Paper 3
Response from : Care & Repair Cymru
1.
About Us
Care & Repair Cymru (C&RC) are the “Older People’s Housing Champion”. We are a national charitable body and actively work to ensure that all older people have homes that are safe, secure and appropriate to their needs. Care & Repair Cymru is committed to improving the health & wellbeing of older people in Wales by providing advice and assistance with home improvements, adaptations and general repairs. C&RC are part of a group structure with Community Housing Cymru and the Centre for Regeneration Excellence Wales and jointly champion not-for-profit housing, care and regeneration.
C&RC work in partnership with a number of organisations including the Welsh Government, Local Government Housing and Social Care Teams, NHS, Occupational Therapists, third sector organisations such as Age Alliance Wales, the Older Peoples Commissioner, and Housing Associations to ensure that older people have access to a range of housing and social solutions that enable them to live in housing that meets their individual needs.
There are 22 Care & Repair Agencies covering the whole of Wales. Each agency provides a wide range of services and support for older and vulnerable people, helping them to remain living independently in their own homes and communities. Every year, we provide services to some 30,000 older people, many of whom receive help with housing adaptations.
2. General comments
Care & Repair Cymru welcomes this opportunity to provide written evidence to the Inquiry into Home Adaptations.
It is well documented and recognised that we are living in an ageing society. In his publication ‘Adding Life to Years’, John Osmond (Institute of Welsh Affairs) says that in the next 10 years, the number of people aged over 65 in Wales will increase by about 5%, an increase of 130,000, and the number aged over 85 will increase by 30,000. In the next 60 years, the number of people in the UK aged over 65 will more than triple from 4.6 million to 15.4 million, and in that same timescale, according to the UK Government’s actuary department, the number of people aged 100 will increase from 10,000 to 1 million. Meanwhile, half the babies born in the UK today will reach the age of 100 according to the medical journal The Lancet. Care & Repair Cymru believes that ageing is one of the most important public policy issues facing the Welsh Government and it is important that good policy, practice and targeting of resources occurs to cope with the huge scale of increased need for services by older people, including from the NHS, Social Services and Housing.
The role of housing and in particular housing adaptations is important. Services such as those delivered by Care & Repair, and housing adaptations generally prevent the need for more expensive NHS and residential care services. On Health costs, the Independent reported that falls amongst older people cost the NHS in the UK £4.6 million a day or £1.7 billion a year. Hip replacement surgery costs about £25,000-£30,000 per case. Delayed Discharge of Care in Wales has been estimated to cost the NHS in Wales £30 million per year. The recent BRE report for Shelter Cymru estimated that poor, inappropriate housing costs the NHS £56 million per year, with the majority of costs due to falls amongst older people.
In relation to residential care costs, a recent study in a Welsh LA concluded that providing timely housing adaptations reduces the need for daily care visits; can reduce or remove costs of home care packages; and delays entry into residential care by an average of 4 years. The cost of residential care per case per year was estimated as £19,760. With the average cost of a DFG being around £7000, this equated to a cost saving of £72,000 per case for a timely adaptation. Put another way, each year delay in providing a DFG costs £18,000 to Social Care.
In Wales, we have a Rapid Response Adaptation Programme (RRAP), delivered by Care & Repair and funded by the Welsh Government. RRAP works by getting health or social services professionals to refer clients for relatively inexpensive work that either gets them out of hospital and back home, or prevents them being admitted in the first place. The average cost per job is just £135. We have estimated conservatively from information gathered over the last 10 years that each pound spent on Rapid Response Adaptations saves Health/Social Services around £7.50. The programme is acknowledged by all partners to be efficient and effective, yet demand exceeds funding and the programme has to be rationed.
In summary, timely adaptations contribute significantly to many of the Welsh Government’s strategic objectives in relation to older people, re-ablement services, prevention, early intervention and helping keep older people living independently at home for as long as possible. Keeping older people living independently at home and in their communities is where they tell us they prefer to be. In both social and financial terms, it is a better and a far more cost effective solution.
Therefore, further scrutiny of the adaptations system is welcomed, given the unacceptable delays still encountered by our clients. The focus on DFG however is too narrow. This is just one of many funding routes and mechanisms available to provide housing adaptations, albeit DFGs fund a significant and important chunk of adaptation work. We also believe that the Committee’s Inquiry needs to cross reference to the forthcoming review of housing adaptations which was a commitment of the Minister for Housing, Regeneration and Heritage within the recent Housing White Paper (and has already commenced). That said, our specific comments to the questions asked by the Committee are as follows:
3. Why are there still significant variations in the time it takes to deliver aids and adaptations funded by disabled facilities grants across Wales?
Significant variations exist because of the different ways that different LAs in Wales deliver their DFG and adaptation services. Those who have embraced best practice outlined in the Jones Review for WG (published in 2005), the follow
up Review of the Equality of Opportunity Committee report in 2009 and best
practice with regard to partnership working invariably deliver quicker, more cost
effective adaptation services. In summary, this best practice is:
Ø Working closely with Care & Repair in delivering smaller adaptations through the innovative Rapid Response Adaptations and/or Independent Living Grants.
Ø Delivering minor / smaller adaptations through less bureaucratic processes (e.g local authorities using flexibilities under the 2002 Regulatory Reform Power to Provide Assistance to undertake smaller, repetitive adaptations more quickly, often without resort to a means test or OT assessment)
Ø Operating accessible housing registers (in partnership with local Housing Associations) whereby adapted housing is matched and allocated to those who need it rather than taking out adaptations and letting as general needs housing.
Ø Ensuring that alternative funding is used for Social Housing tenants ie MRA for Council Tenants and PAG for Housing Association tenants, thereby ensuring that DFG funding goes further for homeowners.
Ø Where the social housing landlord function has been transferred through stock transfer, stock transfer organisations building the cost of future adaptations to meet the Welsh Housing Quality Standard into their Business Plans
Ø The need for Local Authorities to give sufficient priority, and thus funding, to DFG programmes from their unhypothecated general capital settlements from WG. Essentially, once authorities have streamlined their systems, and implemented best practice, there is still a need to adequately fund DFGs to meet the needs of demand led, mandatory DFGs. It is often reported that DFGs are delayed towards the end of a financial year as “the money has run out”. This clearly will increase DFG delays and waiting times.
4. Whether sufficient progress has been made on implementing recommendations from the Equality of Opportunity Committee’s report on home adaptations.
Following the Committee’s 2009 review, Care & Repair Cymru led the
development of better information on DFGs and housing adaptations generally
(both hard copy and web based), and produced this publicity information in
partnership with the College of Occupational Therapists, Age Cymru and the
Older People’s Commissioner. However, there are some parts of the 2009
Review which we feel may have not been sufficiently progressed. This includes:
Ø more formal review of Local Authorities progress in implementing the 2005 Jones Review
Ø providing assistance where poor practice is detected, and developing an on-going mechanism for sharing good practice
Ø the Welsh Government to determine local authority areas where partnership working could be improved and investigate the potential for Local Service Boards to drive improved partnership working
Ø The need for widespread good practice on adapted housing registers and allocation systems
Also it is unclear whether the recommended investigation by WG into LA numbers of Occupational Therapists (to meet demand in an ageing society) has been undertaken, and given this, whether LAs have sufficiently planned future workforce needs for OTs.
5. What impact reduced resources for housing are likely to have on the provision of home adaptations
Funding is an extremely important element of DFG performance. The Committee
will be aware that there is no ring-fenced provision of funding for LAs for DFGs,
and each LA determines the amount of funding it wishes to allocate for DFGs
from its general capital allocation. In this respect, LAs determine whether they
will reduce funding for DFGs and makes these decisions in light of other priorities
and pressures.
While it is clearly important to work in partnership with third sector organisations such as Care & Repair, to develop and implement good policy and practice for providing DFGs and housing adaptations, and streamlining systems to make them more efficient, more client focused and less bureaucratic, if there is no funding at the end of this, DFG waiting times will inevitably increase. The effect of this will be magnified as demand for DFGs and adaptations increases- in other words the double whammy of increased demand coupled with decreased funding will lead to much longer waiting times.
6. Is the Welsh Government effectively monitoring the provision of adaptation services
Committee will be aware that there is a statutory performance indicator for DFG
that measures the time taken from a client first contacting the LA about a DFG
to completion. In 2011, waiting times across Wales varied from 180 days
(quickest) to 638 days (longest), with a Wales average of 326 days. It is fair to
point out that this is an improvement from 2004 (when the average time across
Wales was 595 days), and 2005 (when the Jones Review for WG was published
and 3 authorities had an average waiting time in excess of 1000 days).
It could be concluded that the statutory PI and other recommendations introduced following the Jones Review has driven this improvement. However, it is also right to say that the current average time of 326 days is still far too long, and more improvement is necessary, particularly those LAs taking the longest.
As stated above, while the PI information is available and monitored, Care & Repair Cymru feel that more could be done to monitor LAs progress in implementing best practice from previous reviews, providing assistance where poor practice is detected, developing an on-going mechanism for sharing good practice and determining in which areas partnership working could be improved.
7. What more needs to be done to improve home adaptation services in Wales
· A major challenge is improve services around consistency, best practice, and partnership working, as identified in 3) above. Care & Repair Cymru believes that full implementation of previous reviews, along with specific following points will significantly improve adaptation services across Wales.
· The Rapid Response Adaptations Programme, as recognised good practice in delivering small adaptations should be expanded (with increased funding, ideally from central WG Health funding to compliment the current Housing funding and also be made available to Social Housing tenants, as recognition of the direct benefits to Health in terms of prevention and Delayed Transfer of Care (DToC).
· The Independent Living Grant programme brings flexibility for works costing between £1000 and £10,000 and independent evaluation concluded that it worked in terms of enabling innovation and shorter waiting times. This programme should be funded annually. This would ensure that recognised benefits are able to be consistently delivered.
· Continuing to nationally highlight the cost benefits to statutory services of delivering quick housing adaptations to ensure local political and officer priority and adequate funding to deal with demand