Dr Jenny Preece (University of Sheffield) and Prof Vikki McCall (University of Stirling) provide an overview of their recently published research on home improvement services in England.
Today, we are launching the final report for the national evaluation of home improvement services in England, in collaboration with research funders at the Centre for Ageing Better. Home improvements involve changes to the home, which can support healthy ageing in place as well as enabling disabled adults and children to live safely, independently, and with dignity. Improvements may be as simple as grab rails or a key safe or as complex as an extension or through-floor lift. As part of a consortium led by the Centre for Regional Economic and Social Research (CRESR) at Sheffield Hallam University and including the University of Sheffield, the University of Stirling, the Building Research Establishment (BRE) and Foundations, we have spent the last 18-months building an evidence base on the contribution and impact that home improvement services make.
We know from research as part of the evaluation that over two million owner-occupied homes do not meet the decent homes standard, nearly double the number in the private rented sector, and that over half of these non-decent homes are headed by someone over the age of 55. Improving housing quality is therefore key to preventive housing and health agendas in the context of an ageing population.
Good practice and the value of home improvement services
To provide an understanding of best practice and how high-quality services are delivered, we focused on eight case study organisations offering comprehensive services through a range of delivery models, covering six English regions, including urban and rural areas.
Adaptations to the home have a significant impact for service-users, improving quality of life, reducing pain and discomfort, and providing confidence and independence in their daily lives. As well as being physically safer, we also found that adaptations positively impacted mental health and wellbeing, reducing stress and anxiety. This also extended into the relationships individuals had with their family and friends. A case worker-led approach could be particularly beneficial in helping individuals navigate different services to achieve personalised and tailored outcomes that were focused on a holistic understanding of needs and preferences.
These positive outcomes stem from wider good practice evident within the case study services. Strong leadership drives a broad mission throughout all organisational levels to promote dignity, independence, control, and quality of life for clients. Service managers are important in being proactive, with an outward-facing mentality and ability to see past obstacles, enabling the case study organisations to maintain and grow services despite some very challenging contexts.
Case study services take a holistic and person-centred approach with a focus on prevention. Many services are comprehensive, which means that they can proactively assess for multiple needs in one visit; this is facilitated by training and upskilling staff. Having some relatively low-threshold access to services – such as handypersons services or boiler servicing – without too many preconditions also supports a preventative agenda by enabling services to get through the front door and identify other problems in the home. A casework approach supported clients in making decisions, ensuring that their voices were heard, building trust and being accountable for leading clients through more complex cases.
Whilst some services were more integrated or co-located alongside aligned services such as occupational therapy or private sector enforcement, strong local knowledge, clear referral pathways and good communication could also deliver some of the benefits of integrated services even with different delivery models. The precise mix of services and interventions available varies geographically, but by designing services in conjunction with local strategic partners areas could benefit from locally relevant offers which were responsive to changing needs, demographics, and population risks. Developing trusted relationships with key stakeholders was an important route to ensuring the value, role and opportunities of home improvement services were understood and well-represented at strategic forums.
Making the economic case for home improvement services
Understanding the cost effectiveness of home improvements was a key part of the evaluation. Qualitative evidence from stakeholders such as commissioners overwhelmingly points to the case study services as providing value for money. A number of hospital discharge interventions provided evidence of the way in which home improvements can deliver cost savings to the wider health and care system, freeing up hospital beds, preventing readmissions, and delaying the onset of acute care needs. Whilst gaps in the evidence base prevent a comprehensive assessment of the return on investment from home improvement services, the basic cost savings to the NHS from hospital discharge freeing up beds is an average of £2,690 per supported discharge, before any further direct or indirect costs/benefits are considered.
Turning to other areas, considering fall prevention, the expected return on investment for every £1 spent on adaptations to prevent falls is £1.10 cost saving to the NHS or £4.56 to society. Using a similar approach and applying this to the prevention of harm from excess cold, the expected benefit of prevented harm from excess cold is a £52,230 cost saving to the NHS or a £728,182 cost saving to society. Based on cautious assumptions, it is estimated that interventions in 1,000 households would prevent excess cold harms for 25 individuals; this would provide a cost saving of £1.3 million to the NHS, a return on investment of £0.16 for every £1 spent on interventions to address excess cold. This could be improved with a higher degree of targeting, e.g. on fuel-poor households and/or those most at risk of harm from excess cold.
Across the evaluation, when speaking with case study organisations, wider practitioner networks, and local and national stakeholders, a series of important challenges were highlighted. These include the cap on Disabled Facilities Grants (which has been eroded by high inflation), insecurity of funding streams affecting the long-term delivery of services, increasing demand (including as a result of the withdrawal of other services), and recruiting staff with technical skills. These are pressing issues which require urgent attention, and the report makes a number of recommendations for change at different scales. You can read more about this and the different work streams that make up the evaluation in our summary and final report available here.
