Memoranda by Care & Repair England
1. CARE &
1.1 Care & Repair England is a national
charity established in 1986 to improve the housing and living
conditions of older and disabled people. Its aim is to innovate,
develop, promote and support housing policies and initiatives
which help older and disabled people live independently in their
homes for as long as they wish.
1.2 One of its main achievements over the
past 15 years has been the development of local home improvement
agencies, often referred to as Care & Repair or Staying Put.
These services help mainly older and disabled people who are living
in poor quality private sector housing, to carry out essential
repairs and adaptations.
1.3 The interconnection of housing and health
has been at the forefront of Care & Repair England's work.
A major part of the wider remit of the charity has been to champion
joint initiatives between housing, health and social services
at a local service delivery level.
2. THIS EVIDENCE
2.1 The aim of this evidence is to highlight
one specific aspect of delayed discharge from hospitalthe
problem of older and disable people being unable to return to
their own homes until essential repairs and adaptations have been
2.2 It is not a comprehensive submission
about all aspect of discharge from hospital but highlights the
findings of recent research carried out by Care & Repair England.
On the Mend1 examines hospital discharge services which help to
speed up this process of repair and adaptation and thereby enable
people to leave hospital faster.
Mr Watt is a private tenant. He was unable to
be discharged from hospital because his landlord refused to mend
a dangerously broken banister. Discharge was delayed for six weeks
whilst both social services and health authority solicitors were
involved in negotiations with the landlord's solicitor. The hospital
discharge service was approached and they immediately sent in
the handyperson (acting upon the clients instruction) and the
banister was repaired within hours, enabling Mr Watt to return
Source: On the Mend1
3. HOUSING AND
3.1. Poor housing has an adverse effect on people's
health and contributes to delayed discharge from hospital and
higher readmission rates. Whilst to date these have not been quantified
in detail, the Standing Committee on Public Health2 estimated
that the cost of poor housing to the NHS could be as much as £2.4
3.2 There are 1.5 million unfit homes in
England3, with an estimated two million in need of adaptations4.
Most of these homes are owner occupied5, and most are lived in
by older people, with women over 80 being by far the most likely
to be living in poor housing6 and ethnic minority households also
more likely to face poor housing conditions7.
4. HOW DO
In two main ways:
(i) When an elderly or disabled person is
waiting to leave hospital, their home may be visited by an occupational
therapist or social worker to check that it is suitable. If the
home is found to be unfit or in need of adaptation, there may
be considerable delays whilst work is carried out. During this
time the person may remain in hospital or be sent into residential
care, both of which are expensive options if the person does not
actually need the associated medical and care services.8 note
Audit Commission research
(i) A person may be discharged back to a
home which is unfit and not adapted (see attached Appendix ADescription
of the experience of Mrs Wood). This in turn can lead to further
health problems and re-admission to hospital.
5. IS THERE
5.1 Delayed discharge from hospital is a
complex problem and there are no simple solutions. Whilst the
falling number of residential and nursing care places is a significant
factor, the vast majority of older and disabled people leaving
hospital are returning to ordinary homes in the general housing
stock. Ensuring that those homes are fit and adapted can contribute
both to fast and effective discharge and also to enabling people
to live independently.
5.2 Home improvement agencies and other
service providers have developed effective, fast small repairs
and adaptations services which help to improve discharge arrangements
and reduce the risk of hospital admission (eg improving home safety
and preventing falls, repairing heating systems in order to improve
respiratory problems and avoid hypothermia).
Mr Dunn is 90 years old. He lives alone in his
own leasehold flat. Following several months in hospital after
a fall, he was referred to the hospital discharge service when
he was medically fit. The social worker felt that he could not
be discharged to his unfit home and he was offered residential
care, which he refused. The hospital discharge scheme caseworker
arranged a home visit with Mr Dunn and a care manager. The flat
was extremely cluttered and dirty with no hot water in the kitchen,
an inaccessible bath, broken lavatory and a large hole in the
flat roof over his kitchen. With Mr Dunn's agreement clearance
and cleaning of the flat was arranged and applications made for
three minor works grants for installation of a shower, a new lavatory,
repairs to the roof and a hot water boiler. A community care grant
was obtained for a bed, cooker, and fridge. The care manager arranged
for regular home care and Mr Dunn is now happily living independently
Source: "On the Mend"
5.3 The majority of the people being helped by
these services cannot afford to pay for the necessary building
work. The most effective housing related hospital discharge services
have rapid access to funds (usually via the local housing authority
or social services) to meet the cost of small repairs and adaptations.
5.4 Where the local housing authority, social
services and the health authority all work together and each allocates
resources for hospital discharge repair and adaptation costs,
the most effective hospital discharge services can be established.
In Bristol, social services provide the home
improvement agency with a budget for small adaptations, the housing
authority makes available a ring fenced home repairs assistance
grant budget (operated on a fast track system) for hospital discharge
cases, and the health authority co-fund a handyperson service.
Consequently, many repair and adaptation jobs are completed within
24 hours and the majority done within a week.
6.1 If national targets for improved hospital
discharge, improved health and an increase in the numbers of older
and disabled people living independently in their own homes are
to be achieved, a national housing strategy is needed to ensure
greater coherence of public assistance for low income people living
in private sector housing.
6.2 The imminent ending of a national framework
of grants for low income homeowners and the introduction of a
new general discretionary power for local housing authorities
to provide assistance in the way that they may choose to tackle
poor housing could impact on discharge from hospital.
6.3 A positive impact would be the innovative
use of this new general power, such as the provision of a rapid
response fund for use by hospital discharge services. Housing
authorities could be encouraged to develop a radical new private
sector renewal policies in partnership with health and social
services, pulling together a whole systems approach to housing
and hospital discharge. However, there is the significant threat
of further reduction of any financial help for low-income people
in poor private sector housing, with further burdens on the health
sector resulting from this
7.1 The process of discharging patients
from hospital should include a full assessment of the home that
they are returning to, both with regard to unfitness and adaptation.
An understanding of housing repair and adaptation options should
be incorporated into the training of all community health professionals.9
7.2 Primary Care Trusts (and future Care
Trusts) should be required to develop and support fast track small
repairs and adaptations services, incorporating accident prevention
and home safety measures.
7.3 The forthcoming guidance (currently
being drafted by The Department for Transport, Local Government
and the Regions) setting out the framework for local authority
private sector housing strategies should require local authorities
(a) address how their proposals contribute
to the Health Improvement Programme, the Joint Investment Programme
and discharge from hospital process
(b) consider development of a special "rapid
reaction" joint fund (with financial contributions from housing,
health and social services) to meet the cost of urgent small repairs
and adaptations in the homes of people who are either at risk
of hospital admission or who cannot be discharged from hospital
until such work can be undertaken.