Age, home and community: a strategy for housing for Scotland's older people 2012-2021

CHAPTER 3: CLEAR STRATEGIC LEADERSHIP

The Scottish Government should provide a clear vision for housing for older people in Scotland, which supports older people to live independently at home.

3.1 The Scottish Government is working to improve outcomes for older people, enabling them to live independently at home for as long as possible. Our role is to set the policy direction for Scotland as a whole, with our priority on facilitating the development of housing and services which help older people to live comfortably and securely. In doing this, we recognise that decisions on local policy and service delivery should be taken by those who know the local area and people best, and that there will be variations between local authority areas.

3.2 The National Performance Framework ^[24] underpins delivery of the Scottish Government's agenda. It is designed to be clear, logical and easy to understand, with each part of the framework contributing towards a single overarching purpose:

• 'to focus government and public services on creating a more successful country, with opportunities for all of Scotland to flourish, through increasing sustainable economic growth'.

Delivery of the purpose is underpinned by five strategic objectives: wealthier and fairer; smarter; healthier; safer and stronger; and greener. Purpose targets are high level targets that show progress towards the purpose, and national outcomes describe what the Government wants to achieve and the kind of Scotland we want to see. National indicators enable us to track progress towards the purpose and national outcomes. Under the outcomes based approach, the Scottish Government provides leadership and direction, while detailed management of services is undertaken by delivery partners, such as local government.

3.3 Our commitment to older people is integrated throughout the Framework, and there is a specific national outcome:

• 'our people are able to maintain their independence, as they get older and are able to access appropriate support when they need it'.

Appropriate housing and support for older people play a key role in delivering this national outcome.

3.4 Our work on the Reshaping Care for Older People programme has helped to increase understanding of the challenges of demographic change across Scotland, and the need to create an environment where housing, health and social care at all levels work together more effectively and efficiently. To support closer working between housing, health and social care at national level, the Reshaping Care programme includes in its vision a specific outcome that more older people should live in housing, which suits their needs and helps maintain their independence. ^[25]

3.5 Many different types of organisation are involved in the delivery of housing and support services to older people. These include local authorities and housing associations, as well as private and voluntary sector providers. It is important that these organisations work in partnership, so that older people have choice in the services that can support them to maintain independent living. Extending partnership working beyond the public sector can provide access to different skills, expertise and sources of finance. These can help to improve service quality and choice. We also recognise that we can learn from the private sector and its responsiveness to changes in demand and the provision of choice.

3.6 Many of the preventative support services which help older people to live independently at home are delivered by organisations in the third and voluntary sectors. This provision helps to extend the range of services from which older people can choose those that meet their needs. We will work with the third and voluntary sectors at both national and local level to support them to develop sustainable funding models that will ensure their survival through difficult economic times.

What we will do

3.7 We will improve our strategic leadership by:

• Setting a clear vision for housing for older people. Through this strategy, we are setting out what we want to achieve for older people's housing and housing-related support, along with a national framework for delivery, focusing on increasing alignment between housing, health and social care.

Consultation with older people

Policies and services that affect older people's housing and support should be developed in consultation and partnership with older people themselves.

3.8 We are clear that, in developing policies relating to older people and services for them, we need to listen to older people and encourage their opinions both nationally and locally, and shape our services accordingly. At a national level, this strategy has been developed with the help of members of Age Scotland's Local Housing Panels. Many local authorities and housing associations have also been undertaking reviews of their services for older people in consultation with older people themselves. This is progress. However, we need to bear in mind that the services older people need and want will change over time, so this collaboration will continue.

3.9 Self-directed support enables people to make choices about the support services they need to live independently at home and to select those which meet their individual needs. At the moment, many older people are not aware of self-directed support and the opportunities it could provide for them. There is, therefore, a need to increase awareness of self-directed support and its benefits. The level at which people will wish to direct their support will vary between individuals. However, self-directed support should help to improve the integration and personalisation of services to each person's circumstances and provide a way for older people to be more involved in developing their own support.

Case study: Aberdeen Sheltered Housing Network

Aberdeen City Council established a Sheltered Housing Network to improve communication and consultation with sheltered housing tenants in 2008, following the transformation to an Integrated Care at Home and Housing Support Service.

The Network has enabled sheltered housing tenants to work with the Council to improve service delivery and has ensured tenants have a voice in decision making. They have participated in the design of a sheltered housing review; recruitment of senior housing and social work posts; and in producing their own magazine.

The benefits of the network are evidenced through improvements in working relationships between tenants, housing and social care services, with the real winners being the tenants themselves. They are passionate that older tenants are consulted and involved in decisions about their housing and support, and now have a way of ensuring their voices are heard. In 2010, the Sheltered Housing Network was the first tenants' group in Scotland to win the Tenant Participation Advisory Service ( TPAS) Accreditation for best practice in tenant participation.
http://www.aberdeencity.gov.uk/home/home.asp

What we will do

3.10 We will involve older people in the development of policy and services that affect them by:

• Promoting consultation with older people. We will engage with, and take account of, the views of older people, in the development of policy initiatives which affect them.

Strategic planning

Housing should play a full role in partnership with health and social care in supporting older people to live independently.

3.11 Strategic planning is about setting out what we want to achieve and how we will do it. We recognise that effective strategic planning processes are vital to ensuring that we have the right mix of housing and support services, as our population ages and changes. However, the housing sector does not operate in a vacuum. It needs to work with health and social care and other sectors, such as planning and transport. Unfortunately, the different processes, business cycles and terminology used by different sectors can create barriers to working together effectively.

3.12 We need to strengthen the connections, particularly between housing, health and social care, but also with other sectors, with greater use of shared outcomes, objectives and performance frameworks. Articulating how each sector contributes to the others' outcomes and objectives should help to ensure mutual understanding and alignment of priorities and roles at a strategic level. All sectors should be involved from the outset of policy and service development to achieve clarity about the links to local delivery and the incentives needed to make things happen and achieve progress. A common language and simpler strategy documents will help this process, along with greater focus on prevention and planning.

3.13 We will support the continued development of Local Housing Strategies, ^[26] which provide the strategic direction for dealing with identified housing need and demand, as well as the delivery of housing and related services across the local authority area. Alignment between the Local Housing Strategy process and local health and social care planning, through joint strategic needs assessments, will help to identify common aims and priorities, which take account of demographic change. This process will also support closer working on the assessment of overall local need and associated planning of investment and services.

Case study: Angus Community Health and Housing Partnership

Angus Council started building a strategic multi-disciplinary approach to older people's services some years ago. A Joint Consultative Group was then set up in 2010 between Social Work, Health and critically, Housing. This group, made up of senior officers from each sector, meets regularly to discuss national and local issues; monitor the progress of initiatives; and agree responsibility for delivering specific outcomes.

A key element was the early participation of Housing professionals in the shaping of strategy, so that effective and realistic outcomes could be designed, along with practical delivery. Cultural and methodology barriers between the different sectors have been broken down, and they now work in partnership towards common goals, based on mutual understanding of each partner's business aims and processes. However, the initiative goes much deeper, as there is now routine consultation at every level between Housing, Social Work and Health officers, in areas such as the Local Housing Strategy; housing adaptations; sheltered housing provision; and housing support.

Older people's services in Angus are becoming more effective as a result of the fully joined-up approach. Planning and co-ordination between the sectors is better, with many improvements, such as housing adaptations, being integrated into work already programmed. This saves both time and money and helps to embed a preventative approach to services.
http://www.angus.gov.uk/
http://www.nhstayside.scot.nhs.uk/

Case study: Aberdeenshire Council's consultation and strategic planning

Aberdeenshire Council is planning how it will meet the future housing, support and care needs of older people. A key part of this strategic planning has been public consultation to gauge the views, preferences and aspirations of people approaching older age.

The Council commissioned research in 2010, and a 'Citizens' Panel' was also held to gather views. This included a cross-section of people aged between 55 - 65 years, who may potentially require care and/or accommodation in the next ten years.

The outputs from the consultation are helping the Council to plan for the anticipated future needs and aspirations of older people. The quality and nature of housing and care will be transformed to provide greater individual choice and control. A range of independent, semi-independent and full care accommodation will reflect the variations in need and preference of an older population in the future. Some sheltered housing is being remodelled to become very sheltered housing, with funding from the Change Fund for Older People's Services, to improve support for independent living. Care villages are also being developed in a partnership between housing, social care and health services, with accommodation providing different levels of support to promote and sustain independent living.
http://www.aberdeenshire.gov.uk/

What we will do

3.14 We will improve strategic planning by:

• Joining up our planning processes. We will continue to work with local authorities, health boards and Community Planning Partnerships to support greater integration of needs assessment and strategic planning at local level.

Local delivery

The should be a range of local services, which have a preventative focus, and support older people to live independently at home.

3.15 Many of the services, which help older people to live independently at home, are delivered by local authorities. Others are delivered by housing associations or the private or voluntary sectors, sometimes on behalf of local authorities. All help to achieve the outcomes in local authorities' Single Outcome Agreements. Single Outcome Agreements identify local priorities in the form of outcomes, which contribute to the national outcomes that the Scottish Government is seeking to achieve.

3.16 Housing, health and social care can work together in many different ways to improve service provision to help older people live independently at home. Greater communication and understanding of what each sector can offer will help to improve co-operation between them. Working to build shared ownership and accountability for delivery of outcomes will also help to improve the quality and effectiveness of services. This could also help all three sectors to streamline and integrate the best of what they can offer. This is particularly important in remote and rural areas, where there are issues of accessibility of services, and the benefits of joining up could include an increase in the choice of services available.

3.17 Reductions in public funding mean we have to be more creative in the way we deliver services. Collaboration may include the sharing of resources, such as staff, buildings or funding, with benefits of increased efficiency in the services people receive and in budgetary terms. Improvements in the assessment of individual needs and allocation of properties can help to make best use of the available housing stock. A holistic approach with integration of the whole package of support that people receive can help to improve delivery, particularly its quality and effectiveness in achieving the desired outcomes.

3.18 Housing and housing-related support play an important preventative role, but interaction with health and social care services often arises at times of crisis, such as following emergency admission to hospital after a fall. This reflects how people's housing needs can change very suddenly and, if mobility is reduced, may result in a need for adaptations, or even a move to a new home. In these types of circumstances, joint working and flexibility are essential to help people return to their homes and communities. This will be made easier if good relationships already exist between housing, health and social care at local level.

Case study: Smithfield Court rehabilitation service

Smithfield Court is a rehabilitation service provided in 22 self-contained flats in a sheltered housing complex in Aberdeen.

The service is provided in partnership between Aberdeen City Council's social work and housing departments and the NHS. It is designed to promote recovery and a return to independent living for older people and other adults with physical or other difficulties, following illness or accident. The service is a key player in trying to reduce reliance on care home placements and support people to live in their own homes. It includes social care, housing support, physiotherapy and occupational therapy. Importantly, dedicated housing officers are available to assist with all housing issues.

Significant numbers of people have been supported to return to their own home or to less supported accommodation, regaining or learning activities of daily living skills; better able to self-manage long term disabilities or conditions; and building confidence. This has meant fewer admissions to care homes following hospital inpatient stay; prevented admissions to hospital; and reduced or ceased packages of care. Two studies have concluded that the service produced excellent outcomes for individuals, along with long term budget savings for health and social work services. What was a "low demand" sheltered housing complex now rarely has many vacancies.
http://www.aberdeencity.gov.uk/home/home.asp
http://www.nhsgrampian.org

3.19 The Scottish Government's £70 million Change Fund for Older People's Services ^[27] has been established, with the agreement of COSLA, to support the improvements needed to 'shift the balance of care' from institutional care settings to the community. The aim of the Fund is to optimise independence and wellbeing for older people at home, and the money can be used by local Community Planning Partnerships to fund change and innovation in a range of local social care and housing services, supporting collaboration between housing, health and social care.

What we will do

3.20 We will support local delivery by:

• Supporting service innovation to 'shift the balance of care'. We have established the £70 million Change Fund for Older People's Services to support the innovations in services which help older people to live independently at home. We will increase funding to £80 million in 2012-13 and work to increase access to the Fund for housing.
• Encouraging local partnership. We will develop a central reference website of providers of housing and support for older people and their remits, for use by organisations seeking local partners.

Demonstrating the benefits of housing and support

There should be greater recognition of the value of housing and housing-related services in enabling older people to live independently at home.

3.21 There is widespread agreement about the social advantages and financial benefits of enabling older people to live independently at home, both to the individuals themselves and to the wider community. Housing adaptations and other housing-related preventative support services play a major role in achieving this.

3.22 Good housing and housing-related support can also provide benefits, which have an impact throughout the health and social care systems, by reducing hospital admissions and delayed discharge. However, this is not always well understood. We know that providers of preventative support services find it difficult to quantify the benefits their services provide, and the value of preventative services is not always recognised. This can make these services vulnerable, when public funding is tight, and there are difficult choices to be made.

3.23 The case for housing-related preventative support services needs to be better made and recognised to enable service providers and others to demonstrate the benefits they bring. We, therefore, welcome the recent Social Return on Investment study ^[28] undertaken by Bield, Hanover (Scotland) and Trust Housing Associations on housing adaptations and very sheltered housing, and the development of the Better Futures outcomes tool for housing support services. ^[29] We also recognise that we need to consider the particular housing and support needs of older people with dementia and other complex needs, and of older people from different equality groups.

What we will do

3.24 We will promote the benefits of the right housing and housing-related support by:

• Demonstrating the case for housing and support. We will identify the case for investment in housing and related support to achieve the outcomes we are seeking for reshaping care for older people. This would bring together evidence of the impact achieved in relation to particular aspects of different support services.

Our vision for 2021 is that a higher proportion of older people will live independently in the community, with a range of housing and support services which help them to do this.