Housing and the social care white paper: a credibility gap?
On the 1 December 2021 the Westminster government published its plans for the future of social care in England – People at the Heart of Care: Adult Social Care Reform.
Much of the popular and political debate that foreshadowed the arrival of the white paper focused on whether people will continue to have to sell their homes to pay for social care in older age. In the event, housing is very much front and centre of the proposals, but not only because of the implications of the proposed £86,000 cap on care costs.
The white paper recognises the well-established and widely acknowledged fact that too many people with care and support needs live in housing that does not provide a safe or stable environment. In response, three housing priorities are identified. First, embed housing as part of the local health and care system. Second, make it easier for everyone to adapt their home so they can live independently and safely as long as possible. Third, increase the supply of specialist housing.
This focus on housing is to be welcomed. Adequate housing is critical to meeting health and social care needs. Home improvements and adaptations can help people to live independently at home for longer. Specialist housing can help meet the support and care needs of older people. It is therefore vital that housing is integrated into health and social care planning.
Whilst welcoming these priorities, it should be pointed out that they are not radical or new. Similar ambitions have been outlined in numerous previous government white papers and strategy documents over the last 20 years. Yet, housing remains a wobbly pillar under the social care system. The reason for this is a gap between rhetoric and reality.
This point is usefully illustrated by the findings of CaCHE research exploring the housing options of older people. Let’s take each of the housing ambitions outlined in the white paper in turn. First, policy has long sought to promote integrated working at the local level between housing, health and social care in order to promote healthy ageing. However, various factors – including resourcing, capacity and siloed working – continue to limit progress. Second, government has long played a role in supporting efforts to maintain and improve the valuable national asset that is housing. However, cracks and fissures have emerged within the national framework for housing improvement over recent years as a results of major cuts in funding, undermining local efforts to tackle the 4.3 million homes in England that do not meet basic standards of decency and the related impacts on health and well-being. Third, specialist housing for older has long been recognised as an important welfare service that enables the delivery of care and support and can improve quality of life. However, there is an estimated national shortfall of 258,000 units of specialist housing in England, with the largest shortfalls in more deprived areas with higher levels of need.
The white paper asserts that we need to make every decision about care also a decision about housing. Few would disagree with this sentiment. The problem is that far too many older people in England today have few, if any, housing alternatives to choose from. In many places, housing improvement and adaptation services have been scaled back, the supply of specialist housing has failed to keep pace with rising demand, and new housing developments have focused on meeting demand for family housing. Many older people are left with the binary choice of either staying put and making do, or moving into residential care.
Will the proposals in the white paper reverse this decline and expand the housing options of older people? Funding is certainly promised – £300 million over 3 years to both support the integration of housing with health and care, with the hope of boosting the supply of new specialist housing; an undisclosed amount of funding for a new minor repairs service; and a further £570 million per year for the Disabilities Facilities Grant. However, these sums pale into insignificance when compared to the scale of cuts made over the last 10 years to housing support and improvement programmes. There is also the question of delivery. How will we ensure more people benefit from home improvements and adaptations? How will the supply of specialist housing be boosted in the places where need is most severe? The white paper leaves these questions hanging.
The white paper should be applauded for placing housing at the heart of future plans for social care. However, it struggles to outline a coherent plan for how we might bridge the widening gap between the ambitions of health and social care policy and realities of local housing provision.
Professor David Robinson is a theme lead and co-investigator at the UK Collaborative Centre for Housing Evidence.
Date: December 2, 2021 11:32 am
Author(s): David Robinson
Categorised in: Choice