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The emergence of housing-with-care

If social care reform was a priority before Covid-19 hitting, then the pandemic has only heightened the urgent need for a new settlement. Of course, finding a funding solution is vital. The Health and Social Care Select Committee noted as much in their recommendation last week for an additional £7bn for social care, just as a “starting point” that would not address unmet care needs nor improve access to care. But funding alone will not transform our social care system in a way that meets the needs of an ageing population – no matter how much is spent.

That is because as well as deciding how social care is funded, we need to reflect on where social care is delivered. Currently, there are basically two choices in the UK: care at home or a care home. Both of these options are vital ones that will without question continue to play a key role in the provision of social care. Firstly, many people want to stay living in their own home for as long as possible for the independence that it brings, and so good-quality homecare is pivotal. And secondly, many people in the last few years of their life need a level of care that requires moving into a care home where they can receive 24/7 support.

But having these as the only care options for older people means we just cover both ends of what should be a wide and diverse spectrum. If an older person starts to consider whether the family home they have lived in for years is still right for them, and wants to move somewhere with a little more support and, if needed later down the line, care, should their only alternative really just be a care home?

Thankfully, other choices are starting to emerge in the form of “housing-with-care”. This middle option stands between care at home and care homes. It offers independence through older people renting or owning their own flat, while having 24/7 staff on site, the option of CQC-regulated social care if needed, and a wide range of communal services and facilities, from restaurants and bars through to gyms and activity rooms. It is often integrated with the wider area, attracting people of all ages to enjoy activities and events at what becomes a community hub.

The limited amount of housing-with-care in the UK has already shown itself to encourage an active, socially connected lifestyle and improve the health and wellbeing of residents – which reduces the need for GP and hospital visits and takes pressure off the NHS.

But “limited” really is the word when it comes to current housing-with-care provision. Compared to more than 450,000 care home beds, there are just 70,000 housing-with-care units. This means only 0.6% of over-65s have the opportunity to live in housing-with-care in the UK, whereas in countries like New Zealand, Australia and the US, the figure is at least 5-6%. That’s despite growing demand in the UK, and increasingly long waiting lists. Popularity is also rising among UK politicians, with 18 MPs and Peers signed up as official Parliamentary supporters for housing-with-care, and Labour’s Shadow Minister for Social Care, Liz Kendall MP, understood to be interested and supportive.

The key question for policymakers is: if funding alone is not going to transform social care in the way needed, what is? What policies will enable a greater diversity of social care settings to evolve, so that older people no longer have to choose between two extremes? Some key steps include clearly defining housing-with-care in the UK planning system (it is currently non-existent) so that it is easier to build, and introducing stronger consumer protection regulation for the sector. Work must also be done to ensure housing-with-care is affordable for all: two-thirds of current supply is affordable extra care, and this should be built upon.

But answering the policy question fully will require different Government departments to collaborate. Housing-with-care cuts across different departments: health and care integration likes with the Department of Health and Social Care, planning policy with the Ministry of Housing, Communities and Local Government, and consumer protection with the Department for Business, Energy & Industrial Strategy. The best solution is a new Housing-with-Care Task Force that cements cross-government working to recommend the most appropriate policy changes.

None of this is to say that with an expanded sector everyone will want to live in housing-with-care. Just look at New Zealand, celebrated as a world leader in housing-with-care: still just 5.5% of over-65s live in this setting. Most older people will continue wanting to live in their own homes for as long as possible, which is why adaptations to make existing homes more age-friendly, and building more new homes fit for all ages, is vital. Care homes will always have an important place for those with high-level needs in the last years of life.

Increasing the diversity of our social care system is about complementing existing options. It is about giving older people more choice. While solving the social care funding crisis is crucial, we must also pay urgent attention to where social care is delivered. The Government can ensure a brighter future for older people if it acts now.

<strong><span class="has-inline-color has-accent-color">Sam Dalton</span></strong>
Sam Dalton

Sam is a policy and public affairs professional with expertise in housing, social care, social connection and loneliness. He works for the representative body for housing-with-care operators in the UK, ARCO, and previously led an inquiry on strengthening ties between young and old with the parliamentary group on social integration.

Sam has written for The Fabian Society and Left Foot Forward, as well as think tanks, social ventures and charities.

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Housing is key to tackling the UK’s loneliness epidemic

This year’s Loneliness Awareness Week could not have come at a more important time. Even before the coronavirus pandemic, the UK had a loneliness epidemic. But the outbreak has drastically worsened and brought into sharper focus the feelings of loneliness felt by people of different ages. The latest figures published by the Office for National Statistics (ONS) show that the equivalent of 7.4 million people across Great Britain said their wellbeing had been affected by feeling lonely in the previous seven days.

Despite this, the last few months have also given us many inspiring moments of social connection, even at a time of physical distancing. The coronavirus crisis has brought communities together and shown our capacity to reach out across social and generational divides. From mutual aid groups to young people sending letters and poems to older care home residents, we seem to have realised what is really important to us: connection and belonging.

Our politicians must act quickly to build on this momentum and create a more socially connected country for the long-term. Housing policy has a key role to play. If we don’t feel comfortable and safe in the home we live in, or have a neighbourhood which provides spaces in which to interact with others, then our hopes for more togetherness and less loneliness will be dashed.

Tackling loneliness through housing: the story so far

Fortunately, the Government doesn’t have to start from scratch. In 2018 its official Loneliness Strategy was published, including a number of ideas for housing and planning to strengthen social connections. These included placing community at the heart of planning and design frameworks, funding research into community-led housing initiatives such as co-housing, and ensuring the wider urban design of towns and cities encourages social interaction through thriving high streets, parks, and other communal spaces. Adding loneliness to the portfolio of the Ministry of Housing, Communities and Local Government (MHCLG) helped cement this focus.

Since then, the Government has released its follow-up annual report on tackling loneliness, published in January 2020. Progress has been made, it said, by including loneliness measures in the English Housing Survey, giving £125,000 towards co-housing research and exploring the role of design in tackling loneliness at various conferences. With all due respect to these measures, they are not going to suffice in the post-coronavirus world. Rather than light-touch nods to loneliness – a piece of research here and a few conference presentations there – the Government need to put social connection at the front and centre of housing policy, and treat it as seriously as the issue deserves.

Tackling loneliness should not be some after-thought; a soft, woolly topic to be explored once all the important issues have been sorted out. Loneliness is as bad for you as 15 cigarettes a day. It kills people.

What more must be done?

Tackling loneliness has got to be made an explicit priority in the planning system, nationally and locally. Though promoting social interaction is mentioned once in the 61-page National Planning Policy Framework (NPPF), tackling loneliness as a specific aim is nowhere to be seen. Next time the framework is updated – which may be some years away – the section on ‘promoting healthy and safe communities’ should be updated to include a focus on reducing loneliness. More achievable in the short-term is updated ministerial guidance on the framework, setting out how local authorities can plan for developments which foster social bonds across ages. Local authorities should not only be nudged to think about loneliness in their local plans, but required to do so.

This general emphasis has got to be accompanied by specific examples of schemes which have shown promise. The Government is right to highlight co-housing as one model which can bring people together. Residents often play an integral role in the initial design of the community, which typically consist of private properties with pooled funds for communal resources and facilities. Intergenerational living is increasingly high on the agenda, for instance through integrating general needs housing with housing for older people, retirement villages acting as hubs for the whole community, properties designed for multi-generational living, and simple yet effective design tweaks such as having interconnected gardens between properties, or building windows that look out on to communal courtyards.

It is the design not only of housing but of the wider village, town or city which can make all the difference in bringing people of all ages together. Are there enough good-quality communal spaces such as parks and squares to encourage social interaction? Are there enough benches for people to sit down on and chat? How about level pavements and fewer trip hazards so that older people can walk into town?

Tackling loneliness is not only linked to bridging generational divides, but reducing ethnic and income segregation, too. It’s no good fostering close connections between some groups if others are left out – or worse, stigmatised. Last year’s south London scandal over a private playground that barred poorer children entering from the socially-rented block of flats opposite was a case in point. Thankfully, Henley Homes reversed the policy once their disgraceful approach was splashed across national newspaper pages.

Connecting the economic to the social  

The Henley Homes example points to a broader point: you cannot disentangle the economics of housing from the social connections you may seek to create through it. That is why progressive housing policy will win out when it comes to tackling loneliness. We already know that those on lower incomes are more likely to be lonely. Good-quality social housing can help massively, providing homes people can be proud of and live comfortably in, so they are happy living in their community. Gentrifying developments which reduce the number of socially-rented homes in favour of expensive private flats, forcing people with roots in the local area to leave, are only making matters considerably worse. 

Providing better conditions for private renters is crucial, too – another group more prone to loneliness. The Government should prioritise the development of its framework for longer tenancies for private renters, so they feel more secure in their property and have a better chance to build connections with neighbours in the long run.  

Time for action

The coronavirus crisis has illuminated both the tragic scale of the UK’s loneliness epidemic, and the desire of the young, old and everyone in between to overcome it through stronger social connection. If our streets, neighbourhoods, towns and cities don’t foster feelings of togetherness, then we have no hope.

It’s time for housing policy to respond.

<strong><span class="has-inline-color has-accent-color">Sam Dalton</span></strong>
Sam Dalton

Sam is a policy and public affairs professional with expertise in housing, social care, social connection and loneliness. He led an inquiry on strengthening ties between young and old alongside the parliamentary group on social integration, and authored its ‘Healing the Generational Divide’ report published last year.

Sam has written for The Fabian Society and Left Foot Forward, as well as think tanks, social ventures and charities. He led policy workshops for young people at last year’s Millennifest events in London and Bristol.