Shaping the Housing and Care Markets for All Older People

1. Shaping the Housing and Care Markets for All Older People Julie Ogley Director of Social Care, Health and Housing Central Bedfordshire Council

2. The Housing and Social Care Dimensions – the similarities • Different origins but converging missions… • A focus of resources on those most in need • Neither system exists in isolation • Public sector housing operates alongside the open market for housing • Social care is delivered in a market that has a significant element of private provision • Benefits of a joined-up approach (especially if Health can be included as well) are better outcomes for customers and greater efficiency for organisations

3. The Housing and Social Care Dimensions – the differences • Buildings will be around for a long time and can be difficult and costly to adapt to changing requirements and expectations • Social Care services can be scaled up and down and adapted to changing requirements relatively quickly and cheaply • As with the Health dimension there are legal and cultural barriers to be overcome.

4. Central Bedfordshire – Challenges and Opportunities • Challenges: • An ageing population • Mainly small/medium size towns plus rural area • Budgetary pressures

5. What does ‘market-shaping’ mean in practice? • Two dimensions: • First - knowing what we want to achieve: • What our customers need and want • What delivers best outcomes • What delivers most effectively • Second – the delivery mechanisms – knowing how we intend to achieve it

6. How can we shape the market? • There is a continuum of delivery mechanisms • Direct provision of services • Contracting for service provision • Joint ventures and partnership working • Grant-funding • Benefit in kind • Generating opportunities • Statements of intent • All mechanisms have their place – choose the most effective solution to the circumstances.

7. What tools have we got? • Reshaping of direct services • Using our commissioning and purchasing power • Actively managing existing contracts. • Using the Council’s powers to create innovative solutions, develop ventures and partnerships. • Using the Council’s land-holdings • Whole council solutions – regeneration, assets, housing, planning, economic development all working together • Use of the Planning System: • Market Position Statements / Investment Prospectus / Design Guides

8. Who are our customers? • Housing needs and social care needs overlap but are not the same thing • Our responses to housing need and social care need is different and affected by a number of factors: • Legal duties: housing and social care eligibility • Council policies: preferences for one policy solution over another • Intrinsic factors: it takes longer to scale up and down housing responses to need than social care responses • Housing need is multi-dimensional, social care need less so. • Care Act makes clear that that we have a duty to all vulnerable adults – not just those in need of public subsidy. That duty is across the whole council and beyond – not just social care directorate.

9. Our responses to customers’ needs • Stay independent in own home if possible • Choice of accommodation and care options for those who can’t • Choice not limited to those who have the ability to pay • It should not be assumed that older people staying in their own home means that they will be more independent than other housing solutions. A person living in extra care or a care home may have more independence, choice and control over their day-to-day lives than someone living in their own home. A home which may not be suitable for their needs and where they are reliant on inflexible domiciliary care visits for basic care.

10. What does this look like in practice – what’s happening now • Services to allow people to remain independent in their own homes: domiciliary care, reablement, assistive technology, respite care, aids and adaptations, tenancy sustainment • New affordable extra care schemes across Central Bedfordshire – delivered by the Council’s HRA and Housing Associations • Replacement of outdated facilities – care homes and sheltered schemes

11. Priory View, Dunstable

12. Croft Green, Dunstable

13. What does this look like in practice – what’s still to be done • More affordable extra care schemes • More care home provision in key areas • Open market housing with care for older people • New mainstream housing suitable for older people

14. Some examples • Direct investment: Priory View • Market-led approach to care home reprovision • Make this someone’s job – MANOP Team • Regional modelling of impact of Care Act on care home fees

15. A suggested process • What have you got and what do you want • Describe the gap between the two. • Identify what you need to fill those gaps. • Think about which organisations could be part of a solution. • Work your way up the options sequentially – starting with the lowest cost option. • Keep reviewing progress and be prepared to change and take opportunities when they arise. • Don’t forget the outcomes you are trying to achieve.

16. Finally… • This isn’t easy • We are working within complex systems • The historic, cultural and legal barriers are real but can be overcome • We need to be adaptable to circumstances • We should support each other to shape the market and look for commonality of interests and economies of scale • Sharing success stories is important but we can also learn from ‘what went wrong’