Social housing providers should start with care – health incomes will follow

Campbell McDonald calls on social housing providers not to walk away from health and care integration just yet.

Recent weeks have seen two of the heath and housing sectors’ big ticket events come and go – NHS Confederation and Housing 2017. I came away from both with a profound concern.

Right at the very moment where we need health to be sat round the table with care and social housing, the very opposite is happening. The latest NHS reorganisation is in stark danger of happening behind closed doors – and the uninvited are starting to walk away.

I’d like to rant quickly about how truly calamitous that is – before making the case for how and why social housing providers should continue to innovate in this space.

It’s hard to go with the flow when you’re uninvited!

Flow. That’s the word with the highest currency currently in NHS-land. The holy grail of system-wide sustainability is wholesale improvement of managing the flow of individuals from safe and well in their own homes through the health system and (wherever possible) back home again.

The more attentive of you will have spotted that the word home appears twice in that last sentence, health only once. And therein lies a critical problem.

Getting the home bit right is non-negotiable if you want to fix the health bit. Everyone seems to understand this. Yet only a small number of early adopters are actively working towards it. And the latest NHS reorganisation risks working actively against it.

Put it differently: the NHS cannot solve flow all by itself. To hear the system speak, you’d believe it was well aware of this fact – but its actions suggest different.

From NHS England (NHSE) to the frontline, wrestling the demon of delayed hospital discharge has rapidly woken managers up to the critical role that care providers must play in this fight. However, importantly in almost every area of the country the same logic that has started to open up a spot at the table for social care is not being extended to social landlords.

Of 44 STP areas, only 12 of those plans contain explicit references to the role of housing and only 3 go into it in any detail. This in spite of the growing over-65 population in social housing in England and Wales.

NHSE have vanguards for almost everything under the sun, including addressing health in care homes to bring down numbers tipping through the front door of A&E. How can it be then that there isn’t a vanguard programme for impactful early adopter partnerships between health organisations and social housing providers?

The NHS surely needs to broaden its understanding of what falls under the heading of home. And quickly.

Local organisations who simply must find ways to work together are headed in opposite directions. Integration of health, care and housing featured less on the agendas of NHS Confederation and Housing 2017 than it did 2 years ago – and yet the need for it is more pressing than ever.

Some leaders of social housing providers are openly saying they’re sick of being talked at about the importance of working with health commissioners who show no real interest in engaging with them. Only this week a survey by the Local Government Association found that 7 out of 10 local councillors disagree that they’ve been effectively engaged by STPs – at the same time as social care managers are going to war with NHSE over how this year’s pittance of additional care funding gets spent locally.

Simple truth is that too many vital discussions about STPs and Accountable Care Systems are still happening behind closed doors. Faced with all of this, what wonder then that social housing providers are throwing their arms up in despair and falling down the hole between the NHS’s words and its actions.

And yet if we’re going to fix flow, social housing has to be a part of the solution.

Start with care, health will follow

My plea with social housing providers is not to walk away. Instead, start with care.

Every provider in the country is acutely aware of the challenges of an ageing tenant population. Many providers effectively offer some kind of informal care already. Many have looked more closely at formalising that role and becoming registered care providers themselves.

Even here, many are walking away – falling back on bringing in 3rd parties to provide the care and sticking to the housing knitting. I’d like to argue that this is a missed opportunity.

In every part of the country there is a market place for care. Local authorities are not the only buyers of care, individuals with personal budget and self-payers are also part of the same rapidly expanding demographics of soaring demand for support.

All that means there are multiple different ways in which social housing providers can start to deliver care in a financially sustainable fashion – one which protects current housing incomes whilst introducing new mixed payer income models – across different sites and different types of care.

Getting this right requires you to know your way around the care marketplace, to do the right analysis to understand how you can deliver something of quality so that the numbers also stack up. Just remember, for every small care home or domcare provider you read about in the papers going to the wall, there are others who are not much bigger but are generating 25-30%+ margins. Imagine how helpful it would be to both meet the needs of your tenants, and bring in even close to those kinds of surpluses over upcoming years.

Ultimately, if you do some or all of this effectively, you will be keeping your tenants out of hospital – and that is the route to heart of health commissioners.

Bear in mind that one of the principal reasons that many Clinical Commissioning Groups are losing their appetites to think creatively is that they may well not exist in current form within 18months. But for all that change the nature of the system’s challenge will not alter – the NHS needs the ‘out of hospital’ bit, the supported at home bit, to work a whole lot better than it does today. And they will be willing to pay for solutions that are proven to work.

So my advice is to social housing providers is go with the flow – focus on care as the immediate route to supporting the growing needs of your tenants, doing so will give you track record and evidence the NHS cannot ignore forever and may just help your bottom line in the meantime.

For our part, we continue to work with some of the most exciting early adopters in this space. Between now and the end of the year, we will be shining a spotlight on some of those examples of where this is already working well – and calling on those we don’t know today to let us know what you’re doing so we can shout about it.

Email Campbell.McDonald@Baxendale.co.uk to start a conversation.

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