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Is this to be the cross-party decade of housing-with-care?

Growing calls for 2020s to be the “decade of housing-with-care” as new task force awaits

At the end of March, more than 40 MPs, Peers, charity and private sector leaders joined forces to urge the Prime Minister to make the 2020s the “decade of housing-with-care”. The signatories to the open letter – who included Labour politicians, such as Siobhain McDonagh MP, Parliamentary colleagues from three other parties, plus household organisations like Age UK, Legal & General, the British Property Federation and Campaign to End Loneliness – said that “just as previous decades saw the expansion of the care home and home care sectors, there is now a new consensus that the 2020s need to be the decade of housing-with-care”.

Why, you might ask, should there be such widespread clamour for the growth of housing-with-care at this particular moment? At the top of the list is the urgent need to solve the UK’s social care crisis – made more pressing than ever by the Covid-19 pandemic. While finding a consensus on how social care is funded is pivotal, of equal importance is answering the question of where social care is delivered. Are we to stick with a system largely defined by two options, a care home or care at home, or are we to give older people a true choice by creating a greater variety of care settings?

There is a growing recognition that – for the social care sector – it cannot be business as usual. New ways of caring for older people are needed, which combine independent living with high-quality care and support; which not only enable older people to live longer but to live healthily for longer; which tackle the loneliness crisis by keeping older people connected with their community. As the letter’s signatories say, we need to create a “world-class system of housing-with-care that couples a focus on independence and prevention with a safety net of care services and consumer protection”, to “complement existing care options such as care homes and home care.”

It is an argument that has been gathering serious Parliamentary momentum in recent months. Alongside the open letter to the Prime Minister, MPs and Peers from four different parties, plus influential crossbencher Baroness Sally Greengross, contributed to a ‘Housing with Care Grey Paper’ in March with policy ideas to help grow the sector.

Labour politicians have been providing a strong voice on the issue, with Shadow Social Care Minister, Liz Kendall, arguing in a major speech a couple of weeks ago that we need more options inbetween a care home and care at home. The party’s former Shadow Secretary of State for Communities and Local Government, Andrew Gwynne, pressed the Government to respond to the open letter to the Prime Minister, and consider setting up a new task force to expand housing-with-care.

Why a task force? The challenge with growing housing-with-care is that it straddles multiple Government departments and so requires a new, collaborative vehicle for action. The “housing” part of housing-with-care lies with the Ministry of Housing, Communities and Local Government (MHCLG), while the “care” part stands with the Department of Health and Social Care (DHSC). A new Housing-with-Care Task Force, which Ministers are actively considering, would bring the two together to thrash out concrete policy changes so that the sector can play its full part in the social care system.

While the task force would need to decide its focus, there are a number of core policy areas that it would have to address to make the 2020s the “decade of housing-with-care”. Just as the expansion of care homes in the 1980s and 1990s and homecare in the 1990s and 2000s was largely driven by pieces of legislation and regulation specific to these sectors, we now need the same for housing-with-care.

That means properly defining housing-with-care in the planning system so it can be more easily built, providing strong consumer protection for residents moving into housing-with-care, and developing appropriate models of tenure. Ensuring the sector remains affordable for older people of all incomes is also crucial.

Some of these policy changes might sound minute, niche, even quite dry. The results will be anything but. A social care system where living a thriving, active lifestyle and receiving care don’t have to be in opposition but can be achieved together. Retirement communities which help regenerate high streets and bring people of all ages together through shared activities and services. Older people having great options to ‘right size’ and homes freed up for younger people. The list goes on.

We are on the verge of overcoming a perennial public policy challenge: getting different Government departments to talk to each other across competing priorities and bring about collaborative change. As we move closer to a cross-government Housing-with-Care Task Force, the prospect of a varied and imaginative social care system which meets the diverse needs of our ageing population is in sight.

Let’s keep up the momentum to make this a reality.

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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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.

Sam Dalton

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