Putting Older People First in the North West a Whole System Approach to Meeting Housing, Health and Wellbeing Outcomes for Our Older Populations in North West England

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Putting Older People First in the North West a Whole System Approach to Meeting Housing, Health and Wellbeing Outcomes for Our Older Populations in North West England North West Housing LIN Leadership Set Vision Putting Older People First in the North West A whole system approach to meeting housing, health and wellbeing outcomes for our older populations in North West England This paper has been prepared for the North West Leadership Set to set out the challenges faced by those involved in the housing, health and care of older people in the North West between now and 2030, and to provide a range of innovative, local examples in the Appendix that can help to meet those challenges while delivering better outcomes and efficiencies. The paper: introduces the Leadership Set and its aims; provides a summary of the key characteristics of older people in the North West and how these are expected to change between now and 2030; highlights the implications for services and the workforces of the changes in the older population; describes the policy context; and presents a broad range of practical examples of initiatives to tackle the current and future challenges. June 2017 © Housing Learning & Improvement Network www.housinglin.org.uk About the Housing LIN North West Leadership Set We are at the cutting-edge of knowledge and expertise across policy and practice in housing and care for older people in the region through our strong networked relationships, to test out new ideas and new ways of working. We represent a wide range of social housing and housing related support service providers across the region, as well as leaders from related fields including adult social care, public health, acute and primary health care, and technology enabled care. We meet regularly as a group to develop and deliver a programme of activities which seek to build capacity across the region and promote innovation and good practice particularly in areas which crossover the traditional housing, health and social care boundaries. Our vision: a whole system approach to meeting housing, health and wellbeing outcomes for our older populations We are a group of leaders working across North West England in the housing, health and social care sectors. While the spotlight on closer integration has focussed on Greater Manchester’s devolution agenda, we represent a range of different organisations and services but share an aspiration to build a whole system approach to meeting housing, health and wellbeing outcomes for our older populations across the region. We aim to: • Act as role models and leaders in our field, and so influence practice more widely across the region and nationally. • Co-produce directly with older people to ensure our work is in tune with future expectations. • Improve the way we work together to develop, share and diffuse good practice and expertise in the design and delivery of our services across housing, health and social care. • Identify opportunities and create new and innovative ways of working as a response to the issues facing the region. • Encourage and build effective networks to add value to the strategic partnerships between the sectors. • Provide ideas around how integrated approaches inclusive of housing could be embedded into wider system planning mechanisms. Why do we think this is important in the North West? Some of the key characteristics why this is important to us include: We have a rising older population across the region The over 65 population across the North West is set to increase by nearly one-third (31%) between 2015 and 20301, while the population aged 90 and above is projected to more than double to over 120,000 older people. 1 All population data is taken from Projecting Older People Population Information System www.poppi.co.uk © Housing Learning & Improvement Network – www.housinglin.org.uk 1 There is significant variation across the region: for example, in Halton and Warrington the older population is projected to grow by around 40% over the next 15 years, while in Salford the projected increase is 27%. Sefton, Cheshire East and Cumbria are all projected to have more than 5% of their population aged 85 and over by 2030, while in Manchester the percentage of the population aged 85 and over is projected to rise the least to 1.6%. There are significant numbers of older owner occupiers in the region While more than 75% of people aged 65-74 in the North West are owner occupiers, the level of owner occupation is lower for those aged 85 and over (69%). The highest levels of owner occupation among the very old are in Blackpool (78%), Sefton (78%) and Stockport (77%). Housing options need to include a mix of tenures to reflect the proportion of older people across the different tenures, as well as housing related support services which enable older people to remain living independently in their own home for as long as they wish. The number of older people needing care support is projected to increase significantly and unsustainably People are living longer, but with increasingly more complex care needs, people now live longer than ever before, but are more likely to develop long term conditions and/or disabilities, which can mean that the numbers in future requiring care support are likely to increase. Assuming there is no change in policy and provision of alternatives to residential care, the number of older people living in care homes in the North West is projected to increase by 55% to over 67,000 between 2015 and 2030. In some areas (Wigan and Warrington), the number of people aged 85 and over in care homes is likely to double in the same time period. Given the evidence that older people want to remain living in their own homes for as long as possible2,3, and the pressures on public budgets, we need to ensure there are housing options available which provide an attractive choice and which meet a range of health and social care 2 Shelter (2012) A better fit? Creating housing choices for an ageing population 3 Davies, B. (2014) For future living: Innovative approaches to joining up housing and health. IPPR Department for Communities and Local Government Paper © Housing Learning & Improvement Network – www.housinglin.org.uk 2 as well as housing needs. It is also worth noting that the residential care market is not solely driven by statutory placement and funding. In Lancashire, for example, only 49% of residential placements are funded by the Local Authority and 12% by the NHS. In 2002, national build standards were introduced for all new homes (or extensions to existing homes). By 2015, only 40% of rooms in care homes in Lancashire complied with these standards. A societal shift is required in the perception that hospital care is a place of safety for frail older adults. Clearly people do sometimes require hospital admission, but evidence suggests that it should be increasingly focussed and time-limited due to the consequences of an extended stay on older adults. • 48% of people over 85 die within one year of hospital admission.4 • 10 days in hospital (acute or community) leads to the equivalent of 10 years ageing in the muscles of people over 80 if people remain inactive or on bed rest (which tends to be the norm).5 More than 70% of hospital bed days are occupied by emergency admissions. • 10% of patients admitted as emergencies stay for more than two weeks, but these patients account for 55% of bed days. • 80% of emergency admissions who stay for more than two weeks are patients aged over 65, just over 30% over 85. Typical diagnoses among older patients with very long length of stay include stroke, hip fracture, pneumonia and urinary disorders. Dementia and delirium are also associated with longer length of stay. • This suggests that focusing on reducing the length of stay for older people has the most potential for reducing hospital bed use and improving patient safety and outcomes.6 • Over the past two years the data from the National Audit Office7 shows there has been an increase of 270,000 (31%) in days in acute hospitals when beds have been occupied by patients who have had their discharge delayed unnecessarily, to the current figure of 1.15 million days. (The increased delays are predominantly for older adults.) 4 Clark, D, et al (2015) Imminence of death among hospital inpatients: Prevalent cohort study, Palliative Medicine, Volume 28, Issue 6 5 Kortebein, P. et al. (2008) Functional impact of 10 days of bed rest in healthy older adults, Journal of Gerontology, Volume 63, Issue 10 6 Thompson, J. & Poteliakhoff, E. (2011) Emergency bed use, what the numbers tell us, King’s Fund 7 National Audit Office (2016) Discharging Older Patients from Hospital © Housing Learning & Improvement Network – www.housinglin.org.uk 3 The link of housing, ageing, poor physical health, and emergency care needs with mental illness and dementia According to national estimates, 30% of the population of England has a long-term condition (such as diabetes, heart disease or cancer), and 30% of this group in turn also has a mental health problem.8 Applied to the population of Pennine Lancashire, for example, this would imply that around 48,000 people have both a long-term condition and a mental health problem. Nationally, the average cost of NHS service use by people with a long-term condition and a mental health problem is approximately £5,670 per person per annum, which is almost half as much again as for those with a long-term condition alone.9 Having depression doubles the risk of developing coronary heart disease and people with depression have significantly worse survival rates from cancer and heart disease.10 And more than 2 out of 5 people admitted to hospital in an emergency have dementia.11 In making the case for age-friendly environments, the WHO notes that older people who live in an unsafe environment or areas with multiple physical barriers are less likely to get out, and are therefore more prone to isolation, depression, reduced fitness and increased mobility problems.12 The majority of older people (90%) live independently in mainstream housing, and some will need help to maintain their health and independence in those homes for longer.
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