The “confusing myriad” of home support services that help vulnerable people live more independently should be combined to create a one-stop shop, according to a new report.
Commissioned by Foundations – the national body for Disabled Facilities Grants (DFGs) and home improvement agencies – examining how DFG has developed since it was introduced in the early 1990s.
The report highlights areas at the cutting edge of provision – such as Knowsley, Cornwall and Ealing – where services have been joined up to great effect.
Some 40,000 people a year receive DFGs to pay for home adaptations such as stairlifts, level access showers and ramps.
This is set to rise to 85,000 by the end of the decade thanks to increases in government funding.
That should pave the way to greater increase use of a cost-effective grant that helps to reduce hospital admissions, cut care costs, delay the move into residential care and speed up hospital discharge.
Yet the report reaveals awareness of DFGs is still low, provision is fragmented and too often older and disabled people are left to search out solutions themselves.
By pulling together support from home improvement agencies, occupational therapists and other health and care professionals – potentially in the form of new arm’s length management organisations, as Sunderland has done – the report suggests support will achieve a higher profile and be delivered more efficiently.
Such an approac, the report says, has the potential to build greater capacity to support those not eligible for DFGs, relieving the pressure on hospitals and social care departments through preventative approaches as England adapts to an ageing population.
DFGs are awarded by local authorities and are predominantly delivered by home improvement agencies, a network of 200 organisations across England based in local authorities, housing associations or run as standalone charities.
DFG became part of the Better Care Fund (BCF) in 2014 after a period of “policy vacuum” described by report authors Sheila Mackintosh and Philip Leather as not really belonging to housing, health or social care.
The report highlights alignment with BCF as an important breakthrough saying: “The accessibility of the home is finally being recognised as important for successful hospital discharge, to enable care to take place at home, and to allow people to live independent lives… it is possible to join up the previous disjointed pathways and link the DFG to other related health and care services in a way that will make much more sense to customers. Rather than standing alone as a single solution it can be part of a more holistic range of interventions to help older and disabled people remain independent at home.”
The report identifies key ways in which DFG can fulfil its potential:
- Areas that have multi-skilled teams and have adopted lean systems, such as Ealing, appear to be delivering faster services with fewer staff – this approach needs to be adopted elsewhere
- Older and disabled people often have to navigate complex service pathways to find the support they need. A much simpler system could be created that joins up provision – run by a local authority, HIA, combination of the two or through a new arm’s length management organisation
- Funding levels clearly affect delivery times as backlogs occur when funding is restricted. This is less of an issue where teams have strong management, are outward looking, engaged with the health and wellbeing board, and where they have the support of elected officials
- More robust information is needed on the outcomes of adaptations. Better data would enable the case for additional resources to be made much more effectively. Up to now the focus both locally and nationally has been on presenting data on expenditure rather than the impact on customers and on health and social care spending
- Better Care Fund plans should include more detail on DFG including financial and staffing resources, the DFG delivery process, and the measurement of outcomes
- GPs and other health professionals should be more involved in referrals to ensure better targeting of DFGs
Paul Smith, director of Foundations, said: “This report will be invaluable to all those involved in the commissioning and delivery of DFG – from health and wellbeing boards and clinical commissioning groups to home improvement agencies and disability organisations.
“We must work together to maximise the record levels of public money now being allocated to DFG and deliver more integrated and targeted services. This report sets out how that can be achieved.”
- DFG helps about 40,000 people every year with adaptations to their homes
- Over 60s account for 71% of grants
- 22% go to those aged 20-60 and 7% to children and young people
- Most grants go to owner-occupiers (61%), followed by those in social housing (32%) and private rented accommodation (7%)
- Average DFG awarded is £7,255 with 58% at £5,000 or lower