NHS Trusts urged to work with housing associations to deliver long-term care
Unless the inefficiencies of the NHS are addressed, this great foundation of the welfare state will crumble under the weight of its own responsibility argues the author.
NHS reform has rarely been out of the headlines in the past few weeks. As politicians lobby claim and counter-claim across party lines, it can be difficult to isolate the economic facts from the political spin. As the arguments rumble on, we are in danger of missing the central argument; reform is desperately needed.
Yet while the press and politicans are quick to criticise the proposed changes, hardly any have been forward enough to propose reforms of their own. This reticence is understandable. The NHS is one of the greatest achievements of the post-war British state; it is right that it should be protected. However, while the NHS is a venerable cornerstone of our society, it is also in dire need of repair. It is rich in assets, but fails to manage them effectively; it is responsible for addressing a huge range of social and health issues, but lacks the necessary resources to do so. Put simply, the NHS no longer delivers value for money, either for its patients or the taxpayers who keep it afloat.
This topic was debated at length during our roundtable discussion which was chaired by health expert Baroness Julia Neuberger and addressed by Prof. Steve Field of the NHS Future Forum. The group felt that the NHS should shed some of its under-used assets and devolve some of its responsibilities. Better integration between housing associations and long-term care services and relieve pressure on NHS resources. By releasing some of its unused land to housing associations, the NHS would enable the development of more specialist housing with on-site, secondary health care for the people who most need it, such as the the mentally ill, the elderly and the physically disabled.
Housing associations like One Housing Group can build and operate long term care schemes such as supported housing at a fraction of NHS costs. The costs of caring for a patient on an NHS ward is £400 a day; compared with around £100 per day in a One Housing Group scheme. This is not at the detriment of the quality of care. Just the opposite in fact. Our experience shows that patients have a better experience as they are living in a homely environment rather than on a hospital ward. In the long term, these savings could be used to provide the complex portfolio for a range of services such as supported housing for the elderly.
The group highlighted that it was not about short term gain; either for housing associations or for NHS Trusts. It is about long term sustainable plans that deliver value for money for the public over a period of time, long after the plot of land is sold. Unlike private healthcare providers or developers, housing associations are not obliged to make profits for private shareholders; nor are financial resources consumed by bureaucracy or multi-tiered management structures. Any profits we make are ploughed directly back into our social objectives – relieving the burden on the NHS and enabling it to devote more time and money to delivering acute care services.
Our experience could go a long way to solving some of the NHS’ endemic long term problems. Take, for example, provision of housing and care for the elderly. The UK is sitting on a demographic timebomb – an ageing population. Age UK last week warned of a ‘Crisis in Care’, as local councils devote less spending to residential care and other services. Using NHS land to build housing designed to fit the needs of this group not only provides the answer to the UK’s ageing population but also offers a long term financial solution to the NHS.
Much of these savings will come not from cutting investment in care but simply by managing existing assets more effectively. This is something that housing associations are well placed to do; they have seen their funding slashed but have been able to adapt and still deliver high quality services but in a more prudent way. At One Housing Group, we cross subsidise our the building of new homes and through profits generated from sales of private sale and rent properties. We propose a similar business model for secondary care provision, whereby profits are directly reinvested to deliver better value for money and consistently high standards of care.
Our proposals are still at the ideas stage. Ultimately to achieve better integration between health and housing is going to take some time. One Housing Group already develops specialist housing and provides care and support to people with a wide range of needs. This could be further extended to cover a swathe of secondary healthcare services currently provided by the NHS. To make this a reality, the subject of NHS land utilisation to deliver lower cost long term care schemes needs to moved higher up the organisational agenda. Health and Wellbeing Boards need to be brought on board, to steer integration. There is a critical role too for the National Commissioning Board and local CCGs to look at the inequalities and needs of adults across local authorities. Perhaps an additional case in the five-case business planning model can help test the value the NHS is getting from its proposals.
In short, many more conversations need to be had before a new, integrated care model can be brought about. However, if it can ease pressure on the NHS, and deliver high-quality services to the most vulnerable sections of our society while saving taxpayers money, then surely these are conversations worth having.