Come in! The door is open…….#widerworkforce

Two reports out today show how the housing workforce can and does play a significant role in supporting people’s effective discharge from hospital, and their ability to live independently and healthily at home.

The Royal Society of Public Health have produced a new report on how the #widerworkforce can play a part in the delivery of public health messages. Once you get behind todays media fascination with getting your barber or your barmaid to tip you a wink about health checks – there is a critical message about how to engage the wider workforce.

I was delighted to see the leadership role of housing recognised within the report, and Sitra’s recent research on behalf of Public Health England showed that the housing sector was already contributing to the delivery of healthy conversations, supporting positive behaviour change and increased partnership working across health and housing. Clearly, the housing workforce has huge amounts to contribute to the promotion of better health in communities as one of the key trusted professionals crossing the threshold. In addition, housing provides a critical piece of the healthy living jigsaw, contributing invaluable expertise on the impact of the built environment on an individual’s ability to enjoy healthy independent lives at home.

Today, Healthwatch England also published their report ‘Safely Home’, bringing evidence from the experiences of over 3000 people leaving hospitals and care settings. This report particularly hones in on the experience of older people, homeless people and people with mental health problems. The report has five key messages about what people were experiencing when leaving hospital – poor co-ordination between services, not being involved in decision making , not having their full set of needs met, experiencing stigmatisation for their condition and feeling left alone without the services they need. On reading the report, I was heartened to see a number of good practice examples highlighting the effectiveness of an integrated approach between health and housing. However, despite having the term ‘home’ in the title there is clearly much to be done at both a strategic and operational level to securely bring housing and housing into the frame in order to improve the experience of those coming ‘home’ from acute care.

We know from the 2013 DCLG English Housing survey that 3.7 million households live in social housing, and an ever growing number of these households will be populated by exactly the people that both Healthwatch and the RSPH reports highlight as critical to reach. Both reports give greater strength to the message stated in the Care Act 2014 that, ‘housing is a health related service’ and our research with Sitra members shows that there is a skilled and willing workforce who are holding the door to health wide open……

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#Integration – a three legged stool……. #health #housing #socialcare

The Care Act 2014 raises the profile of housing as a health related service. It particularly highlights the importance of it in the statutory guidance to be found in section 15. Key phrases there include:-

“Housing is therefore a crucial health related service which is to be integrated with care and support and health services to promote the wellbeing of adults and carers and improve the quality of services offered”

Section 15.48

Yet – why is it that everywhere I go, the debate about integration seems firmly fixed on how to integrate health and social care – leaving housing firmly on the shelf. We do that at our peril, it seems to me, particularly as the ambitions of health and social care are fixed firmly on a future where provision is focussed around strengths and independence and remaining at home.

Sitra and Skills for Care have started off a series of events looking at the Care Act and the Integration of the housing and care workforce. Looking particularly at the points where housing and domiciliary care intersect, and how that interface could be improved in order to achieve greater outcomes for the individual. The challenges coming out of it will not be a great surprise to anyone who has been working on the agenda of integrating health and social care and included:-

  • There is a need for central coordination, as without this integrated approaches could get very messy. This is particularly an issue when discussions around data sharing come to the fore.
  • Holistic approaches to working are not part of most workforce development approaches, so integration efforts are rowing against a tide of professional practice that focusses on boundaries, rather than connections
  • Relevant partners do not know enough about what each other are doing – key roles such as GPs and tenancy support officers need to know enough about what other partners can offer. It also needs to be clear when, and why, responsibilities end.
  • Some of the challenge of working in this way arises from different perspectives of how to work with individuals – interplay between medical and social model.
  • Funding streams do not encourage integration. Better care fund seeks to address some of this, but does not include the funding of key integration partners – reinforcing the drive to integrate – but only within the new funding regime.

The need to have housing firmly involved in integration discussions seems compelling. The challenges raised above are being replayed all over the country, and the resource and effort to enhance integrated working should focus on getting all three key partners round the table. The people that are at most risk, that need the most support to live independently, that would most benefit from early intervention and preventative services are frequently of shared interest to all three partners. If the positive support and efforts of the parties could be coordinated, with the individual at the centre, then the current challenges of integration could quickly become the benefits of holistic person centred care and support.

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From #strength2strength…….

Strength – we all have it – but sometimes it is more difficult to let it show, or to believe it will be valued, or indeed to recognise it in ourselves.

Our Sitra conference this year brings to life the many different ways in which people can and do show their strengths, and celebrates success, diversity and difference.

Delegates can expect to sing out in celebration with the Choir with No Name, challenge the stigma around mental health with Time to Change, sit in on a conversation with dementia communication activist Sarah Reed , Chris Roberts and Suzy Webster, hear how coproduction is going down with Sitra partners in Europe and understand from Martin Simon of Nurture Development how strength based working is the only way forward for communities! But that is not all! Jimmy Carlson, OBE, will be sharing how his life has changed and the importance of client led initiatives such as Groundswell. Peter Yarwood will inspire with his story of how he used his strengths to form the Lancashire User Forum, a dynamic stakeholder group for people with a commitment to recover from substance misuse. Colleagues from Change People will challenge us to think differently about how people with learning disabilities can and should be employed in the delivery of support services. We will also hear from participants from the London Housing Foundation funded programme Pulling Together who will share their experience of how a tailor made accredited training programme has brought their lived experience into the learning and development arena.

The policy agenda is shifting to sit firmly behind the strengths based agenda, and this will also be an opportunity to think about how the housing sector can show its strengths. Shirley Cramer from the Royal Society Public Health will talk about the great opportunity for the housing sector to lead the way in promoting health messages – building on our trusted connections across our tenants. Sticking with this them of building on existing relationships, Sian Lockwood from Community Catalysts will talk about how community based housing related support services have nurtured the development of new enterprises to better meet the needs of individuals within the community.

Person-centred work remains key to Sitra, and Think Local Act Personal (TLAP) will be at the conference, sharing resources and ideas for how organisations can ensure their services are focused on supporting independence and strengths. Sitra have been working with TLAP to develop ‘Making it Real’ for Housing with support, and hope to use the launch of it later in the year to boost integrated understanding of how key messages to strength based working can be used across sectors and settings.

Finally we are delighted that alongside our fantastic array of speakers, we will also be joined by a great range of exhibitors, many of whom will be showcasing the strengths and success of client led enterprise.

If you can’t join us in person – then do at least connect by following #strength2strength

 

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‘Patchy’ Progress – Housing and the Care Act 2014 #healthbeginsathome

Last July, myself and a large group of Sitra members, sat listening to one of the Transformation Managers for a London Borough, talk through her responsibilities for the successful implementation of the Care Act 2014. The list of tasks, partnerships, priorities, and plans seemed endless, and the ambition was huge. Around the country, hundreds of staff in Local Authorities have been following the same agenda, and today is the day when plans become realities and policy becomes practice.

So – have you managed to take the opportunity to influence your local authority? Have you got round the table to inform the integrated spend of the Better Care Fund? Have you reframed your services around wellbeing and prevention – key components of the Care Act?

At the national level, there is growing support and understanding of the role housing has in ‘integrated delivery’. A recent blog by Andrea Sutcliffe, Chief Inspector of Adult Social Care, highlights her understanding of the housing role – with a key reminder that ultimately the prize is better services for people, not more efficient processes (because – let’s not be shy – it is possible to get the latter without the former!!). A conference held this time last year, by Placeshapers, brought together public health, NHS England and ministerial support for the role that housing could play in the delivery of community based, integrated, preventative services. Finally, if you are keen to wave a piece of paper to get your point heard – you need reach no further that the long awaited Memorandum of Understanding between Housing and Health, which came out at the very end of 2014. This key document outlines a national commitment and understanding of the role that housing plays across the health spectrum.

So, if nationally there is a growing voice, how does it feel on the ground? ‘Patchy’ seems to be the political phrase of the day! (Oliver Letwin’s words – according to Tony Stacey). Telling, I agree, but not news! I have spent December and January touring round with the LGA hearing about how the integration of health, housing and social care is working on the ground. I know that where it is working, the results are positive, but there is no obvious structure/plan for scaling up. I think that we have that structure now in the form of the Care Act 2014. It seems to me this is the only structure we are going to have for the foreseeable future – and very importantly it is a structure that recognises the potential role for housing.

I am cheered by the way that housing organisations have responded to the opportunities arising as part of Devomanc, and see this type of ‘alliance’ as a critical part of future discussions with health. Whilst I too share the frustration that recent announcements around Vanguard sites and Integration pioneers do not ‘name’ housing, I think that there is really positive work in play that has already influenced national parlance around housing, and will soon support the local shift from ‘implicit’ to ‘explicit’. Just remember – if the local priority is to keep people living as independently as possible, as healthily as possible for as long as possible – they need a home to do it in! #healthbeginsathome

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Reflections on #Leadership in the #Homelessness sector

The London Housing Foundation Leadership programme comes at a very important time in transition of the sector, reflects Julia Unwin of Joseph Rowntree Foundation. Next year is the 50th anniversary of Cathy Come Home – this will bring a sharp focus on the work of homelessness and housing. Julia reflects how this narrative set in train a series of actions that changed things within the sector- putting a statutory and regulatory framework around the sector which offered a stronger base to support individuals and families at risk of homelessness.

Despite the focus on street homelessness in the 80’s and the public outcry that ensued, the problem still grew. A critical breakthough came about by the ability to define the problem in a way which showed that it could be solved. The ability to do this, and lobby government to understand the problem, was critical in shaping the Rough Sleepers Unit. During the 90’s under the Rough Sleepers Unit there was real reduction in the number of people living on the streets. Importantly, Julia feels that during that period there was a real break in the connection between poverty and squalor. Is there evidence that we are slipping back to this connection – when we are seeing the advent of ‘beds in sheds’.

Are we heading for another significant transition – what are the key factors that we need to recognise, anticipate and understand. Deficit reduction will be the priority of any future government’s top priority. This drive is raising a really big discussion about the size of government and this impacts on the views about what government can do and what it’s priorities are. This has huge impacts on the available directional spend of local authorities, but perhaps almost in response, authorities are now flexing their power in defining their legitimacy in terms of their local democratic responsibilities.

It is important for the homelessness sector to understand the impact of a hugely bifurcated workforce – where there are two completely different experiences of employment – those with better paid job security – and in a contrast a huge growth in very insecure positions, with an extreme levels of casualization in the labour market – and the crisis in the housing market is making that notion of ‘getting on your feet’ being further from the reality for the vast majority.

Julia also reflected on how technology is not just changing the way we do things, but also the things that we do. This provides the ability to deliver much more detailed analysis of individual’s potential outcomes – around health, educational attainment, and many other social determinants. The homelessness sector needs to understand the potential impact on those who are homeless and we must understand how that might impact on the ability to generate ‘solidarity’ within communities. Need to recognise that welfare reform and the sanction regime will drive many people under the radar.

Leaders of the future need to recognise that there will be even more accountability, even more scrutiny and even less understanding of those who are homeless, a strong creation of ‘other’ that we must challenge and ensure that the voice of those who are homeless is heard and listened to.

Matthew Taylor of the RSA then joined the session – and from the start – was modelling his vision for effective leadership by bringing challenge and support to delegates on the London Housing Foundation leadership course. He urged the sector to bring some clarity to what it is talking about when it talks of homelessness. By conflating issues associated with inadequate housing and those who are sleeping on the street – the sector runs the risk of being out of control of how the discourse we wish to inhabit is interpreted, or with what it is aligned.

Matthew also laid out some pointers to the future leaders of the sector – starting with a timely reminder of the moral imperative that you must constantly ensure that you focus on mission rather than organisational glory!! We share challenges that the third sector as a whole faces around impact and the need to have clarity about what we want to do, be courageous and understand what your ‘model of change’ will be. In the process of change, then you may need to ‘dethrone the elite’, capitalise on untapped assets, co design and examine culture.

In order to be successful leaders you need to collaborate. He reminded us we are not in a ‘self indulgent’ period, where existence is a given, you need to get challenged, ask for help, break down barriers and look outside of the sector. Innovate – but radically – not incrementally – and ensure you have, or make, the capacity to stand back and look at how things could work differently. For example, if we fail to understand and connect with new social movements then we will get left behind. The way in which the homelessness sector operates needs to tap into this much more localised space.

He also left us with a poignant thought around the politics of ‘telling it as it is’. What are we afraid of? If we are clear what we are talking about, and give people the full picture, then they can act. He warned of the dangers of ‘progressives’ (I think he was talking about us!) leaving a vacuum in social and political debates where there is no obvious ‘blanket’ incitement or opposition in support of the sector as a whole. If we can’t or won’t articulate a nuanced response – then the space is left wide open for those who wish to polarise and simplify opinion and perspectives.

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Shining a blue light on housing……

Domestic news has been dominated this week by hospitals – with headlines focussing on the rate of admissions – and behind the scenes focus on the rate of discharge. The connect with the hospital location has meant that so much of the dialogue has been around peoples immediate health needs, but in a sense, the story I want to talk about is about what do people need to get back home.

Over the last month Sitra have been working with the LGA to promote the role of Housing in the integration agenda – recognising that together health, housing and social care can provide real alternatives to the existing models of provision. I think that this is the thinking that housing can bring to the current acute crisis. For most people entering or leaving hospital, they will be coming from home and wanting to return home. It stands to reason then that those who offer housing services are a critical part of the response. To date that contribution has been largely untapped – now we want that to change.

I have been talking with our members about what could be offered to support the immediate challenge – and there are definitely both national and local responses which could support both the push and pull on acute services. Key resources exist within the housing sector.

For example there are large numbers of highly skilled housing support workers whose focus is on supporting people to live independently who could be a critical force in enabling someone’s smooth return home. They are often strongly connected to a locality, and could be an immediate bridge to local services, helping build up a robust network of support, for instance, in those first 48 hours and beyond, when someone comes home.

Many localities will have handyperson or home improvement teams who can rapidly respond to help make temporary adjustments to individuals homes to ease their return home after an operation or fall – including grab rails, moving furniture round for ease of access or beginning the process of longer term adjustments such as stair lifts or flat access bathrooms. Peoples entry to hospital can often be exacerbated by their living environment – and connecting up with landlords early on can mean that issues around heating, damp, condensation or hoarding – can be addressed during the hospital stay – meaning that they can return to a safer healthier environment.

Finally, housing may have suitable short term accommodation to offer a transition for those who no longer need hospital care, but are unable to return to their own home – potentially for short term access reasons, for example they have short term use of wheelchair for recuperation purposes or indeed whilst repairs or longer term adjustments are being made to their own home.

To get the most out of housing, we need coordinated responses which have housing at the table. There are a small number of existing examples of housing support professionals embedded in hospitals – both in the accident and emergency room – and in the discharge team. We need to escalate this approach and make sure that every hospital has the support it needs to make the best use of these housing resources. Pilots have shown it works – it saves money – and most importantly – it gets people back where they want to be – home.

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Dementia Leadership – Housing takes up the challenge…..

 

Earlier this year, a new partnership was formed between Sitra, the Housing LIN and the Association for Dementia Studies (University of Worcester). This partnership developed a number of courses that were specifically tailored to help housing providers – both general needs and specialised providers – to understand the role that they could play in supporting people with dementia living in the community.

Professor Dawn Brooker, International expert on Dementia, leads Day 1 of the strategic leaders event and here reflects on the importance of the course.

“If you’re wondering why managers in the housing sector should be interested in dementia, read on. The housing sector has a vital role to play in helping people with dementia to live well as most people with dementia live in their own homes, including sheltered housing, extra care and general needs housing. With the number of people living with dementia set to double over the next 30 years, having an informed and skilled workforce is essential for improving care and support for people with dementia and their carers and as a manager you are a key part of this picture.

In order to be an effective leader and manager you need to have the right knowledge and new courses have been developed specifically for managers in the housing sector, so whether you are a manager working at a strategic level or an operational scheme manager, there is a course to suit you.”

The Strategic Leaders Programme a 2-day course, was recently held in Birmingham in July, and received excellent reviews. It covered  a range of topics including person-centred care, the enriched model of dementia care and how it relates to practice, and the VIPS framework. The course also provided an insight into developing best practice around housing and dementia, helping you to appreciate ‘what good looks like.’

I was involved in delivering some of the sessions, and attended the review day for the course, where participants talked about how they had implemented the learning. I was inspired at the progress that organisations had made including:-

  • Work taken place with property services team and in the process of setting up dementia friendly brief for all new developments and for cyclical planned work.
  • Visits made to over 400 older residents – providing a fantastic opportunity to understand what they want from services to support their continued independence.
  • Senior Directors have attended dementia champions training. They are now rolling out dementia friends training to five hundred care and support and housing staff including the chief contractor, handypersons and voids services

Recent research carried out by the Housing LIN into the skilling up the general needs housing sector around Dementia highlighted the need for a bespoke course. I am really pleased that Sitra, Housing LIN and ADS have formed this exciting partnership to put this into action. We are running another strategic leaders course on the 25th and 26th November in London and taking bookings now – for more details check our the Sitra site here.

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