The contribution that housing associations can make in relation to public health improvements in recent years has been increasingly recognised within both the research and policy literature. The provision of basic housing requirements is linked to health improvements. Wider factors such as neighbourhood quality, security of tenure and modifications for those with disabilities have also been shown to improve well-being (see https://www.kingsfund.org.uk/publications/economics-housing-health and http://www.parliament.uk/documents/post/postpn_371-housing_health_h.pdf)
We were recently commissioned to examine the approach taken by one housing association (Connect Housing http://www.connecthousing.org.uk/home.aspx) in partnership with a community healthcare service provider (Locala https://www.locala.org.uk/home/), who had joined forces with the aim of improving the health and well-being of people with complex needs in one Yorkshire area.
The pilot project established a new model of care as part of an approach to improve the health and wellbeing of vulnerable people in one specific geographical area. Individuals living in a Connect Housing property with a long-term health condition or disability who were in receipt of care from community health teams (provided by Locala) and deemed at risk of needing increased health care, were eligible for a referral by a health professional to the intervention. A dedicated worker (employed part-time) conducted a home visit, and made a confidential assessment of those referred across five key areas; economic well-being, home and housing, maintenance of health and well-being, life skills and social isolation. Eligible service users were provided with one-to-one support tailored holistically to their needs, and were signposted to other services where appropriate. This support was not exhaustive, therefore provision of general social care, day to day repairs, cash handling, decorating services, domiciliary and home care, gardening, health care, personal care and rehabilitation were all excluded. The premise of the pilot was that individualised assistance would support Care Closer to Home as envisaged in recent policy direction (see http://dx.doi.org/10.1136/bmj.39371.523171.80), and improve health. 27 clients were supported over the evaluation period of one year (September 2015- 2016).
We interviewed service users and a carer (5 interviews), who all reported positive outcomes resulting from the intervention including improved health and well-being, more independence and less social isolation, making a significant difference to their lives. We talked to those involved in developing and delivering the service (10 interviews), who reflected upon their learning from collaborative multi-agency working and referral processes. We also examined health service usage data to see if there had been any changes in the uptake of services, in patterns of demand and associated costs. From this analysis, we determined that the intervention was associated with reduced use of healthcare services (including community services, GP appointments and Accident and Emergency visits); with an estimated net saving of £20,818.20 to local services over the one year in which the pilot was delivered.
In summary, this small-scale localised intervention supported clients with complex health needs whilst reducing demands on community health care services. There is more work to be done in analysing the impact of interventions such as this in terms of scaling them up and assessing their longer-term sustainability. However, it is a clear conclusion of our evaluation that this co-commissioned new model of care was impactful in terms of promoting health and reducing health service usage, alongside associated costs. The full report can be found here (http://eprints.leedsbeckett.ac.uk/2989/).
Louise Warwick-Booth, Susan Coan and Anne-Marie Bagnall