Supported housing – a prescription for the NHS

Demos discovers the value of sheltered housing to a cost pressure sector short-changed over LHA reform.

Demos-001

Here’s an NHS pledge worth putting on the side of a bus – a near £500m a year saving secured through sheltered housing.

Think tank Demos got this on track to help Anchor, Hanover and Housing and Care 21 consider the implications of government plans to fund the core rent and service charges for a variety of forms of supported housing through Housing Benefit or Universal Credit up to the Local Housing Allowance (LHA) rate.

Demos reviewed 52 academic papers and policy reports relating to sheltered housing and quantifying its value.

Research that revealed sheltered housing – currently offering homes to just under half a million – as an under-researched sector.

Claudia Wood, Demos chief executive and author of the resulting report, maintains such limitations don’t undermine the credibility of the cost saving estimations.

“Rather, it would point to the fact that calculations are an underestimate,” she said.

With that out of the way, what did Demos discover?

Essentially, sheltered housing can save the NHS and social services at least £486m per year – if the government excludes older people’s housing from proposals to cap Housing Benefit for those in sheltered housing.

That £486m – with a provision for independent, self-contained living, wardens, alarms and other on-site staff to provide 24-hour support as the variable – breaks down to:

  • £300m per year from reduced length of in-patient hospital stays
  • £12.7m per year from fall prevention by residents of sheltered housing
  • £156.3m per year from prevention of falls which result in hip fractures
  • £17.8m per year from reduced loneliness experienced by residents

Start with the cost of hospital stays.

The research revealed residents in sheltered housing are more likely to have a disability or persistent health issues than the general older population.

So, unsurprisingly, research also revealed that 21% of sheltered housing residents have been an inpatient in hospital in the previous year – compared to 17% of general population aged 75+.

However, that 21% only spent a week in hospital, compared to 17 nights for an average inpatient stay for the older general population.

At the time of the research there were 485,575 people in sheltered housing, so 101,971 of these spent 7.4 nights in hospital in one year.

Assuming the cost of a hospital bed is £300 a day as figures suggest, then the cost to the NHS was £226m.

But consider the cost to the NHS if those 101,971 people were not in sheltered housing, and so did not have appropriate housing and support to be discharged to.

If they had spent 17 days in hospital instead of one week, the cost to the NHS would have been £520m.

That’s a potential saving to the NHS of almost £300m per year.

Demos-002

Now switch the emphasis to emergencies.

Data from a single sheltered housing site over the study period showed 43% of the tenants went to hospital – 53% were emergency admissions staying in hospital over an average 8.2 days against a 12.9 day average for older people in the general population.

Again suggesting sheltered housing facilitates a shorter inpatient stay.

Go back to that £300 a day bed stay and extrapolate the data to the entire population in sheltered housing, then 110,663 tenants may be admitted to A&E in any one year, at a cost of £272m for that 8.2 day stay.

But if these sheltered housing tenants were not in sheltered housing, their increased length of stay would cost £428m.

So, in facilitating shorter inpatient stays following emergency admissions, sheltered housing saves the NHS £156m per year.

Demos-003

The figures also have the drop on falls.

Demos discovered each year 600,000 older people attend A&E following a fall – with around a third going on to admission.

Every year 300,000 over 65s are hospitalised for a hip fracture.

That alone adds up to sheltered housing as an effective resource to tackle the primary drivers of health and care costs among older people – poorly insulated houses, falls and loneliness.

ONS Population Data from 2015 pitched 14.5% of the 65-79 age group and 29.2% of over 80s as being lonely ‘some or all of the time’.

Demos-004

The Demos research, however, found retirement housing residents were half as likely to report feeling lonely as their counterparts of the same age in the general population.

And studies show the ‘lonely’ use health services more frequently.

They are:

  • 1.8x more likely to visit the GP
  • 1.6x times more likely to visit A&E
  • 1.3x more likely to experience an emergency admission.

See where this is going.

National Audit Office (NAO) statistics put the average cost of a GP consultation at £21, A&E attendance £124, and emergency admission at £2,358.

Combining these figures with the increased likelihood of lonely people using NHS services, Demos can estimate the annual total cost of loneliness to the NHS is £714m per year – or £398.10 per person for the over-65s.

So, take that estimate and apply it to the half a million older people currently living in sheltered housing and sheltered housing saves the NHS £17.8m annually in reduced health service use.

From the frontline, Howard Nankivell, operations director at Anchor Housing said the research demonstrated the valuable role that sheltered housing plays: “It is crucial that we in the sector work with government to achieve their objectives and secure appropriate housing for the older people of today and tomorrow”

Over to Westminister then.

There’ll be one along any minute…

Comments