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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Agree with all you say of course but also agree that lack of funding inevitably has a negative impact on integration. There should be a more formal structures for integrated or joined up working at the front line so it becomes embedded into mainstream culture rather than a luxury that can or (more likely) cannot be afforded.
This has come through loud and clear in workshops we have been running. Peoples ambitions for integrated approaches often have a resource tag attached to them, but the benefits for the individual are manifold. One area where seems to be some easy wins at local level is around information and advice provision – many of the barriers raised seem to focus on lack of appropriate information between and about services.
I’m an occupational therapist and wrote a local report to highlight this fact. Local policy documents in our area related to children, for example, don’t even mention housing. Housing-related issues remain low profile and are perhaps not being fully explored or understood by decision-makers and those holding the purse-strings. Top-down approaches under utilise the skills and experience of those of us who work with people in need on a daily basis who are able to identify the gaps – but find it increasingly difficult to influence how best they can be bridged. Occupational therapists work in all three areas – housing, social care and health – and can help to form links and better understanding of roles and responsibilities.
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