Delivering DFGs – Future Challenges

Delivering DFGs – Future Challenges Robert Cornwall Carlisle City Council

Census 2001-2011 – Population change Cumbria (Rural /Urban) Proportional Change in No. Persons: 2001-2011 Source: Office for National Statistics, Census Cumbria Rural LSOAs

Cumbria Urban LSOAs

% Change - No. Persons

25 20 15 10 5 0 -5 -10 -15 0 - 14

15 - 64

65+

Age Group (Years)

ONS, Cumbria Intelligence Observatory

Census 2001-2011 – Population change Cumbria (Rural /Urban) Proportional Change in No. Persons: 2001-2011 Source: Office for National Statistics, Census Cumbria Rural LSOAs

Cumbria Urban LSOAs

% Change - No. Persons

40 30 20 10 0 -10 -20 0 - 14

15 - 29

30 - 44

45 - 59

60 - 74

75 - 84

85+

Age Group (Years)

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