Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Anchor Trust (DD 3)


  The Anchor Trust is a registered social landlord and registered charity providing care and housing for older people. We are the largest not-for-profit organisation working in the field of housing and social care for older people in England. Our range of services includes:

    —  Anchor Retirement Housing—tenant services in rented retirement accommodation offering the security of a scheme manager and the Anchorcall community alarm service. Such schemes offer Extra Care for frailer residents. 23,094 flats, including 1,125 Extra Care flats.

    —  Guardian Retirement Housing—specialist management of private leasehold and shared ownership retirement properties. 5,697 properties managed.

    —  Anchor Homes—residential and nursing care. 3,130 residential care units. 286 nursing care units. 248 dual-registered units.

    —  Anchor Care Alternatives—home care service for older and disabled people. 5,000 clients. 40,000 hours of care delivered per week.

    —  Anchor Staying Put—helps older and disabled homeowners to repair and improve their properties so they can "stay put" and retain independence. 60 home improvement agencies. 25 small repair schemes. 12 specialised services (home from hospital, home safe & secure, adaptations, energy savings, Keep in Control).

    —  Anchorcall—community alarm and monitoring service for people to summon help 24 hours a day. 28,547 connections. 208,263 calls handled in 2000-01.

    —  Anchor Almshouse Management Service—a housing management service offered to almshouse trustees. 406 units.


  2.1  Why people, particularly older people, remain in acute hospital beds after they have been assessed as clinically ready to be discharged safely is a complex question. Yet a vitally important one given the speed with which, whilst in hospital, older people can lose functional skills and risk compromising their ability again to live independently, not to mention the significant risks of acquiring an infection. Anchor Trust therefore welcomes this inquiry by the Health Select Committee, as it has welcomed the increasing emphasis on this issue in recent Government policy statements.

  2.2  Of course the simple encapsulation of the problem in the phrase "delayed discharges" masks the broad range of factors which contribute to it—and which make its solution so complex. The falling number of residential and particularly nursing care places, especially in the south and south east, is an obvious example. But there are wider factors such as the rising levels of homeownership which often leave older people "asset rich but income poor", and as a consequence living in poor conditions to which clinical staff are reluctant to discharge them.

  2.3  The English House Condition Survey 1996 showed that the highest percentage of those living in unfit homes were older people. This is not just an issue for health. The Department of Transport, Local Government and the Regions has recently consulted its response on changing from Housing Fitness Standards to a Health and Safety Rating System. This will provide for a more holistic assessment of housing conditions against a range of individual primary health and safety risks in the home. The outcome of which will include a health gain by preventing property related accidents and health risks and thus avoidable admission into hospital or access to primary health services.

  2.4  The recent announcement of additional Government funding to social services authorities of £300 million over the period to March 2003 to tackle the issue is welcome, though needs to be seen in the context of overall community care funding of some £5 billion per annum. At this stage it is too early to say what impact the renewed emphasis and funding will have in this area, but we believe that effective partnership with housing providers, such as Anchor, is integral to a "whole system" approach to help with the problems of delayed discharge. It can aid the delivery of intermediate care provision and help prevent some older people being admitted to more costly forms of care which are not clinically necessary.

  2.5  This paper is not a comprehensive submission, but is intended to show some current practical examples of good partnership working with housing providers such as Anchor.


  Extra Care—also known as very sheltered housing—is a development of traditional sheltered housing and aims to support frailer tenants (an increasing proportion of those in sheltered accommodation) to maintain their ability to live satisfactorily in such schemes. The "extra care" schemes aim to promote independence by providing an individually tailored care package provided by a care team which is usually based on site.

Fairfield Court, Tameside

  The block has 14 residents, three of whom moved from some form of residential or nursing placement. Research has demonstrated that for eight tenants there has been a substantial decrease in the care input that they needed, having moved into the scheme with substantial packages of care. The weekly decrease in care needs and costs are briefly as follows (fuller details can be supplied if required):

    —  7 hours care (£42.00).

    —  3 hours care and 1 day Day Care (£43.38).

    —  10 hours care and 5 Meals on Wheels (£72.35).

    —  Was in specialist residential placement for adults with a physical disability (£592.00).

    —  4.5 hours care (£27.00).

    —  Was in family placement (£83.50).

    —  Was in nursing placement (£225.96).

  Other evident reveals that tenants experienced a reduction in stress and improvement in mental health, thus lessening the risk of relapse and hospital admission. Their views echo this.

  "The staff encourage me to do things for myself, plus the way the kitchen and bathroom are designed helps, and so do the wide doors. So I need less help than where I lived before."

  " I'm more confident and I know that I am taking my medication at the right time, in the right quantity so my health has improved, so I am able to be more independent."

  "I feel safer so my mental health has improved and so I am doing more for myself."


  Staying Put Projects are Home Improvement Agencies. They help older and disabled homeowners repair, improve and adapt their properties, allowing them to remain in their own homes.

Hackney Staying Put Hospital Discharge Scheme

  The project began in 1994 with funding from the Department of Health. It is targeted at improving the housing conditions of older and disabled people who live in LB Hackney and have been admitted to local hospitals (Homerton, Barts, Whittington). Hospital doctors, nurses, occupational therapists and social workers refer clients to the project.

  The Hospital Discharge team assesses the client's housing conditions and where necessary temporary accommodation is arranged for clients while work is carried out eg in an Anchor sheltered housing scheme. The client is helped to maximise their income by claiming benefits such as Attendance Allowance and supported through the hospital discharge/home improvement process.

  Most of the work which is carried out using improvement grants administered by LB Hackney's Environmental Health Department, cost in the region of £1,000 per home and usually qualify for Home Repair Assistance, although there are some repairs which require more expensive and extensive work such as major aids and adaptations. The project enables older people to be discharged from hospital into housing appropriate to their needs where they can live independently or with the support of some home care. This is likely to be a more cost-effective arrangement than moving into residential care or nursing care, or having a prolonged stay in hospital. It also reduces the chances of crisis re admissions to hospital due to inappropriate housing conditions.

  A typical example of a person being helped by the project is Mr L who had been admitted to hospital with pneumonia. Whist there he reported to the hospital social worker that his electric water heater had broken down.

  The project's Technical Officer visited his home and arranged for an electrician to repair the water heater as an interim measure. Mr L was then discharged.

  When the Caseworker undertook a detailed assessment, she found that Mr L had inefficient old cast iron heating system. This contributed to his bronchitis and epilepsy. He believed that he would not benefit from a gas central heating system as he and his wife would not be able to afford to run this. The Caseworker carried out a benefits check and established that they were entitled to a large sum of council tax benefit. She assisted them to complete an application, and arranged for a visiting officer to see them and verify their claim.

  They were also assisted with the process of obtaining estimates, and applying for the necessary grants to have a new gas central heating system installed. The work was funded by a Home Repair Assistance grant, a charitable donation, and a small contribution from themselves.

  Mr L and his wife are now happily living in a warm house, and Mr L has not suffered any reoccurrence of his chest pains. They are also able to pay the cost for their fuel because of the savings they have made on their council tax bill.


  Assistive Technology can be defined as a product that enables independence and improve the quality of life of individuals whatever their setting.

  St Johns Court, Rotherham has 32 flats. Over 50 per cent of the tenants are aged 76 years or over. 93 per cent are women.

  The block was fitted with class 5-wire data communication, capable of carrying a multiplicity of data signals. A PABX control system was also fitted. This is, in effect, a mini telephone exchange, that handles incoming data. It provides tenants with telephone extensions (with their own number) and therefore reduces the number of BT and cable lines into the scheme. It also allows telephone based community alarm systems rather than the traditional hardwire alarms. Internal calls (between flats) are free of charge.

  Pendants replaced the traditional pull alarm cords (although one was left in the bathroom as this maybe used at night and when the tenant may not be wearing a pendant). The tenants receives a morning call via their phone. To answer the tenant presses the pendant to open an open communication line with the scheme manager/phone line. This can be done without having to get out of bed. To close the line the tenant simply presses the pendant again. They will then be able to receive telephone calls as normal.

  A camera was fitted at the front door and linked through the system to tenants TV sets. By pressing channel 7 they are able to see who is at the main front door and by pressing the pendant can grant access.

  The flexibility of this system means that it could be adapted to each individual tenants needs and could be used to monitor a range of things from inactivity to flood monitoring. It can also be used to monitor health needs such as blood pressure and temperature.


  1.  Preventative Approaches in Housing: An Exploration of Good Practice by Pat Parkinson & Debby Pierpoint; Anchor Trust 1998.

  2.  Using Telecare: Exploring Technologies for Independent Living for Older People by Jeremy Porteus & Simon Brownsell; Anchor Trust/Housing Corporation 2000.

21 January 2002

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