Ian Thomas sets out the territory and a challenge for housing providers.
Background
There are some bold and stark facts that we have to consider when we look at the issues around older people, health, social care and housing. Put simply, there is no-one reading this that is getting any younger. We are now said to be living in an ageing society, and this has implications for us all.
The socio-economic considerations of the ageing population are now becoming key policy agenda items. These include the pension ‘crisis’ in the UK in general, the fact that more of us are living longer and are thus likely to put more demand on services, and the likelihood that many of us will need to work much longer past the existing retirement age. The net result of these changes is that, as a country, Wales will look a very different place in the next few decades.
Since the dawn of the ‘New’ Labour era, and certainly since devolution in Wales, there has been a constant promise of joined-up thinking around government and key policy areas. Anecdotal evidence suggests that this promise has yet to make it to reality. But if we are to ensure older people in Wales are to be treated with dignity, respect and with the same consideration given to other parts of the population, we need to consider what the Welsh Assembly Government is doing to help us all plan for our futures, and whether or not those plans are realistic and achievable.
Big thinking in Wales
The ‘big thinking’ within government in Wales has indeed become much bigger in scope since the formation of the Assembly. With health and social care as devolved functions, the Assembly has seen fit to introduce much longer term strategies for health and social care. The long-term strategy for health, Designed for Life seeks to plan for the growth of older people within the population, and to plan more closely for their health needs. In many respects, as a strategic document, it is a brave vision, though critics will argue that it does not translate well to the level of service provision. Its partner in social care, provisionally entitled Designed for Care will be similarly brave in scope and outlook. Both documents are meant to work side by side to provide a more unified picture of health and social care across Wales.
When considering these two strategies, the first big challenge is a fairly obvious one. The need for the joint commissioning of services has been apparent for some time, and without it in the context of the ‘Designed’ documents, there will be questions as to how it will work. If we also factor in the issue that there are currently 22 local authorities and 22 local health boards commissioning for services across Wales, then the picture becomes even more complex. By contrast in the South of Ireland there is movement towards a single commissioning body at the level of government. There is a suggestion emerging from the Assembly however, that there will be unification in the world of joint commissioning that will go some way to addressing the current fragmentation.
Despite an apparent move towards simplicity in the world of strategy, we need to also consider other key policy documents in relation to older people. There is the National Service Framework (NSF) and Strategy for Older People that have both emerged from the Assembly. Many older people will also have to be considered under the NSF for mental health, and many older people with dementia will also be in receipt of services from mental health teams.
And housing ….
Arguably, housing, one of the key areas of need for us all regardless of age or social and health needs, doesn’t play a significant enough role in the larger strategy arenas. Yet partners in housing can help deliver key priorities within health and social care across Wales. The key question that we should all consider is, again, a simple one. What kind of place will we want to live in as we get older?
The recent £41 million pledged by the Welsh Assembly for extra care housing may be significant, but does this mean that extra care is important above all else? Of course the answer is ‘no’, it is only one aspect of housing that can cater for the needs of some older people. The housing world needs to consider a range of provision for older people. When asked, the vast majority of people will state that they want to reside at home for as long as possible. All the key strategies noted above are committed to facilitating this need. But when older people develop certain mental health or dementia related problems, they are often transported from home to hospital to nursing care in a fairly rapid continuum. Many extra care schemes simply don’t have the provision in terms of special facilities or registration status to cope.
If we consider people with dementia alone, there are currently around 42,000 people in Wales with some form of dementia, mainly Alzheimer’s or vascular dementia. One in five of people over 80 will have dementia. Given these statistics, there needs to be no great leap of logic for housing providers to consider the market potential for older people either with, or without forms of dementia. There is clear capacity for development of specialist housing below nursing care and, arguably, models that may even provide support below the care thresholds required by Care Standards. Exploration of what is possible is the key.
The real agenda for housing then starts to emerge in light of the current inadequacies in the existing provision. The current situation indicates that capacity in mainstream housing for older people needs to be increased, and specialist provision needs to develop alongside this. It is unimaginative not to consider other options – why not more extra care with specialist provision attached in discrete areas? To condemn older people to move from home to hospital acts against the spirit of the NHS and Community Care Act, a key piece of legislation designed to reduce the number of institutions, especially for people with mental health problems and learning disabilities. We have to ensure that there is no growth in ‘new’ institutions for older people simply because there was not the foresight to plan ahead nor the imagination to develop new models of accommodation to meet needs.
Ensuring that housing strategists are brought into the thinking is important, but they are only one part of the housing world that needs to think seriously about older people. Architects and designers need to ensure flexibility in design, making sure that new housing is varied in its ability to cope with the needs of older people. It also has to be as non-institutional in its design as possible. Re-provision of existing stock is also a key factor. It has been suggested that many sheltered schemes of both category one and category two are becoming difficult to let. There is a need for creativity in re-provision here. In relation to extra care housing that doesn’t currently cater for older people who develop social and health needs, there is a much starker message. The residents in those schemes are getting older and are thus more at risk of developing greater health and social care needs. What will existing providers do when this happens? Evict to hospital?
Planning is the most obvious way forward here, and housing providers need to grasp what the big health and social care strategies are saying, and how the provision already out there, or planned to be out there, can be used in order to provide vital services to tenants and residents both now and in the future. If we are going to treat our older populations with dignity and respect, give them quality of life and, importantly, ensure they are treated with equality and fairness, then we all need to ensure that we know what the key policies and strategies are saying, and essentially, what they are empowering us all to do.
Ian Thomas is Director for Wales, Alzheimer’s Society, email Ian.Thomas@alzheimers.org.uk
www.alzheimers.org.uk.