Housing associations bid to ease the pressure on the NHS
|
Version 0 of 1. What do you do for someone in lonely late middle-age who’s too old for a disco and too young for a lunch club? Find an answer to that question, then – believe it or not – you may have a formula that saves public money and wins you friends in the NHS. Tackling social isolation among the over-50s is key to the “radical upgrade” in prevention and public health demanded by the NHS Five Year Forward View. And housing associations increasingly see themselves as part of the solution to the growing pressure on hospitals and GP practices. “Housing associations like us are extremely well placed to improve the health of our local neighbourhoods,” says Tony Stacey, chief executive of South Yorkshire Housing Association (SYHA). “We have fantastic links with public, voluntary and private organisations locally, so we can bring people together to change systems in a long-term, sustainable way. If we identify people’s issues early, we can avoid some serious health problems later on and spend less on acute services.” Care and support accounts for 60% of SYHA’s offer and Stacey sees it as “core business”. In Doncaster, it has teamed up with the local voluntary sector to provide a “social prescribing service”, in which GPs write prescriptions for things like money advice or social contact, rather than medicines. In Sheffield, it is tackling poor diet with an EatWell project and aiming to counter loneliness and isolation with an Ageing Better programme backed by a £6m grant from the Big Lottery Fund. Despite the government’s supposed focus on preventive services, council spending on the Supporting People policy intended to deliver prevention in the housing sector has fallen by 45% in the past five years, according to figures from the National Audit Office. Some housing associations have pulled out of care as the funding has dwindled, SYHA is in the vanguard of a new movement that sees the Five Year Forward View as an opportunity to expand. “If our NHS partners are looking to answer the big questions facing them, easing the burden on acute services and making sure that health and care services are delivered as close to home as possible, housing associations have a massive amount to offer,” says Emily Bird, policy lead at the National Housing Federation. “There’s a seismic shift going on in housing, which is about how we can prevent people from needing more formal health and care services. And there’s an increasing understanding in the health service of the role housing can play in solving their funding problems.” Speculative business cases won’t convince sceptical health commissioners, however. So housing associations are investing in research to produce hard evidence. Family Mosaic is one example: having had “limited success” in winning NHS provider contracts in south-east England, it has joined forces with three other housing associations in a “Health at Home” initiative. The initiative draws on existing projects to show that the numbers stack up. Family Mosaic set up a health and wellbeing service as part of a research programme to demonstrate that it could fulfil an earlier pledge to save the NHS £3m a year. In an 18-month health pilot, conducted as a randomised control trial, health and wellbeing support workers gave 200 tenants with long-term health conditions intensive support, encouraging them to participate in activities and nudging them towards healthier lifestyles. Initial results suggest that the project has saved the NHS £75,000 in reduced hospital and GP visits over a year. Family Mosaic thinks that the final figures, scaled up, will provide the “robust case” that it seeks while showing that it can meet the needs of a group of people who would otherwise fall through the net. “Several were not registered with GPs, had undiagnosed health conditions and were extremely vulnerable and in need of immediate support,” says Jemma Mouland, Family Mosaic research analyst. “It was only through us calling them and talking to them about their health that we were able to identify the problem. “The health pilot is just one of the many ways that we as a provider could save the NHS money,” she adds. “There’s already a wealth of evidence out there about the cost of poor housing to health, so everything from our repairs service to energy-saving initiatives will also contribute.” The three other housing associations in the Health at Home collaboration hope that their evidence will prove equally alluring. Midland Heart is testing a reablement facility; Riverside has focused on a telecare project with cost savings of “over £50,000” to A&E; and Home Group’s home treatment team claims to have relieved pressure on the NHS by saving it more than £10,000 for every individual it helps. Similar results have been obtained by South Yorkshire. A pilot of the social prescribing service involving 10 Doncaster GP practices yielded savings of £230,000 on an investment of £160,000. Early data indicate that more than six in 10 of the sample visited their GP less frequently. Solutions to loneliness and isolation are high on the list of preventive stratagems almost everywhere, especially as it has been shown by some studies to have the same impact on health as smoking 15 cigarettes a day or excessive alcohol consumption. “The person who told us they were too old for the disco and too young for a lunch club neatly summarised the fact that there needs to be more flexibility in what is offered to tackle isolation,” explains Gareth Parkin, programme lead for SYHA’s Ageing Better scheme in Sheffield. “Unless the city starts to address the root causes, we’re unsure how the already strained health and social care system will cope.” The scheme is steered by a “core partnership” including the local authority, NHS, and the voluntary and private sectors so that its reach is both integrated and city-wide. SYHA has a foothold in communities with the starkest health inequalities and its housing officers are well positioned to spot people aged 50-plus who face multiple risks including isolation. “We have a key role in prevention and we’ve worked hard over the last year to break new ground with our health partners,” Parkin says. “We increasingly see our work as broader than care and support and more about health and wellbeing.” |