We may have just survived the worst of the winter without the much-anticipated NHS collapse: thus far, no television pictures of old people queuing in hospital corridors.
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A degree of success can be attributed to the extra £232m funding directed at PCTs and Adult Social Care teams for re-ablement services to prevent re-admission and respond to “winter pressures”.
Last month the Department of Health responded to a report noting that the 81,000 fewer care home beds predicted by 2020 may not result in hospital bed-blocking because demand for care home places was falling and “most older people want to stay supported in their own homes for as long as possible.”
However, across the NHS, delays in discharges still account for 113,304 “delayed days” - and rises in re-admission rates following discharge are a problem which the recent re-ablement funding has sought to address. Home-based rehabilitation and care is now being mooted as expensive specialist provision and faces deep cuts.
One recent example was the announced closure of 70 intermediate care beds in Nottingham. Instead, the council plans to provide services such as occupational therapy and ‘confidence building’ in people’s homes. The problem is that people’s homes often provide unsafe or unsuitable environments for giving and receiving care and rehabilitation, and there is now also a lot less money available to help take remedial action.
Central government grant funding for emergency repairs in private homes has been completely wiped out by the spending review. While local authorities could still choose to prioritise local funding on housing repairs, a common response has been for private sector housing teams simply to be closed down.
Grants for housing adaptations have been maintained, although un-ring-fencing means that local authorities will have the power to reallocate this funding elsewhere if they see fit.
Home improvement agencies, that specialise in carrying out repairs and adaptations in the homes of older and vulnerable householders, put in bids for re-ablement funding and several have been successful. In the London Borough of Newham, the agency made a case for spending re-ablement funding on essential repairs.
It’s senseless that thousands should be wasted on hospital beds when, in some cases, all that might be preventing an old person’s return home is a repair to a faulty stairlift, or a partial electrical rewire to enable a community alarm to be installed.
I am hopeful that this trend signals a leap of faith by health and social care commissioners and their recognition of the key role played by housing in the future care of older people. Home-based care is undoubtedly the majority preference, but let’s not delude ourselves that it doesn’t carry its own price tag.
Malcolm Ramsay is head of policy at Foundations, the national body for home improvement agencies. Foundations is appointed by the Department for Communities and Local Government.