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Caring for the Future Together transforming housing and care

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IN WALES WE’RE RE-IMAGINING HOW WE CARE FOR THE FUTURE. CONTENTS THE INTRO 03 Caring for the Future 05 Wales Leading the Way 06 The Challenge 08 What’s the mission 10 Hafod’s Reality 11 Hafod’s Vision 12 Where Do You Come In? THE IDEAS 13 An Integrated System for Housing & Care 14 Ideas for Changing the System 16 The Need for Big Ideas 19 Neighbourhood level outcome commissioning THE CHALLENGES 20 Looking Beyond the Symptoms 21 Framing the Challenges 23 Worksheet: Map Your Challenges & Sketch Your Ideas APPENDICES 24 The Journey So Far 27 Notes 28 Mapping a Journey Through ‘the System’ 31 Thank you and notes 32 Change Lab Agenda 33 References 34 Bibliography 2


Caring for the Future We find ourselves at a moment of significant transformation in the future of our neighbourhoods - from the roles and provision of social housing, our capacity and ability as a society to care, and our models of economic development and resilience building.

As for Hafod, with the significant scale and scope of our delivery across care and social housing, we recognise that we are in a position to innovate, by developing revolutionary ideas to integrate housing, health and care. Working with our residents and our partners in Wales we intend to disrupt and transform, helping to build neighbourhoods truly fit for the 21st century.

Our communities in Wales face growing challenges of persisting austerity, growing inequality, a shift in demography, increased loneliness and isolation, and concerns over falling levels of well-being. However we also have the best policy landscape in the UK to make the changes we need. The opportunities of new technology, new business models and new means of operating, invite a once in a generation opportunity for transformation.

Whilst we at Hafod and our partner Dark Matter recognise the need to actively lead and host this transformation, we also recognise that this shift cannot be undertaken by one organisation alone, requiring a movement for system transformation with collaborative innovation across all sectors.

3


A COLLABORATIVE WALES ‘People [should] have control over what support they need, making decisions about their care and support as an equal partner’ Social Services & Well-being (Wales) Act 2014


Wales leading the way... Parliamentary Review of Health & Social Services 2018

Prosperity for All

- A call for a fully integrated system - Put people in control of their health - Empower care staff and carers - A call for innovation and learning

2017

Taking Wales Forward

- Care as a foundational sector - Focus on innovation and technology - Focus on regional economic development - Commitment to improving mental health

2016 - Recognition of a full spectrum of prosperity and care - Commitment to technology - Support for cooperatives & mutuals - Measures to address land economy

Social Services and Well-being (Wales) Act

Well-being of Future Generations (Wales) Act 2015 - Long term & future focused - Defined well-being goals - Duty to future generations - Sustainability at its core

2014 - Well-being focus - People First - Partnership & Integration - Emphasis on prevention

Housing Act 2014 - Focus on early intervention - Make best use of resources - Working with people - Working across organisations

5


What’s the challenge?

Disposable Household Income (relative to UK)

105

+145%

% Relative to UK

100

+40%

0-16 yrs 16-64yrs 65-84 yrs 85+ yrs INCREASING DEMAND FOR -1% -1% CARE & HOUSING...

15

19

97

75

By 2030 household age in [1] will be...age By Wales 2030 household

20

Next 20 years of Demographic Change

UK Scotland Wales England N. Ireland

Next 20 years of Productivity demographic change across the UK in Wales [2]

in Wales will be..

UK Scotland Wales England N. Ireland

105

Output per hour

100

+145%

+31% more people

+40%

predicted to suffer from dementia by 2021[3]

1/7

20

19

15

75 97

Next 20 years of Demographic Change 55+ yrs

65+ yrs

0-16 yrs

16-64yrs

-1%

-1%

40,000 £10bn

By 2030 household age people evicted in 2015 will physical care costs caused in22% Wales be.. 22% of people of people in Wales have in a Wales have a

85+ yrs

£3.6bn

annual public spend due half of all ApproximatelyApproximately half of all up 33% since 2003 (UK) by mental illness (UK) (£1,150/ long-term health problem or disability to poverty buildings used asper.) adult long-term health problem or disability

People live in poverty due to housing costs

[5]

buildings used as adult [6] [7] limits their day-to-day activities. that limits theirthat day-to-day activities. care care homes are overhomes 50 are over 50 This of rises to 33% ofinpeople living in old. This rises to 33% people living years old. years social housingsocial housing

1 in 5 people in

30% of adults are

30 min

65-84 yrs

active for < 30 mins a week - costing £35m in preventable treatment [8] 30 min

ovation and energy and energy Renovation ormanceperformance will be a key issue will be a key issue

1/5

1/5

65+ yrs 6

Predicted housing Predicted housing demand is citydemand focusedis city focused

% change of

% change of

Wales have a long-term health problem or disability - rising to 1 in 3 in social housing. [9]

55+ yrs


100

15 20

19

THE SOCIAL CONTRACT IS UNDER STRAIN...

Productivity across the UK Disposable Household

Productivity (relative to UK) [10] Income (relative to UK)

Productivity 75 across the UK

30 min

97

UK Scotland Wales England N. Ireland

19

Disposable Household Income (relative to UK)

Disposable Household Income (relative to UK) [11]

% Relative to UK

20 15

100

UK Scotland Wales England N. Ireland

15

% change of projected housing need over next 20yrs

UK Scotland Wales England N. Ireland

HOUSING NEEDS ARE CHANGING...

2.5% of housing built in last 25 years 105 100

15

20

90%

of Welsh housing is more than [13] 25yrs old

-2%

15

19

97

75

+19%

+17%

2 Adult w. more than 2 children

0%

-6%

20

19

97

Output per hour

Output per hour

Productivity across the UK

demand is city focu

20

20

15

UK Scotland Wales England N. Ireland

19

19

97

75

105

75

household of councils in 2017 Household profile is composition change over becoming more individual anticipated making cuts in the next 20 yrs Predicted front-line services (UK) [12] housing Predicted

UK Scotland Wales England N. Ireland

vation and energy Productivity across the UK mance will be a key issue 100

+40%

105

99 7

Output per hour 1

100 75

97

UK Scotland Wales England N. Ireland 15

100

75

1/5

20 15

100

Output per hour

19 97 105

105

UK Scotland Wales England N. Ireland

105

75

% Relative to UK

UK Scotland Wales England N. Ireland

20

% Relative to UK

97

75

Powys 1 Adult 1 Child

1 Adult

Merthyr Tydfil

Smaller homes

Predicted demographic change over the next 20 years [14]

A CARE INFRASTRUCTURE NOT FIT FOR PURPOSE...

1/3 of

300%

39% of

increase in home visits in bed-blocking [20] Wales are less (2010-2016) than 30 mins[19]

80% of councils

Britainâ&#x20AC;&#x2122;s care providers are at risk of failure [21]

report not having enough older peopleâ&#x20AC;&#x2122;s care to 12% of population 32% est. domiciliary meet demand (UK) provide unpaid care care staff turnover [16]

[17]

7

[18]

1%

Angles


What’s the mission? CREATING A CARE MOVEMENT

LEADING FROM THE FRONT In recognition of our collective responsibilities, we are hosting an intensive ‘change lab’ to understand what a caring neighbourhood fit for the 21st century looks like. In this two-day event we’ll focus on some of the ideas and challenges laid out in this booklet. We believe Wales sets a strong context for change and our ambition is for Hafod to become a world class organisation ‘Caring for the Future’.

Change of this scale needs many of us to work collaboratively together whilst growing our capacity to innovate. We cannot do this alone, so we’re launching a movement which we call ‘Caring for the Future’. With this we hope to design a shared mission for change and create neighbourhoods truly fit for the 21st century.

These laboratories will be focused on system innovation, recognising change has to span from policy & procurement to services and the social contract. For some time Hafod has been exploring what it means to be an innovative caring organisation and what it might look like if people, practitioners and organisations were to have greater control of their needs.

MOVING BEYOND SILOS Making this future a reality requires us to transform together, both internally and together as a movement.

Temporary support housing with integrated care support built in

To address the systemic problems of our age; poverty, obesity, climate change and inequality, we must think outside our current methods. We need a more collaborative and system based approach to care & housing. This means moving beyond silos - that create their own internal methods, cultures and languages - which can create strong barriers to positive change. We have already started this work in dismantling our internal silos – driving the integration of our housing and care services.

‘Home-grown’ respite centre

Social prescription

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RESPONDING TO CHANGE

FROM GLASS HALF EMPTY TO GLASS HALF FULL

The Welsh Government recognises that our existing ways of measuring care outcomes requires new thinking, and is leading by example with key shifts in policy. Both the Well-being of Future Generations (Wales) Act 2015, and Public Health Walesâ&#x20AC;&#x2122; Outcomes Framework signal a significant turning point in how we create the right conditions for care. Our ambition is to incorporate and manifest this framework into the reality of our neighbourhoods in Wales, both in terms of what we do and how we do it together.

The things we measure define what we manage, and with it the quality of the outcomes. In systems designed to care and safeguard, we often end up focusing on trying to avoid negative outcomes, which cultivates a highly transactional service pattern. We believe this approach can be challenged with a more asset based approach, not only in practice but also in how we measure our success. Shifting the aspirations and outcome metrics from ones that are purely deficit based - glass half empty - to a more asset based model glass half full - is the only way we can build on potential in our communities, drive greater involvement with people, engagement amongst staff and innovation capacity within the organisation.

Sustainable forest for local house building Local energy production with person to person trading

Community facilities funded by joint social prescription Self-build neighbourhood

Self-managed community nursing team

Local anchor institutions

A dementia friendly high street

A care home come nursery

9


Hafodâ&#x20AC;&#x2122;s reality Hafod services currently span a network of care and housing models across ten local authorities in Wales - including extra care, nursing homes, supported housing, home care and affordable housing. Hafod has a strong commitment to training and development of staff, the improvement and reconfiguration of services, investing in collaborative partnerships and driving cutting edge research and evaluation to better serve the care and housing sector in Wales.

1,200

staff members

ÂŁ56m turnover

16,000 people

5,000 homes

across 10 local authorities 10


Hafodâ&#x20AC;&#x2122;s vision

CREATING A NEW NEIGHBOURHOOD MODEL BY INTEGRATING HOUSING AND HEALTH ON THE GROUND Our goal is to build momentum around shared purpose and develop partnerships across the board; from schools, families, hospitals, GPs, universities, alongside commissioners across local authorities and local health boards. By reconfiguring existing provision, developing new services, and forming new partnerships we want to develop an environment that provides housing, care, skills and support focused on community based, person-centred services. Our vision of care will be:

PERSON CENTRED

Focusing on community and citizen strengths to help people take ownership to achieve their personal and collective ambitions

TACKLING CAUSES NOT SYMPTOMS

Delivering preventative services that improve the quality of life of the individual and create sustainable finance for the long term

A SEAMLESS SERVICE

OUTCOME BASED NEIGHBOURHOOD

UPSKILLING THE WORKFORCE

A ROBUST EVIDENCE BASE

One provider able to support people along different stages of their personal journey

To work across organisation and service boundaries

A service delivery model in which services are delivered against commissioned outcomes

That measures the impact of interventions against a suite of financial and wellbeing metrics agreed with commissioning agencies 11

OPEN CO-PRODUCTION

Kick starting with an open and transparent lab, inviting external partners for crosssector collaboration to tackle complex challenges


Where do you come in? CARING FOR THE FUTURE – A CHALLENGE NO ONE CAN DO ALONE.

Wales is at a moment of radical transformation. From the impacts of austerity, an ageing population, rising levels of poverty, isolation and inequality – the very basis of our social contract is at stake. Yet the new technology, new business models and new models of cooperation and coordination are inviting the catalyst for change. The two-day change lab aims to build an integrated movement for care and housing; to kick start a new chapter in our capacity as a society to care. We thank you for your attendance and look forward to working with you.

IT’S TIME TO CHANGE TOGETHER; JOIN US AND BE PART OF THE SOLUTION.

12


housing

Fully integrated housing & care system IMAGINE IF... ...housing was an integral part of any health care model. A fully integrated housing and care system tailored towards creating an environment for preventative healthcare. One that aligned the supply chain, construction, adaptation and allocation of housing to drive new partnerships, practices and services.

WHAT DOES IT ADDRESS? We know that the built environment is one of the largest determinant factors on our health & wellbeing. We also know that until now the financing, commissioning, planning and provision models for both of these sectors have been categorically and systematically siloed. Creating a model that can sufficiently address these challenges will require massive cross sector and organisational collaboration in order to drive a fully outcome based care model. 13

care


IDEAS FOR CHANGING THE SYSTEM When we think about new ideas for care and housing we often jump straight to ‘the service’ or the ‘housing type’ - that we should find the examples of good work and scale them up. However beneath the surface of these great ideas there are often structures and systems that keep them from growing. This drawing brings together a series of ideas that we think can create a new system for a fully integrated care & housing model - a ‘Caring Neighbourhood’ for the 21st century. Sustainable forest for local house building Local energy production with p2p trading

Self build neighbourhood

Temporary support housing with integrated care support built in

Self managed community nursing team

‘Home-grown’ respite centre

Community Impact Bonds

2 Housing Association as Platform

The Caring Neighbourhood

1

10

12

4

3

Allocation to Context

Co-designed Investment Planning

6

9

Community Anchor Institution

New Services & Typologies

A dementia friendly high street A care home come nursery

Social perscription

A New Model of Ownership

Local anchor institutions

New Allocation Methods

Neighbourhood Outcome Commissioning

5 An Employment Contract for Care

7

8

11

A Regulation Sandbox for ‘Care-Tech’

Neighbourhood Planning for Well being

Preventative Accounting Innovation

A new civic platform for Wales

New Business Models

New Supply Chains

A Smart Contract for Care

00

New Technology

New Policy & Regulation


NOTES


The need for big ideas We should not underestimate the scale of the challenge we face; currently our care sector is on the brink of collapse, while the housing market continues to fundamentally under serve vast amounts of the population. While examples of great work can (and should) be highlighted - many great ideas in isolation don’t add up to meaningful change at a whole system level. One of the real structural challenges we face is the systemic loss of our ability to imagine a better tomorrow — real alternative futures — not just tinkering with the old world we find ourselves locked into. These alternative future ideas can transcend our day-to-day reality through the articulation of a greater goal. These are not unachievable hypotheses. We have a history of realising these imagined alternative futures. Wales’ favourite son, Aneurin Bevan, built the National Health Service - totally dismantling a private health care market. Nye Bevan, a working-class coal miner’s son who failed at school, had a vision of socially compassionate communities. At the age of 23 he founded a club to collect money each week for those in need in his locality – the majority of which was for healthcare. This initiated his desire to become the architect of the NHS – to influence this he needed to be Minister for Health…a long way from the mines of Tredegar.

Aneurin Bevan had a vision - that would not be achieved by sitting back and not alone. Yet now, as the threats to our institutions and systems we most rely on mount, we are reduced to tinkering. This is an age with a necessity for big ideas to become reality – not a time for conceptional conversations. It is a time for ideas which seek to transform and disrupt our shared perception of reality. Those that end in action and outcomes for our community. The real innovations of our age are not beyond our imagination or even our scientific analysis. If we are to really address the crisis facing our societies at all levels we must re-embrace our ability to make better futures and believe we can make better societies.


‘Discontent arises from a knowledge of the possible, as contrasted with the actual.’ ANEURIN BEVAN 1952


What if...

A FUTURE WALES A prosperous, resilient, healthier, more equal and globally responsible country with cohesive communities, a vibrant culture and a thriving Welsh language. Well-being & Future Generations (Wales) Act 2015 18


Neighbourhood level outcome commissioning IMAGINE IF... ...we could commission for the well-being of entire neighbourhoods - rather than just for specific services for individuals. An environment providing housing, care, skills and support, but focused on community based person-centred services. What if this created fundamentally new roles in our society - reshaping the role of a GP team to be able to shape a network of formal and informal services, housing provision and preventative investment.

HOW COULD IT HAPPEN? The reconfiguration of some existing provision, developing new services, and forming new partnerships. Ideas and actions underpinned by a robust evidence base that measures the impact of interventions against a suite of financial and well-being metrics agreed with commissioning agencies. The model would include the upskilling of the workforce to work across service boundaries.

WHAT DOES IT ADDRESS? Commissioning is largely focused on new services and signposting - while this remains useful - it destroys the capacity for informal care to play. Tying health and well-being outcomes of a neighbourhood to commissioning funding structures would form the basis of a new type of universal service - lifting the outcomes of all, rather than individual service users or specific groups. This would allow us to move away from service provision at the point of crisis to a model of preventative commissioning based on neighbourhood level outcomes that allow for a local, contextual network of care.

19


CONTRACTING

HR contracting focuses on avoiding risk rather than inviting you to care for people & their environment

PLANNING FOR THE FUTURE Isolation is designed into the system

REGULATION

Centralised risk management creates more bureaucracy and deskills staff

BUSINESS MODEL

MANAGEMENT

Centralised management destroys the capacity for informal care and alienates people through bureaucratic processes

Changing demand & new technology is driving a move from cost mitigation to value creation

Emotional and social isol ation

‘Bad’ financial management Reduced face to face interaction

Increased demand

Increase in digital services

Poor mental health

Financial pressure

Increased demand for public infrastructure

Digitisation of services

Availability of debt finance

Unsus tainable tenancies

Low productivity

Social ly isol ated community

More cars

Cheap debt financing

Demographic/ househo ld chan ge Build on the outskirts of the city

High demand for social services services

Rise of zero hours contracts

Lack of signposting

Social stimga

Cuts to public services

Demand for cheap housing

Insecure work

Sho rtfall in housing

Falling productivity

High demand for social housing

Austerity Change in policy

Low staff moral

Efficiency and centralised management

Political resentment

Higher eligiability criteria for public money

Brexit Focus on void and bed management as a proxy for need

Increased future cost to the system

Increased bureaucracy

Crisis management Lack of informal support

Escalation of conditions

Managerial language

House used as a savings pot

Lack of resource to cater to people’s needs

Criteria driven process

Care at the point of crisis

Rise in ‘bedblocking’

‘Time & task’ care

Standardised services and over simplified metrics Focus on where stock is available

Difficulty to create integrated community

Loss of personal agency

Unsustainable tenancies

Burden of bureaucracy

Alienating language Homelessness and temporary accommoda tion

Stigma of social housing

ACCOUNTING No way of knowing future costs across the system

Poor quality, unaffordable housing

Resisitance to new development

Housing as crisis support

Consolidation of people in crisis

Housing speculation

Increasing house prices

Throughout a series of workshops, interviews and stakeholder engagements we mapped out the forces that connect the common problems we often talk about high demand, reduced budgets, bureaucracy, etc. - in order to uncover the system challenges that lie behind them.

Looking beyond the symptoms...


... and framing the system challenges

We discovered seven core challenge categories that span the entire system, not just within individual organisations. These categories helped us to frame specific questions for how we might think about the future of care.

â&#x20AC;˘

What it would look like if we could account for the value business creates, rather than just the costs it saves?

How do we manage risk in a decentralised, informal care network?

REGULATION

How do we plan for demand across silos and across organisations?

PLANNING FOR THE FUTURE

BUSINESS MODEL

MANAGEMENT

COMMISSIONING

How do we build the trust, support & accountability in a de-centralised informal system?

How do we commission the informal everyday conditions for preventative care?

ACCOUNTING

HR POLICY

What type of financing allows us to see welfare as an investment rather than a cost?

What does a HR contract look like which invites care rather than risk avoidance? 21


REGULATING THE FUTURE

PLANNING FOR THE FUTURE

Regulation centralises knowledge, skills and risk management. What does regulation, risk management & insurance look like if we want to create individual, user centred care?

Predicting demand is largely an illusion - many services within the care system are reacting to multiple real time crisis situations simultaneously. How do we plan for demand in a changing, multi-actor system?

COMMISSIONING FOR THE FUTURE

MANAGEMENT FOR THE FUTURE

Our funding models focus largely on services - with the language, criteria and regulation often blocking a more human-centred approach. How do we commission to create the everyday, informal conditions and the preventative investment?

High demand & high risk often create top down, centralised management systems. This is expensive and reduces the agency, knowledge and creativity across the board. How do we build the trust, support & accountability to create de-centralised management?

CONTRACTING FOR THE FUTURE

FUTURE BUSINESS MODELS

Much of our HR systems are designed for the worst case scenario - inviting liability rather than possibility. What is a HR contract which invites care in an ‘Emotional Labour Economy’?

Our current ‘business’ of care is focused on getting as much value for money as possible. What would a caring organisation look like if it could account for the value it creates, rather than just the costs it saves?

22


Challenges

What are the biggest challenges facing housing and care systems? Why is this a problem?

Your big ideas What is your idea? What would we need to change in the system? Who and what resources would it involve? How could it make a difference?


The journey so far... For some time Hafod has been exploring what it means to be an innovative care organisation and what it might look like if people, practitioners and organisations were to have greater control of their needs. This timeline shows the foundational work done to this point and what has guided and informed the journey so far.

Recognising the Need for Change

Intensive Housing Services Pilot

Traditional housing service delivered working to standardised KPIs meauring the negative, not the positive. This prompted a review of services delivery and focused on understanding how we deliver more sustainable tenancies, reduction in evictions & abandonments.

Hafod understanding not all tenants trust their landlord to reveal what is happening in their lives: • Universal Credit door knocking exercise, we spoke to over 3,500 tenants • Insight pre tenancy financial credit checks • Intensive housing services pilot

Housing Act 2014

Well-being of Future Generations (Wales) Act 2015

24

Housing Service Pilot User Feedback Session

Hafod Neighbourhood Coaching

• Housing services reactive and respond to a problem. • Unintentional divide between tenants & landlord • Service delivery is remote, office based, reliant on letters, websites & social media • Lack of face to face contact limits understanding of what is important to tenants.

• Introduction of more Neighbourhood Coaches & coaching approach to housing services • Smaller ‘patches’ • Emphasis on personal engagement with our tenants • Identify tenant and community potential not problems

Social Services & Well-being Act

Taking Wales Forward

2015

2016


Meeting housing residents

Housing 01 10.01.18

Mapping the drivers of change and new needs in housing.

11.01.18

Understanding services, interactions and journeys with residents in St. Mellons, Cardiff.

Building shared intelligence through system mapping A NEW VISION In Hafod we no longer see ourselves as a housing & care organisation but an integrated housing, care & health provider. The work allowed us to uncover that housing services are working in silos and we recognise the need to work more closely with local services on the front line to holistically help tenants and understand the wider challenges in their lives.

Coffee conversations

Opening workshop Dec 2017

Opening the public conversation around a change programme with a broad range of stakeholders.

Care 01 17.01.18

Mapping the drivers of change and new needs in care.

25

Meeting care home residents 18.01.18

Understanding the challenges in providing care services with residents, carers and managers in Hafod homes.


Housing workshop 02 08.02.18

Building a collective understanding of housing development cycles and hidden constraints in each step.

Housing workshop 03 01.03.18

Redefining the systematic challenges in the housing and care systems and re-imagining the possibilities.

Contextual understanding of systemic barriers

Exploring innovation & plausibility

Designing the change lab April 2018 onwards

In-depth interviews with Hafod staff 30.01.18

Validating the â&#x20AC;&#x2DC;system storiesâ&#x20AC;&#x2122; with practitioners.

Care workshop 02 06.02.18

Building a picture of the care system and uncovering hidden drivers.

Care workshop 03 28.02.18

Validating the whole system of housing and care services, journeys and hidden drivers to define the systematic challenges.

26

Synthesising collective learning from workshops and planning the two days change lab to test and iterate our framing of the challenges and solution domains.

Moving towards change lab to test and build ideas


NOTES

Send your ideas to caringforthefuture@hafod.org.uk Please share your views #caringforthefuture


Snapshot of Hafod Mapping a user through the system

ENTER HOUSING SYSTEM Change of circumstance / housing need

Hidden Drivers Become homeless

Care leaver

Prison leaver Different assessment of needs & no data sharing

Can’t account for future costs

Paper based with set criteria boxes

Service based commissinig & standardised services

INITIAL ASSESSMENT Homelessness application

WAITING LIST Join housing & housing ‘accessible homes’ waiting list(s)

Conflation of two housing needs: 1. affordability 2. support

ALLOCATION Distribution of general housing stock

46% of tenants have someone in the household living with a disability

At least 60,569 households are on waiting lists in Wales Lack of support means the house is allocated a person rather than the other way around

Across the UK, over 40,000 tenants were evicted from homes by landlords in 2015 (up 33% since 2003)

FINDING A PLACE TO LIVE connect with a community, set up care & services

Lack of support around housing results in unstable tenancy

In Wales, social housing tenancies in rent arrears increased during 2016-17, up to 79,716 tenancies in arrears (35% of total)

44% of prisoners reoffend...and 58% for prisoners with <12 month sentences


ADMITTED TO HOSPITAL Care at point of crisis

Gatekeeping pushes more people to crisis point before

Service based commissioning & standardised services

More than one million visits a year to Welsh urgent care departments

24% of community hospital beds occupied by dementia patients; many with nowhere to go (lack of nursing and residential care homes) and others because of delays in getting funding.

POINT OF CARE NEED needs assessment

Needs assessment

Needs assessment

Needs assessment

Self or social services referral

Self or social services referral

In hospital

Must take place in hospital setting

May delay stay & lead to deterioration in health

Between 2010 and 2016, the number of â&#x20AC;&#x2DC;bed-blockingâ&#x20AC;&#x2122; patients rose by 300% 10 days of bed rest led to the equivalent of loss of 10 years of life

PLANNING FOR CARE make care plan & enter care system

Increase bureacracy to define difference between health & social care

FINANCIAL ASSESSMENT funding ongoing care

Professionalised + standardised services reinforces alienation

85 percent of local authorities restrict funded care to those with substantial and/or critical needs Financial products focused on care costs, private and siloed data modelling


ENTER THE CARE SYSTEM

Health care at home

Private care home

Specialised rental property

Recieve care at home

Move into residential home

Move into Extra care home

Move into nursing home

Move â&#x20AC;&#x2DC;intoâ&#x20AC;&#x2122; care

Public stigma against moving into a care home Public funding only available for domestic and domiciliary care

People entering care homes at an older age and have more complex needs Increased cost and gatekeeping to funding

REASSESSMENT revising the care plan

FULLY CARED ENVIRONMENT Admitted to hospital

Move to a hospice

END OF LIFE CARE

The average age at the start of a care home placement in Wales is 82

Scheduled monthly/annually

Can feel as though it is a requirement of regulation rather than genuine need


Thank you for being part of the conversation to transform housing and care in Wales. Your role in this new chapter of integrating housing and care is pivotal to making this future a reality. We fully appreciate your commitment to helping Wales become more prosperous, resilient, healthier, equal and globally responsible. If youâ&#x20AC;&#x2122;d like to get involved in our working groups or want to talk further please let us know. Follow our progress at www.caringforthefuture.co.uk To keep in touch and receive updates, email your contact details to caringforthefuture@hafod.org.uk Continue the conversation on Twitter using #caringforthefuture Together transforming housing and care.

NOTES

31


Agenda 18.04.18 day 1 seeding the movement

9 9.30

9.30 10.30

Network and coffee

Welcome - Caring for the Future Break

11 12.30

13.15 13.45

13.45 14.15

day 2

19.04.18

Shaping a manifesto for change 9.30 10

Network and coffee

10.30

Welcome and recap

10

10.30 11.30

Exploring the challenges

Roundtable - with Rebecca Evans AM

group discussions to explore the shared challenges and potential solutions

Minister for Housing and Regeneration in conversation with care + housing staff and tenants

Lunch

Break

Global showcase

11.45

live talk from innovation success

12.30

National showcase

Lunch

live talk from innovation success

13

Break

Addressing the challenges

lessons from day 1, panel discussion debrief & key takeaways

13.15

Curating the big ideas

hafod and dark matter

â&#x20AC;&#x2DC;

HafodĂ&#x2022; s reality

14.30 15.15

system change & collaboration

16

Round up

15.15

13.15 15

Solution laboratories discovering practical steps for meaningful system change

Break 15.15 16

16 16.30

Rotating feedback and reflections Round up and next steps


References

[1] [2] Demography 2016: Infographic (2016) Public Health Wales Observatory http://www.publichealthwalesobservatory.wales.nhs.uk/infographic-demography [3] ‘National Dementia Vision for Wales: Dementia Supportive Communities’ (2011) Alzheimer’s Society http://gov.wales/docs/dhss/publications/110302dementiaen.pdf [4] [7] ‘Prosperity without poverty’ (2016) Joseph Rowntree Foundation https://www.jrf.org.uk/report/prosperity-without-poverty [5] [24] ‘Poverty, evictions and forced moves’ (2017) Joseph Rowntree Foundation https://www.cchpr.landecon.cam.ac.uk/Projects/Start-Year/2016/Poverty-evictions-and-forced-moves/OutputTemplate/ DownloadTemplate [6] ‘Transforming the delivery of health and social care’ (2012) The King’s Fund https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/transforming-the-delivery-of-health-and-socialcare-the-kings-fund-sep-2012.pdf [8] Public Health Wales (2017) http://www.wales.nhs.uk/news/46348 [9] ONS - 2011 census [10] StatWales (2017) https://statswales.gov.wales/Catalogue/Business-Economy-and-Labour-Market/Regional-Accounts/Household-Income/ grossdisposablehouseholdincome-by-area-measure [11] StatWales (2017) https://statswales.gov.wales/Catalogue/Sustainable-Development/Sustainable-Development-Indicators/gva-bymeasure-welsheconomicregion-year [12] State of Local Government Finance (2017) Local Government Information Unit https://www.lgiu.org.uk/news/39967/ [13] [14] [15] Housing Horizons Data Resource (2017) Savills, Community Housing Cymru https://chcymru.org.uk/uploads/general/Housing_Horizons_Data_Resource_-_Establishing_the_Challenge_FINAL.pdf [16] ‘Older People’s Care Survey’ (2016) Family and Childcare Trust https://www.legalandgeneralgroup.com/ media/1082/older_peoples_care_survey.pdf [17] ‘2011 Census analysis: Unpaid care in England and Wales, 2011 and comparison with 2001’ (2013) ONS https:// www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/ [18] ‘Domiciliary Care Workforce’ (2016) Welsh Government https://beta.gov.wales/sites/default/files/cnsultations/201801/160119document1en.pdf [19] ‘Care worker zero-hours contracts tackled by Welsh Government’ (2017) BBC http://www.bbc.co.uk/news/ukwales-40201678 [20] [29] Bed-Blocking Up 300 Per Cent (2016) GMB http://www.gmbwalesandsouthwest.org.uk/news/bed-blockingup-300-per-cent [21] ‘Does the social care crisis demonstrate the failure of outsourcing public services? (Feb 2018) Independent https:// www.independent.co.uk/news/long_reads/social-care-outsourcing-public-services-government-contractors-carehomes-carillion-terra-firma-pfi-a8195001.html [22] Hafod survey [23] ‘Housing ‘crisis’: Shelter Cymru urges investment’ (March 2018) BBC http://www.bbc.co.uk/news/uk-wales-43476298 [25] ‘Social housing vacancies, lettings and arrears’ (2018) The Welsh Government http://gov.wales/statistics-and-research/social-housing-vacancies-lettings-arrears/?lang=en [26] ‘Wales Reducing Reoffending Strategy 2014-2016’ (2015) The UK Government https://www.gov.uk/government/publications/wales-reducing-reoffending-strategy-2014-2016 [27] ‘A&E attendances in Wales above one million a year mark’ (Dec 2017) BBC http://www.bbc.co.uk/news/uk-wales-42252298 [28] ‘Bed blocking dementia patients stuck in hospital beds for as long as 145 days’ (Oct 2017) https://www.dailypost.co.uk/news/north-wales-news/bed-blocking-dementia-patients-stuck-13758281 [30]‘Discharging older patients from hospital’ (2016) NAO https://www.nao.org.uk/wp-content/uploads/2015/12/Discharging-older-patients-from-hospital.pdf [31] ‘Transforming the delivery of health and social care’ (2012) The King’s Fund https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/transforming-the-delivery-of-health-and-socialcare-the-kings-fund-sep-2012.pdf [32] Wales Market Analysis of Care Homes for Older People)


Bibliography Demography 2016: Infographic (2016) Public Health Wales Observatory http://www.publichealthwalesobservatory.wales.nhs.uk/infographic-demography

‘Dementia UK: Update’ (2014) Alzheimer’s Society https://www.alzheimers.org.uk/download/downloads/id/2323/dementia_uk_update.pdf ‘Prosperity without poverty’ (2016) Joseph Rowntree Foundation https://www.jrf.org.uk/report/prosperity-without-poverty ‘Poverty, evictions and forced moves’ (2017) Joseph Rowntree Foundation https://www.cchpr.landecon.cam.ac.uk/Projects/Start-Year/2016/Poverty-evictions-and-forced-moves/ OutputTemplate/DownloadTemplate ‘Transforming the delivery of health and social care’ (2012) The King’s Fund https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/transforming-the-delivery-ofhealth-and-social-care-the-kings-fund-sep-2012.pdf Public Health Wales (2017) http://www.wales.nhs.uk/news/46348 StatWales (2017) State of Local Government Finance (2017) Local Government Information Unit https://www.lgiu.org.uk/news/39967/ Housing Horizons Data Resource (2017) Savills, Community Housing Cymru https://chcymru.org.uk/uploads/general/Housing_Horizons_Data_Resource_-_Establishing_the_ Challenge_FINAL.pdf ‘Older People’s Care Survey’ (2016) Family and Childcare Trust https://www.legalandgeneralgroup.com/ media/1082/older_peoples_care_survey.pdf ‘2011 Census analysis: Unpaid care in England and Wales, 2011 and comparison with 2001’ (2013) ONS https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/ articles/2011censusanalysisunpaidcareinenglandandwales2011andcomparisonwith2001/2013-02-15 ‘Domiciliary Care Workforce’ (2016) Welsh Government https://beta.gov.wales/sites/default/files/cnsultations/2018-01/160119document1en.pdf ‘Care worker zero-hours contracts tackled by Welsh Government’ (June 2017) BBC http://www.bbc.co.uk/news/uk-wales-40201678 Bed-Blocking Up 300 Per Cent (2016) GMB http://www.gmbwalesandsouthwest.org.uk/news/bed-blocking-up-300-per-cent ‘Does the social care crisis demonstrate the failure of outsourcing public services? (Feb 2018) Independent https://www.independent.co.uk/news/long_reads/social-care-outsourcing-public-services-governmentcontractors-care-homes-carillion-terra-firma-pfi-a8195001.html ‘Housing ‘crisis’: Shelter Cymru urges investment’ (March 2018) BBC http://www.bbc.co.uk/news/uk-wales-43476298 ‘Social housing vacancies, lettings and arrears’ (2018) The Welsh Government http://gov.wales/statistics-and-research/social-housing-vacancies-lettings-arrears/?lang=en ‘Wales Reducing Reoffending Strategy 2014-2016’ (2015) The UK Government


https://www.gov.uk/government/publications/wales-reducing-reoffending-strategy-2014-2016 ‘A&E attendances in Wales above one million a year mark’ (Dec 2017) BBC http://www.bbc.co.uk/news/uk-wales-42252298 ‘Bed blocking dementia patients stuck in hospital beds for as long as 145 days’ (Oct 2017) https://www.dailypost.co.uk/news/north-wales-news/bed-blocking-dementia-patients-stuck-13758281 ‘Discharging older patients from hospital’ (2016) NAO https://www.nao.org.uk/wp-content/uploads/2015/12/Discharging-older-patients-from-hospital.pdf Parliamentary Review of Health and Social Care in Wales Final Report (2018) Welsh Government https://beta.gov.wales/sites/default/files/publications/2018-01/Review-health-social-care-report-final.pdf Parliamentary Review of Health and Social Care in Wales Interim Report (2017) Welsh Government https://beta.gov.wales/sites/default/files/publications/2017-07/170712-review-interim-report-en.pdf ‘Is excessive paperwork in care homes undermining care for older people?’ (2014) Joseph Rowntree Foundation http://www.hub.careinspectorate.com/media/195659/jrf-administration-care-homes-full_0.pdf ‘‘Above and Beyond’ National review of domiciliary care in Wales’ (2016) Care and Social Services Inspectorate Wales (CSSIW) http://careinspectorate.wales/docs/cssiw/report/161027aboveandbeyonden.pdf National Housing Federation regional policy documents Cardiff and Vale’s Integrated Medium Term Plan 2018-2021 http://www.cardiffandvaleuhb.wales.nhs.uk/sitesplus/documents/1143/Public%20Boardbook%20 March%202018%20vol%202.pdf Cardiff and Vale’s Integrated Medium Term Plan 2017/18 – 2019/20 http://www.wales.nhs.uk/sitesplus/documents/866/ABUHB%20IMTP%20APPROVED%20 WG_10MAR17.pdf Torfaen Local Development Plan (LDP) Draft Review Report - January 2018 https://www.torfaen.gov.uk/en/Related-Documents/Forward-Planning/Local-Development-PlanReview/Draft-Review-Report-Executive-Summary.pdf Newport Supporting People Local Commissioning Plan 2016-2019 (annual update 2018/19) http://www.newport.gov.uk/documents/Care-and-Support/Supporting-People-Local-CommissioningPlan-2016-2019-update-2018.pdf Bridgend Corporate Plan 2016-2020 https://www1.bridgend.gov.uk/media/341723/corporate-plan-2016-2020.pdf Supporting People Commissioning Plan 2017-2018 (2017) Rhondda Cynon TAF County Borough Council https://www.rctcbc.gov.uk/EN/Council/CouncillorsCommitteesandMeetings/Meetings/ Cabinet/2017/03/09/Reports/AgendaItem17SupportingPeopleLocalCommissioningPlan.pdf Social Services and Well-being Act: Draft CWM TAF Regional Plan 2018-23 (2018) https://www.rctcbc.gov.uk/EN/Council/CouncillorsCommitteesandMeetings/ Meetings/Cabinet/2018/02/15/Reports/ AgendaItem4SocialServicesandWellbeingActDraftCwmTafRegionalPlan201823.pdf


HOW TO GET IN TOUCH: Jas Bains Hafod CEO jas.bains@hendre.org.uk +44 (0)29 2067 5888 Charlotte Whitney Executive Business Manager Charlotte.Whitney@hafod.org.uk +44 (0)29 2067 2453 Karen Healey Director of Nursing, Quality and Regulation (RI) Karen.Healey@hafod.org.uk +44 (0)29 2067 2461 Richard McQuillan Head of Housing Services richard.mcquillan@hafod.org.uk +44 (0)29 2067 5800

Hendre HENDRE - HAFOD Established in 2002 the Hendre Group, delivering its services under the Hafod brand, operates across 10 local authority areas in South Wales. Providing care and support to over 16,000 people with 5,000 homes, Hafod has an extensive range of property within their portfolio from family housing, supported living, residential and nursing care facilities. Employing more than 1,200, the Group has a turnover of ÂŁ56 million per annum. Hendre Limited provides strategic direction to Group members and is governed by a board of 10 members. Nigel James is the Group Chair and Jas Bains is the Group Chief Executive. www.hafod.org.uk

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