The recent report from the National Audit Office (NAO) on ‘Discharging Older Patients from Hospital’ made for uncomfortable reading. A rapidly increasing older population means that 62% of hospital patients are now over 65 and delays in their discharge from hospital accounted for 1.15 million bed days in 2014/15 at an estimated cost of £820m. However, a quick word search reveals not a single mention of ‘housing’ in the report despite numerous references to assessments and care taking place in the person’s own home.
Since the report was published other housing organisations have called for surplus NHS and to be given over for new supported housing schemes to provide a ‘step-down’ facility between hospital and home. The theory is that this would create a buffer at a lower cost, but it would take several years to realise and it would still cost more than helping people back to where they want to be – their own home.
So what can the housing sector do in the short term? Well, the NAO report does talk about adaptations as part of the ‘home with support’ discharge pathway.
Funding for Disabled Facilities Grants (DFGs) has increased significantly this year thanks to extra investment from the Department of Health. DFG is the main source of funding for home adaptations and is increasingly being used more flexibly to meet local needs. For instance, fast tracking adaptations to make a house safer to return to.
Home Improvement Agency (HIA) services are also helping people to return home sooner. Revival is a great example of a HIA run by Staffordshire Housing Association. They employ support workers based in the local hospital whose role is to meet the patient on the ward and then visit their home to assess how safe it would be when they’re discharged. They can arrange all sorts of services like cleaning, fitting grab rails, moving beds downstairs, identifying and removing trips hazards, fitting smoke alarms, repairing faulty boilers and so on.
Whatever the solution, the inclusion of DFG funding within the Better Care Fund means that discussions are now happening at Health & Wellbeing Boards across England. Some are at a very early stage, but it is opening the door to more joined up working across health, social care and housing for all tenures. However many accessible new homes we build, the issue for the vast majority of people will be the safety and accessibility of their existing home. We need to take this opportunity to ensure that housing services are in place to support hospital discharge for older people in a timely manner.
Foundations is now coordinating the pioneering Health and Housing Memorandum of Understanding (MoU) between government departments, its agencies such NHS England and Public Health England and a range of professional and trade bodies. It offers a great opportunity for more collaborative approaches to hospital discharge to be developed and the learning disseminated.