Social Care

Baroness Wilkins Excerpts

Thursday 29th November 2012 Lords Chamber

[Baroness Wilkins]

My Lords, I, too, warmly congratulate my noble friend Lady Pitkeathley on obtaining this debate. Most especially, I applaud her for highlighting the significant role which housing plays in this debate. The impact which the lack of housing—poor, inaccessible and unsafe homes—have on our health and social care is too often ignored. It is rarely even mentioned, but cuts in the housing budget impact significantly on increasing expenditure on health and social care. I thank Sue Adams of Care and Repair England for her advice and help.

The crisis in housing means that, at last, it is moving up the political agenda. The Government have set out plans for a £220 care and support specialised housing fund to encourage providers to develop new accommodation options for older and disabled people. That is very welcome, but it comes in response to a severe housing shortage and a scandalous lack of new homes being built. In the past year, new home starts fell by 9%. Building new homes takes time. In the mean time, the Government’s benefit and housing policies are greatly exacerbating the problem, creating what many people have termed a perfect storm. The benefit cap, the bedroom tax and the removal of permanent tenancies and succession rights will all serve to increase the ill health of those affected and impact particularly severely on disabled and older people, multiplying the pressures on the health and social care services.

In 2006, a PSSRU discussion paper pointed out that, if we do nothing to change the current housing situation, occupied places in care homes and hospitals would need to rise by 151% by 2051. Some estimate long-term care expenditure will rise by around 325% in real terms by 2041. With such a depressing prospect, let us not waste this crisis but seize the opportunity to put effective reforms in place.

The Papworth Trust published a timely report this month based on a survey of 640 disabled and older people. It clearly demonstrates the cost to our health and social care budgets of not addressing the problems with housing. The trust’s research found that almost one in four people could not get around their home safely and two in five said that the design of their home meant that they needed help to do everyday things, such as cooking—all increasing their dependence on other people and potential costs to the health and social care budgets. The great majority of those people did not require rehousing, with the cost and upheaval that that entails, but the provision of relatively simple adaptations, such as grab rails, more accessible shelves and cupboards or level-access showers.

There is ample evidence that spending on those relatively simple adaptations to people’s homes can produce major savings to the health and social care budgets. A study published this year by the London School of Economics suggests that the annual spend of about £270 million on disabled facilities grants is worth up to £560 million in health and social care savings and quality-of-life gains. In other words, for every pound spent on DFGs, two pounds is saved on health and social care costs. A fractured hip can cost the state an estimated £28,000, so £30 on a grab rail is quite good value for money. Falls by older people cost more than £1 billion a year in the UK. The Welsh Government have estimated that a programme to help older people to remain living independently in their own homes has saved the NHS and social care budgets more than £101 million since it was set up 10 years ago.

Local authorities administer the home adaptation services, so cuts to local authority budgets are impacting on an already inadequate, overstretched and underfunded service. The service consists of two main elements: disabled facilities grants, which provided finance; and home improvement agencies, providing help and advice. For many years, there have been calls to strengthen the system and address its many problems.

A survey of English local authorities published in August this year by the Labour Party through freedom of information requests found that 17% fewer grant applications were approved in the past two years. That means that an estimated 10,700 fewer people received funding for home adaptations in 2011-12 than in 2009-10. Over the past two years, there has been a 31% increase in the number of delayed discharges from hospitals due to lack of appropriate home adaptations. That is costing the NHS £985,000 a month.

Despite a welcome extra £20 million provided by the Government for DFGs in January 2011, the money is not ring-fenced, with the result that some local authorities have used the extra funding to reduce their contribution rather than to fund extra work. The trust’s report of October this year found that, of the 326 local authorities which receive DFG funding from the Government, 62 have stopped providing Home Improvement Agency services altogether. That figure has doubled since June 2010.

The Papworth report recommends a radical overhaul of the DFG system. It sees it as wrong that responsibility for home adaptation lies solely with district councils, and proposes that local government and health money is pooled together in a DFG pot to be administered by the new health and well-being boards and clinical commissioning groups.

Finally, anyone who heard yesterday the devastating account of the research done into the situation of spinal-cord injured people in care homes, recently published by ASPIRE, could not fail to acknowledge the crucial role which housing plays in reducing the health and social care budgets. Following successful rehabilitation in a spinal injuries centre, the scandalous lack of accessible housing results in 20% of those patients being discharged by their local authorities into an elderly care home, with an average stay of two years. Twenty-five per cent of those people had tried to kill themselves. ASPIRE has made repeated requests to meet the housing Minister, with no success to date. I ask the noble Earl to do all he can to facilitate that meeting.

In conclusion, there is no denying that we are in a crisis, but let us not waste the opportunity that this crisis offers to make sure that we put in place the essential reforms needed, just as Beveridge did in the Second World War.