellbeing projects such as sports equipment, play activities, skate parks, multi use games areas
• New build developments – independent living projects for older people and young people with learning difficulties
• 50 staff have completed a Level 2 certificate in Mental Health Awareness
• Smoking intervention workshop for staff planned with Somerset Partnership NHS FT
building communities
Something to think about …
The Yarlington Household Ambition Plan:
• All new tenancies to be subject to a HAP
• The aim of a HAP is to provide support to residents and their families to help them reach their potential and to transform their lives during a fixed term tenancy
• The HAP will include:
– Employment, education and training
– Skills for life
– Health and wellbeing
– Getting involved in the community
– Building capacity to move to a different tenure, market rent, an equity share or home ownership
• A two-way contract individually tailored to household needs and ambitions
• Delivered in partnership with other agencies including the NHS
• A new culture
building communities
Housing and health integration – the benefits
• Fully connected to our charitable objectives
• We can do more together than apart
• Integrated care
• Supports the creation of sustainable and healthy communities
• Better use of combined assets
• Value for money for the tax payer
• It’s the right thing
