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How models of NHS care need to change; a view from the housing sector



Curo's Step Down From Hospital accommodation in Bath

This summer I attended the National Housing Federation’s inspiring Care and Support Conference in Manchester and came away motivated to share the role Housing Associations play.  We are the hidden heroes of the NHS nationwide; if the NHS is to stack up, it’s essential that it makes a significant cultural shift.  It would do well to embrace the things that community and voluntary organisations like Curo do to keep people out of hospital beds, GP surgeries and emergency admissions.  I’m passionate about the stuff we do at Curo, together with a huge range of voluntary partners, and see huge potential for helping the NHS in its transformative development.

Current models of NHS care appear to be inward-looking and exert an almost centrifugal force, pulling people towards a costly medical or hospital-based offer when what they need is a community-based solution. In many instances people end up being sent to hospital, or go back into hospital following discharge, because of a failure to address the social causes that meant they ended up unwell in the first place.

GPs are overstretched and cannot be quasi-social workers on top of their current jobs. They simply can’t do everything for their patient community.  GP’s areas of expertise don’t widely encompass community-based solutions which can include: step-down from hospital transition accommodation and wraparound support packages; warm and well schemes; village agents; home improvement or repair services; aids and adaptations; telecare technology; dementia community support; re-ablement services; and independent living support.  However it is very much the bread and butter of what Housing Associations and Voluntary Sector Services do and could do much more of.

Any effective model of NHS care in the future would be well-advised to partner, as an equal, the amazing range of current, well-established community provision from housing associations and the voluntary sector.  There needs to be a more in-depth understanding that the NHS cannot cure itself - it needs to share resource into the community, to trust that others can deliver better health for people, and to have the evidence to prove it.

Step Down 2

Housing Associations like Curo have a shared value base with the NHS and as such are natural partners in a future model of care that seeks to deal with health care before it reaches the front door of a hospital or specialist residential setting. Community-based offers from the voluntary sector are needs-responsive and have been around for more than 30 years.  In spite of that, in recent years our care and support activities have been unrecognised by many in health and social care as well as under-funded despite the significant contribution to public health and well-being that we make. Many Housing Associations offer services to the public and not just their residents, although it’s also the case that we house the most vulnerable people who have experienced lifetime deprivation and poverty and consequentially are in the poorest health.

Every week Curo supports 2,300 people living in sheltered housing and over 50’s in the community who own their own home but need help to remain independent.  Last year we worked with 743 people with co-morbidity factors, 865 people who said they were disabled in a way that impacted their mobility and well-being, and 180 people with dual diagnosis or complex needs. We do this by providing low-level, low-cost interventions such as a 24 hour alarm, a weekly home visit, help to access benefits and work through debt, help to work heating systems and ensuring that people get early diagnosis of dementia and help to remain living at home.

The results speak for themselves.  Overall, through outcomes such as preventing 1,373 likely admissions to hospital, 408 people from presenting repeatedly at A&E, 855 people from presenting repeatedly at their GP surgery, helping 284 people get early discharge from hospital and 24 to be signed off from secondary mental health services , we have estimated a saving to the public purse in the region of £16.5 million.  Think what economies we could deliver with voluntary sector partners at scale.

The future lies with an NHS model of care that is truly inclusive of the community offer, perhaps delivered out of large-scale GP hubs.  A future NHS model will succeed if it’s one that is understanding of the skill sets and effectiveness of non NHS services, and is willing to share real resource to effect change.

Follow Harriet on Twitter @HBosnellCuro

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