Delivering DFGs – Future Challenges

Robert CornwallCarlisle City Council

Census 2001-2011 – Population changeCumbria (Rural /Urban)

ONS, Cumbria Intelligence Observatory

Census 2001-2011 – Population changeCumbria (Rural /Urban)

ONS, Cumbria Intelligence Observatory

People• Strong correlation between poor housing and ill health• People are affected by poor lighting and excess cold –

excess winter deaths• Falls on stairs after warmth are 2nd most common hazard• Social isolation – more harmful than being a smoker• Reductions in income – annuity rates, pensions, benefits• Living a long way from relatives• Resilience in overcoming a crisis – partner/carer dying• Not feeling safe at home

Context – Social Care/Health• In Cumbria – 45% of the Over 85s use Social Care today• This population is set to double and change – men are

living longer• A&E experienced winter demand level in April/May

this year• Social Care funding has a shortfall and Health spending

is flatlining.• Evidence emerging nationally that authorities which

did not invest in prevention are feeling the pain most

Housing integration – two tier challenge• Fundamental aim to reduce pressure on Health and

Social Care• Section 28a funding goes to the Upper Tier authority

– DFG additional funding has been provided to Districts

• District Councils in Cumbria got £500k in 11-12 and 12-13

• Integration in New Care Bill• “safe and settled accommodation” is a fundamental principle• duties on prevention (preventing, reducing, delaying care

needs), and• duties to ensure integration between care and support, health,

and ‘health related’ provision including housing.

Housing Associations• New Guidance on DFG Good Practice due soon• Difficulties have arisen in getting agreement around

expectations on Housing associations• Riverside in Carlisle has taken full responsibility for

adaptations to their properties– Strong emphasis on management of stock– Void adapted properties are let if possible to suitable tenants

only– Avoid putting in Level access showers to 1st floor of houses– Offering packages to help with moving costs

Mrs Carlisle• Project a year old - led by the GPs• Housing the No. 1 issue • ‘Virtual Ward’ to be established in June• Health and Social Care Coordinators• Targeted at the frail elderly – over 75• Low support needs • Reducing Social Isolation• Risk stratification tool being developed• Community Assets Based Development Approach

Housing response to Mrs Carlisle

• Home Improvement Agency – July 2012– Accredited with Foundations

• Additional services to the DFG work• Providing the Housing Support to keep people

as independent as possible for as long as possible• Housing Caseworker – discharge service• Community Neighbour programme• All funded by Health and Social Care

Developing Products not Policies

• It’s all about the ability to respond – speed is key• GPs need service specs and outcomes – not a policy• It can take a long time (GP time) to set up a new

service• New services can generate income or be cost neutral • Equity release and small affordable loans for house

renovation and repair• Making best use of ECO

Current and Future Challenges• Waiting times are key – GP wants the risk of

falling removed now not in a year’s time• Deterioration in Private Sector Stock condition• Financial pressures on everyone’s budgets• Cultural integration – Health • Demographic pressure on the whole system• Obesity• Closer to Home and even Closer to Home