2.1 The government’s strategic direction for housing and housing-related services for older people responds to what older people have said they want, and to the wider context (and challenge) of a growing older population that is living longer than ever before.
2.2 National direction revolves around two main objectives:
To support older people to make active and informed choices by providing: Access to appropriate housing and services
Advice on suitable services and options.
To ensure older people are able to secure and sustain their independence in a home that is appropriate to their needs.
2.3 These objectives fit with broader policy developments for older people that cross all public services and shift from focusing on those who have most care and health needs towards promoting choice, wellbeing and improved quality of life for all.
2.4 The main policy drivers are:
Rooting out age discrimination in service provision
2.5 To ensure that older people play an active role within society, contributing to the communities in which they live. In practice, this starts with an assurance that older people are treated equally and fairly in the services that they receive.
Flexible service provision directed to the needs of the individual
2.6 With services moving away from providing historic housing models and forms of care and support and instead offering services that are tailored to the individual person and their unique requirements
Increased prevention with services delivered closer to home
2.7 Delivering a wider scope of low-level services at an earlier stage and preventing crises and rapid deterioration through early recognition and targeted interventions
Choice and control about where, how and by whom support and care is delivered
2.8 Supporting older people to make choices through impartial advice and information. A specific initiative to give people control of individualised care and support budgets to buy the services that they believe will make the most difference to their lives.
Improving the quality of new and existing housing
2.9 Housing is recognised as central to retention of independence and health for all of us, but especially older people. The needs of older people must be addressed in local development frameworks and core strategies. There is a specific requirement for all new affordable homes to be built to lifetime standards by 2011 and an intention to introduce this standard to all new market housing by 2013. In addition, national investment is improving the quality of existing homes through insulation and heating improvements, adaptations and handyperson services.
Older people – a changing approach(7)
2.10 This national study, published by the Audit Commission in 2004 in collaboration with Better Government for Older People (BGOP), was also influenced by the Association of Directors of Social Services (ADSS) and the Local Government Association (LGA) and most heavily by information from older people themselves. The report summarises the key issues identified by older people as having most influence on their wellbeing and ability to age successfully and, most notably, identifies the ‘seven dimensions of independence and wellbeing’ that older people themselves say enable them to live independent lives.
2.11 Each of these seven areas has been taken forward through national strategy and policy development to tackle the challenges of ageing:
Information
Housing and the home Neighbourhood
Social activities, social networks and keeping busy Getting out and about
Income
Health and healthy living.
2.12 In this context, ‘independence’ does not necessarily mean living without assistance from anyone else, although this might be the ideal. It means having choice and control in one’s own life. It is therefore not only what is done but how it is done that is important; the national and local response to the needs of older people must be delivered in a way that maximises people’s options and puts them in the driving seat. This principle needs to underlie all activities supporting independence and meeting needs.
2.13 In order to deliver the right services in the right way older, people therefore need to have a strong voice in service development and delivery. This principle was a central tenet of the National Services Framework for Older People in 2001. In addition, failing to involve and listen to (any) people for whom services are being developed can lead to errors that have consequences for everyone.
2.14 Two important principles are therefore established:
Older people must be involved in establishing both direction and detail of services
Services must be delivered in a way that enables older people to take control over their lives and choose what is best for them.
2.15 A suite of national strategies focuses on delivering these policy areas for all older people and these are summarised below. The first two set the wider strategic context for central and local government across all departments with statutory partners such as Primary Care Trusts, fire and rescue, police and so on, together with other local partners including the community and voluntary sector and private businesses and particularly focusing on the role of older people themselves in directing and influencing direction and services.
Lifetime homes, lifetime neighbourhoods(8)
2.16 This is the government’s strategy for older people’s housing, published in February 2008 by Communities and Local Government (CLG). The strategy is based on two drivers:
7 Older people – a changing approach, Audit Commission with Better Government for Older People, 2004 8 Lifetime homes, lifetime neighbourhoods – a national strategy for an ageing population, CLG Feb 08
Economic sustainability – housing must maximise public and private resources and empower older people to remain economically active
Social sustainability – housing must promote equality, social connection and inclusion, and the health and well-being of older people.
2.17 The objectives are:
To plan at all levels so that older people can live independently with and without support within their own communities
To ensure earlier interventions and better advice and information is provided so that appropriate choices can be made by an ageing population
To ensure the right range of choices and opportunities in housing are available for older people.
2.18 The strategy diagnoses the problems and proposes solutions together with a new offer for meeting the housing needs of older people:
Diagram 1
2.19 Based on our consideration of the needs and issues identified for Durham, these problems and solutions have local resonance.
2.20 The government has since introduced funding to explore services that deliver rapid repairs and adaptations and increased handyperson services and has increased funding for disabled facility grants for adaptations in privately owned homes. Changes have also been made to the regulations governing Disabled Facilities Grants to reduce administration (particularly financial assessment) and increase funding flexibility to enable more creative solutions to problems.
2.21 In relation to new homes, the strategy commits that all new affordable homes are to be built to lifetime homes standards by 2011 and that the government will seek through encouragement, and if necessary regulation to achieve the same standards in market housing by 2013.
2.22 In the context of the change in political control of central government from May 2010, the strategy received widespread support at the time of publication, so it is reasonable to assume that the direction is unlikely to be changed in the near future, although the extent to which lifetime homes can be delivered over the next few years will be heavily influenced by the economic situation.
Building a society for all ages(9)
2.23 This follows on from the government’s 2005 strategy for an ageing society,‘Opportunity age – meeting the challenges of ageing in the 21stcentury’and was published by the Department for Work and Pensions (DWP) in July 2009. It presents the government’s vision for a society where people should no longer be defined by their age but where their skills and experiences are harnessed for the benefit of Britain as a whole. Six themes develop the overall strategic direction of older people as key players within mainstream society, the expectation of longer, healthier and more independent living and extended economic activity:
1. Having the later life you want. 2. Older people at the heart of families. 3. Engaging with work and the economy. 4. Improving financial support.
5. Better public services for later life. 6. Building communities for all ages.
2.24 Prevention and early intervention also lie at the heart of a number of important policy initiatives aimed at the NHS and social care supporting older people to live healthy, active and independent lives for longer and to reduce the numbers of older people needing hospital, residential or intensive care.
Putting people first – the transformation of adult social care(10)
2.25 People have higher expectations of what they need and want greater control over their lives and the risks they take. They want dignity and respect to be at the heart of any interaction, so that they can access high-quality services and support closer to home at the right time, enabling them and their supporters to maintain or improve their wellbeing and independence rather than relying on intervention at the point of crisis.
2.26 At its heart, Putting People First pledges that all public bodies will work together towards a common aim: a society that enables individuals to have choice and control over their lives and values the contribution that all citizens can make, whether they need support from others now or in the future. Lord Darzi’s Next Stage Review(11)(2008) of the NHS makes it clear that only through working in partnership and focusing on people, will the NHS and local government help improve peoples’ health and wellbeing. It also underpins the implementation of other DH priorities such as the national carers’ strategy(12),
Valuing People Now(13)and the Dementia Strategy(14).
2.27 The four elements of policy development are shown in the diagram below:
9 See: http://www.hmg.gov.uk/buildingasocietyforallages.aspx
10 Putting people first: a shared vision and commitment to the transformation of adult social care, DH 2007 11 High Quality Care for All – NHS Next Stage Review Final Report, DH, 2008
12 Carers at the heart of 21st century families and communities, HMG, 2008
13 Valuing people now: a new three-year strategy for people with learning disabilities, DH, 2009 14 Living well with dementia: a national dementia strategy, DH, 2009
Diagram 2
2.28 There must be ‘a locally agreed approach (between all strategic partners) which informs the sustainable community strategy, utilising all relevant community resources especially the voluntary sector so that prevention and early intervention and enablement become the norm.’ The four aspects of prevention are to:
Promote older people’s independence and wellbeing, so delaying or reversing deterioration Reduce the risk of crises and the harm arising from them
Maximise people’s functioning (ie, reablement)
Provide ‘care closer to home’ (ie, the least institutional or intensive intervention that is able to appropriately meet people’s needs).
Living well with dementia: a national dementia strategy(15)
2.29 This national ‘first’ was prompted by the recognition of the devastating nature of the condition for both the people who develop it and those who care for them. There are seventeen objectives – an ambitious agenda – and several of these have a direct bearing on this review about accommodation and support for Durham’s older people. Specifically, the most relevant objectives are to:
Improve public and professional awareness and understanding of dementia, including addressing the stigma associated with it to:
Highlight the benefits of timely diagnosis and care Promote prevention
Reduce social exclusion and discrimination
Encourage behaviour change in terms of appropriate help-seeking and help provision. Improve community personal support services with:
An appropriate range of services to support people with dementia living at home and their carers
Access to flexible and reliable services, ranging from early intervention to specialist home care services.
Consider the potential for housing support, housing-related services and telecare to support people with dementia and their carers
Ensure an informed and effective workforce for people with dementia
Establish a joint commissioning strategy for dementia
Establish effective national and regional support to advise and assist local implementation of the strategy.