The Government has published ‘The Next Steps to put People at the Heart of Care’. They say that people who receive care, staff and providers will benefit from a refreshed plan to bolster the adult social care workforce, speed up discharge from hospital and accelerate the use of technology in the sector over the next two years. The update builds on commitments outlined in the People at the Heart of Care white paper – published in December 2021.

Kathryn Smith, Chief Executive of the Social Care Institute for Excellence, comments:

Like many others working to reform social care, we are disappointed that the government’s plans for delivering long-term change within the social care sector have been considerably pared back. However, we expect the government’s next steps to move the system in the right direction, such as the extra funding to local authorities, digitising the sector, and workforce training and career development.

Kathryn Smith continues:

Reforming the system remains vital and urgent as a policy priority. We know from recently published data that people’s demand for social care continues to far exceed the supply available. That translates into a lot of unmet need in our local communities. Given today’s reality, how do we plan for the future of care?

SCIE Chief Executive Kathryn Smith also says:

One important way forward is expanding the supply of housing with care and support. We were pleased that the Older People’s Housing Taskforce has been re-confirmed in the Next Steps paper. Since we published our own research on housing with care and support (“A Place We Can Call Home”), we have called for no decision about care and support to be made without considering where people live. We look forward to contributing to the Taskforce’s work and shaping its recommendations.

Kathryn Smith continues:

We also look forward to hearing the details about the proposed innovation and improvement unit. Testing and evaluating good ideas for improving care and support is another necessary step forward. For these activities, ongoing collaboration with the social care sector will be essential. We urge the government to maintain a genuine commitment to co-production, with people who draw on care, their carers and local communities playing a central role in the unit’s work.

Social Care Institute for Excellence Chief Executive Kathryn Smith concludes:

SCIE still supports the ambition of the original White Paper, which offered a refreshing 10-year vision for reform. The paper was co-produced with the sector and firmly grounded in valuing the people who draw on care and their carers. By recognising the long-term trend towards more care at home and in the community, the paper’s original proposals offered genuine scope for transforming the future of care and supporting people to live their best lives. Whilst laying out its next steps, we encourage the government not to lose sight of its original vision.

An independent review of integrated care systems, carried out by Rt Hon Patricia Hewitt, was published 4 April 2023.

Chief Executive at the Social Care Institute for Excellence, Kathryn Smith, comments:

SCIE supports the Hewitt Report’s recommendation about removing the boundaries between health and social care to ‘unlock the potential’ for system working on prevention and early intervention. But we would take this even further. For what is sorely needed is a shift in the narrative about social care from NHS acute bed management to community models of care. Social care plays an important role in more than prevention and early intervention, including intermediate care, reablement and supporting people’s independence and quality of life.

Kathryn Smith continues:

By breaking down barriers, opportunities to develop new models of care emerge, from better recovery services to scaling up technology-enabled care. Key to this is resolving the problems of short-term funding and short-term planning cycles, which make it difficult to invest properly in integrated community-based services. Addressing unnecessary ICS bureaucracy will also create more flexibility for use of integrated resources.

SCIE Chief Executive Kathryn Smith concludes:

We strongly agree with the report where it acknowledges ‘a compelling case that social care providers should have a strong voice in every ICS.’ We encourage ICSs to take a wider view of system partners. For instance, local authorities have well-established relationships with social care providers, who will be instrumental in designing and delivering new models of integrated care.

A vision and a roadmap for providing more options for housing with care and support for older people.

A call for an ambitious long-term plan to improve housing with care and support for older people.

Report published today by the Commission on the Role of Housing in the Future of Care and Support.

A new report, published today, concludes that an overhaul is needed on how housing with care and support is planned, commissioned, designed and delivered. The report’s authors say that this will require concerted action nationally and locally, with a ten-year strategy for housing with care and support. It calls for ambitious plans for housing with care and support to be at the heart of the White Paper for social care.

The report, published today by the Commission on the Role of Housing in the Future of Care and Support is called A place we can call home: A vision and a roadmap for providing more options for housing with care and support for older people. The Commission looked at the spectrum of housing options that provide care and support, including retirement housing, care homes, extra care, Shared Lives, supported living and co-housing and heard from a range of older people about the challenges and difficulties they face – and the choices they want to see.

The report includes a number of recommendations for national government, for local authorities and local partners, and for developers and providers and paints a picture of what the route to achieving more choice, more consistently provides could look like.

Key recommendations

The Commission makes a number of key recommendations, including:

For national government

  • Create a national long-term vision and strategy for housing with care and support for older people, co-produced with people with lived experience and other key stakeholders
  • Legislate for a new Housing Future Fund that obliges partners in local places including the NHS and local authorities to pool statutory funding and work together to develop a single plan for housing for older people
  • Streamline and simplify the national planning framework and guidance to encourage greater levels of investment in housing with care and support development
  • Increase capital investment in housing with care developments particular of approaches to housing with care which support people to live independently
  • Invest in improved information, advice and advocacy to support people to find the right option for them.

For local authorities and local partners

  • Form local partnerships to produce a single plan for improving housing for older people within a local place, co-produced with people who draw on support
  • Establish and resource local co-production forums made up of, and speaking for, older people from all kinds of backgrounds, to influence planning, commissioning and design of housing.

For developers and providers

The Commission believes that as much as is feasible, people should be supported to live in their own homes if they choose to, but there will always be some people who need or want to move from their original home and they should have a range of suitable choices available to them, locally.

Co-production

The Commissioners emphasise that the strategy must be co-produced with older people, their carers and families. Co-production is about developing more equal partnerships between people who use services, carers and professionals. Local areas need to develop comprehensive arrangements for co-producing plans for housing with care and support with local people. This includes establishing local co-production forums made up of, and speaking for, older people from all kinds of backgrounds, to influence planning, commissioning and design of housing.

SCIE’s Chair, Rt Hon Paul Burstow, also Co-chair of the Commission on Housing and Care

No decision about care and support should be made without considering where people live. This report is a wake-up call: It makes a compelling case for investing in innovative housing with care and raising public awareness of their later life housing options. Better housing can help people to live in places that matter to them as they age, to remain independent as long as possible and stay connected with their family, friends and communities.

SCIE’s Chair, Rt Hon Paul Burstow, also Co-chair of the Commission on Housing and Care

I said last year that this Commission mustn’t just be a talking shop. I’m delighted that this report makes some tangible recommendations for a ten-year strategy. The seven principles of excellence, identified in the report, are key to delivering our shared vision with Social Care Future, where we all want to live in a place we call home with the people and things we love, in communities where we look out for one another, doing the things that matter most.

Professor Julienne Meyer CBE, Professor Emerita of Nursing: Care for Older People at City, University of London

A test of any country is the degree to which it supports and enables those who need care and support to stay safe and to lead the best lives they can. Excellent housing with care – including care homes, supported living, extra care and the many other models – is at the heart of supporting people to live the best lives they can. I hope that the important recommendations from the Commission will inform future policy and practice for years to come.

Sir David Pearson CBE, Independent Advisor

About the Commission on the Role of Housing in the Future of Care and Support

Funded by the Dunhill Medical Trust, and managed by SCIE, the Commission on the Role of Housing in the Future of Care and Support was established in October 2020. Composed of a group of leaders of care and support organisations, academics, experts and practitioners related to housing with care and support, and co-chaired by the Rt Hon Paul Burstow, Professor Julienne Meyer CBE and Sir David Pearson CBE, the Commission was tasked with developing a vision and roadmap for providing more options for housing with care and support. They were supported by a co-production group of people with lived experience and a Stakeholder Reference group of experts in different aspects of housing with care and support.

The Commission focuses on the options available to older adults, although it also takes account of examples of promising practice in relation to working age adults (including those with learning disabilities), and multi-generational housing options. The Commission also considers the specific needs of diverse communities including BAME (Black, Asian and minority ethnic) communities, LGBTQ (lesbian, gay, bisexual, transgender and queer or questioning) communities and people with disabilities, who often find it more difficult than others to access high-quality housing

About SCIE

The Social Care Institute for Excellence (SCIE) is a leading values-driven improvement agency. In recent years we have evolved from a largely government- funded body to a fast-moving, high-profile and more commercial organisation and thought leader.

Housing settings don’t always provide the choice and availability for people who use care and support services. That’s the conclusion in a report, published today, which looks at the individual needs of older adults.

The new report focuses on care homes, retirement communities, retirement housing, supported living and Shared Lives. The report argues that if we are to successfully improve people’s quality of life in later life, the Government must commit to finding ways to improve the quality and quantity of housing that facilitates care and support.

The report, the first from the Commission on the Role of Housing in the Future of Care and Support, provides an overview of the key issues facing the sector, and outlines a vision for the future and some preliminary ideas which the Commission believes merit further exploration. It’s a discussion document, setting out some questions and asking for people to contribute to the thinking of the Commission. Anyone involved with housing and social care are encouraged to contribute their ideas

The report also sets some initial policy proposals and actions for local area to consider:

  • An increase in capital spending is needed on new forms of housing that facilitates care and support
  • Better incentives are needed to encourage developers to increase levels of investment in appropriate housing
  • Reform in the planning system. For instance, retirement community housing is not currently defined within the planning system, making it harder to build these as compared with care homes
  • A clear regulatory framework for retirement communities. There is a need now to implement sector-specific legislation on regulations and standards
  • Prevention needs to be at the heart of the strategy for improving the quality of housing that facilitates care and support. Initial proposals for further reforms include, for instance, a commitment to invest in housing that facilitates care and support
  • Improved information, advice and advocacy to support informed decision-making for people seeking housing that facilitates care and support.

The Commission was set up to develop an evidence-based vision and roadmap for housing in the future of care and support. The Commission will also produce a cost benefit tool for local commissioners and estimates of the impact of national investment in new forms of accommodation.

The Government’s health and care White Paper has a large housing shaped hole at its heart. The White Paper is all about integrating health and care – getting the right housing options can pay big dividends for people in later life when they have care and support needs. Now is the time for a national strategy that invests in dramatically increasing the number and choice of places to live that provide access to personalised care. Above all we need a change in mindsets so that housing, care and support go hand-in-hand and are sustainable.

Commission Chair, Rt Hon Paul Burstow, who also chairs Social Care Institute for Excellence

The provision of a range of choice of suitable housing within age-friendly communities means we can all look forward to a healthier later life. But it’s clear that this choice is not available consistently up and down the country. This report represents the Commission’s initial findings. and calls for substantial change both nationally and locally if people are to be able to access the choice of housing they deserve. There is strong evidence of the links between suitable housing and health outcomes in later life so joined-up thinking across the health, social care and housing budgeting and planning is long overdue. Using co-production, local leadership and deep local knowledge of the needs of communities can make sure that housing facilitates good care and support for the years to come.

Susan Kay, Executive Director/CEO of the Dunhill Medical Trust

Future vision for housing that facilitates care and support

The increasing demand for housing that facilitates care and support means that the need for change is now critical. The Commission has identified a number of features that need to be addressed in the future, for instance:

  • Housing needs to be in the right place: People should be able to access housing that facilitates care and support in both a place they want to live and a community with which they identify
  • It needs to promote independence: We support people to live independent lives, in a place they call home, for as long as possible
  • Co-production and shared decision-making is essential. Involvement of people who use care and support in respect of housing should be widened and deepened.

The Commission says that, in order to deliver this vision, there must be a dramatic increase the supply of housing that facilitates care and support. Every area should have a full spectrum of housing options including supported living and Shared Lives schemes, retirement communities, retirement housing, and care homes available to meet the needs of a growing number of older people, including those who are living alone.

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A new commission has been set up to develop an evidence-based vision and roadmap for housing in the future of care and support. It will review progress of the 2014 Commission on Residential Care’s recommendations, taking account of COVID-19, and will consider all forms of housing services that provide care and support including care homes (both residential and nursing) and housing with care (supported living, extra care, shared lives and home share).

The COVID-19 pandemic has taken a huge toll on social care. By June 2020, there had been 30,500 excess deaths in care homes, and social care workers have been almost twice as likely to die from the virus as other adults. The impact on older people living alone and without support is yet to be seen.

COVID-19 has served to amplify pre-existing challenges in social care: a crisis in the funding system, unprecedented recruitment and retention problems, and rising demand as people are living longer but not necessarily healthier lives.

As SCIE argued in our recent report, Beyond COVID-19: new thinking on the future of social care, this has also been a period when good things have happened; not only in local communities where we have seen people’s willingness to help one another, but also within social care where the workforce has shown immense resilience, leadership, and creativity.

Later this year we expect to see a long-term plan for adult social care published, which presents a once-in-a-generation opportunity to put social care on a sustainable and secure footing. We want to influence this work by positively raising the profile of social care and asking pertinent questions about the role of housing in the future of care and support.

The Commission on the Role of Housing in the Future of Care and Support is funded by The Dunhill Medical Trust, and will be led by SCIE. The Dunhill Medical Trust is an independently endowed charitable foundation specialising in supporting researchers and community organisations to understand the mechanisms of ageing and improve the health and social care of older people. The Commission will revisit the findings of the 2014 Commission to explore their relevance in view of COVID-19; examine progress with their implementation; and, based on the lived experience of people who use services, carers and providers, will make recommendations and proposals to enable much-needed change. The Commission will also work with the Centre for Health and the Public Interest (CHPI) to assess the financial impact of COVID on the provision of care and what this means for the future of the sector and for people who use services.

The Commission will be chaired by Rt Hon Paul Burstow, Chair of SCIE and former Minister of State for Care Services (2010-12); David Pearson CBE, Independent Advisor and former Chair of the Social Care Sector COVID-19 Support Taskforce; and Professor Julienne Meyer CBE, Professor Emerita of Nursing: Care for Older People at City, University of London and Co-founder of My Home Life.

Guided by an appreciative approach, the Commission will:

  • Explore the financial impact of COVID-19 on the care home market
  • Co-produce with the sector and people with lived experience and their families/carers, a compelling, evidence-based, long-term vision for the role of housing in the future of care and support, including care homes, extra care, supported living and shared
  • Recommend policy changes to inform the Government’s thinking on the long-term plan for social care
  • Develop a roadmap to support the implementation of this new vision
  • Consider how we can fund and test proposals for innovative models of care and support with sustainable financial schemes.

The other Commissioners are: Jane Ashcroft CBE, Chief Executive, Anchor Hanover; Dr José-Luis Fernández, Director Care Policy and Evaluation Centre, London School of Economics; Professor Martin Green OBE, Chief Executive, Care England; Edel Harris, Chief Executive, Mencap; Richard Jones CBE, Chair of Board for Shared Lives Plus; Julie Ogley, Immediate Past President, Association of Directors Adult Social Services; Professor Alison Petch OBE, Chair, The Dunhill Medical Trust; Jeremy Porteus, Chief Executive, Housing LIN; Vic Rayner, Executive Director, National Care Forum; Dr Ossie Stuart, Trustee, Social Care Institute for Excellence; Andrea Sutcliffe CBE, Chief Executive, Nursing and Midwifery Council; Dr Jane Townson, Chief Executive Officer, United Kingdom Homecare Association; Michael Voges, Executive Director, Association of Retirement Community Operators; and Emma Williams, Relatives and Residents Association.

The Commission will report twice; first through an interim position paper at the end of the autumn with the aim of influencing Government thinking on the long-term plan, and again in spring 2021 when it will provide a more detailed plan of action for the social care sector to consider.

Good housing with care is at the heart of having a good quality of life. But we know that the sector, and particularly care homes, are under severe pressure and that many will struggle to survive. In our recent report Beyond COVID-19, we argue that as well as ensuring we develop nursing and care home provision we can be proud of, we invest in a broader range of housing with care and support options, such as extra care and supported living, so that choice is maximised. This new Commission will gather the evidence we need to develop a clear vision for how we can deliver this.

Paul Burstow, SCIE Chair

A test of any country is the degree to which it supports and enables those who need care and support to stay safe and to lead the best lives they can. Excellent housing with care – including care homes, supported living, extra care and the many other models – is at the heart of supporting people to live the best lives they can. I am excited to be asked to co-chair this important commission. I hope that the work we do can inform future policy and practice for years to come.

David Pearson CBE

We must not let this commission be another “talking shop”, we must focus on “action”. Lessons learnt during the pandemic suggest we all need to reflect on what we can do to better meet the needs of frail older people – same old, is not good enough.

Professor Julienne Meyer CBE