SFHA’s new policy lead, Eileen McMullan joined the organisation at the end of last month. She will play a lead role in representing members’ housing-related interests in health, social care and homelessness, housing with care and support and social security. Here she looks at the implications for housing of the Feeley Independent Review of Adult Social Care.
By Eileen McMullan, Policy Lead SFHA
The Independent Review of Adult Social Care published in February 2021 sets out a vision for reform of adult social care that is focussed on human rights and equality, individual choice, quality, empowerment of people who need support and carers and valuing the workforce. Building on the principles of the 2011 Christie Commission, it recommends the creation of a National Care Service to ensure that prevention, investment in people, learning, fairness, and accountability are driven through national strategy and in partnership. At this stage, we do not know how the Scottish Government will take the recommendations forward, however, I have set out some of the implications for members below.
There is a welcome focus on prevention and early intervention and a positive vision for the future. The report recognises there is much about adult social care that is worth celebrating, including self-directed support and health and social care integration. However, although there is reference to housing, it is disappointing that the role it can – and does – play in supporting independence and choice and improving health and care outcomes for people is not recognised. There is a wealth of evidence of the positive role that housing associations and co-operatives already play, working across statutory and third sector organisations to deliver housing, care and support in our communities and developing innovative technology solutions to enable people to live independently at home. Recommendations taken forward for social care must link with the vision for Housing to 2040 to “embed a person-centred approach that aligns housing support with social care services, so people have choices and flexibility to live independently”.
Of some concern is that homelessness is not mentioned at all in the report. While there is little value in creating lists of eligible people, the role of health and social care in working with housing and other partners to end homelessness, as outlined in the Scottish Government’s recently published Housing to 2040 vision, was not addressed in this review and should be considered along with the recommendations.
Some of the report’s highlights include:
The review recommendations fully endorse the case for a National Care Service and while Scottish ministers should be held accountable for care, the recommendation is that the national care service should be delivered through reformed integration joint boards (IJBs). The report also recognises that local authorities have a key statutory role to play in supporting public wellbeing that is wider than the provision of social care support, “extending to for instance housing, transport and, leisure and recreation” and will continue to play a part as public providers of social work and as partners in IJBs.
The structure of this National Care Service and the role of IJBs isn’t entirely clear and needs further detail, including the role that housing must play as a key strategic partner. The proposal is that the budgets should be directly allocated to IJBs and that responsibility for social care commissioning and procurement will transfer to the IJB:
“Integration joint boards should continue to develop strategic commissioning plans, and should be given direct responsibility for procurement, holding contracts and contract monitoring. Strategic commissioning plans must be better linked to planning for other types of service, including particularly housing plans and plans for acute hospital care.”
Although the recommendation is that there should be links across to housing plans, housing support does not appear to be included. It is not clear either, that housing support services have been considered in the context of community-based services and supports or their role in delivering preventative support and tenancy sustainment, potentially creating barriers to joint working between housing and care/support provision.
There is recognition in the review of some of the good examples that exist across Scotland but a concern that innovation is a result of individual effort rather than a systematic approach. If recommendations on new models of care are adopted, this brings opportunities for housing associations and care/support providers to develop alternatives to residential and other forms of institutional care. For example, the review recommends that the Scottish Government looks at policies on discharge arrangements for people leaving hospital to ensure they support its long-term aim of assisting people to stay in their own communities for as long as possible.
Neither housing nor adaptations are explicitly referenced in the recommendations but there are some relevant points around developing new approaches. For example, recommendation 31:
“Investment in alternative social care support models should prioritise approaches that enable people to stay in their own homes and communities, to maintain and develop rich social connections and to exercise as much autonomy as possible in decisions about their lives.”
The role of social housing in this area is key. The recent SFHA publication, Housing Scotland: Models of Housing with Care and Support outlines some great examples of community models delivered by housing associations. In partnership with care and support providers, they can also take a preventative approach by delivering more support at home, developing and adapting homes fit for the future population and investing in technology. However, this needs explicit recognition and will require both capital and revenue investment to make this happen.
The report recognises that “we must do more to improve and adapt those homes to support a better quality of life. Even minor adaptations can deliver significant improvements, particularly when combined with necessary repairs and home improvements”. It also recognises that, in some cases, the process of getting adaptations and improvements done is so complex that even professionals struggle to navigate it.
Housing associations already play a significant role in supporting the Scottish Government’s prevention ambitions in health and social care using technology. There is an opportunity here to link up with the ambition for Housing to 2040 and the development of technology-enabled housing, as well as housing that is suitable for easy adaptation for longer-term needs. Similarly, technology enabled care (TEC) in people’s own homes can support greater freedom while also providing greater assurance for individuals and their carers.
Whilst the recommendations on housing in the review are weak, for successful transformation to a care system that focuses on prevention, independence and choice, housing must play a significant role across the health and social care system in Scotland. There are clear links to the wider agenda for Housing to 2040, preventing homelessness and transforming social care, and this must be recognised to reshape the design of a different environment in Scotland that supports people’s independence.
Eileen McMullan emcmullan@sfha.co.uk
