Housing — it’s personal

Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.

Last week I was honoured to speak at the first open meeting of the National Housing Federation’s Housing and Health group.

In the clamour for joint working between health and social care we often forget the vital role of housing. It’s one of the reasons I prefer a focus on person-centred co-ordinated care rather than integration. Integration can take us down the blind alley of a structural response rather than thinking about what matters to each person and pulling together all the care and support they need — which of course includes where and how they live.

There is much evidence about the impact that housing can have on health and wellbeing and others are better qualified than me to analyse that. At the conference I used the power of personal stories to illustrate two key points — how poor housing can cause health problems and why housing should see themselves as part of the support network for people in vulnerable circumstances.

More than bricks and mortar

Alison Cameron is a remarkable woman with Post Traumatic Stress Disorder who in recent years has used her personal experiences of services to powerful effect becoming the first patient leader to graduate from the NHS Leadership Academy and being one of two patient leaders to be made Associates of the Kings Fund. Space is too short to detail all her activities but suffice to say the Health Service Journal included her in the 2014 list of Inspirational Women.

Alison’s PTSD can be triggered by intrusive noise and (amongst other problems) her flat is opposite a night club that regularly causes disturbances on the street. Anyone who follows Alison on Twitter knows the trauma this can cause and last week she ended up in hospital with a relapse. We can all read about the evidence of the impact poor quality housing has on wellbeing, but sometimes it takes the harsh reality to bring it home.

Alison has tried to get out of this situation but told me her borough housing officer once said:

“We don’t deal with people; we deal in bricks and mortar.”

Making connections matters

My second story was even more personal. I have written before about my brother Adrian, who had clinical depression, to highlight the importance of talking about mental health problems. What may not have been so apparent was the crucial part housing played in his life. In his middle thirties, Adrian seemed to be doing well, but actually he was falling ill again. A telling sign (and we learnt later, a previous predictor of deterioration) was that he got into a mess with his finances and fell behind with his rent. Nobody made the connection and three days before he was due in court for non-payment of his rent, he killed himself.

In both these stories the rhetoric of integration is brought into sharp relief. Housing can make the difference between good health and ill health and housing can be a crucial part of the support mechanism for people with complex needs.

Getting it

The people at the conference get it — that’s why they were there. But often people outside that room, whether in health, social care and housing don’t get it. How can we change that?

The role of leaders is important. David Orr, Chief Executive of the National Housing Federation is providing a clear steer. He told the conference on Thursday that “housing is an intrinsic part of the health and social care conversation” and that housing needed to learn how to “talk health”. Other leaders in health and social care can be equally clear.

We can play our part

But what can we do at CQC as the regulator of health and social care?

Our formal role is sometimes limited by our scope — for example in supported living we regulate the personal care that may be provided but not the accommodation. I know that causes concern for many and we are currently reviewing how this could be improved — it is a topic that has generated much discussion at our external co-production groups.

But even with that caveat, I think we can have an important role to play in setting expectations that health and care services should be thinking housing when they are working jointly with local partners. It may seem obvious but the reason why David Orr is asking his members to “talk health” is because health and social care don’t often “talk housing”. David Buck from The King’s Fund also at the conference on Thursday commented that in his analysis of the 29 vanguard sites he could only find one housing association named. There may be more in the small print but that lack of profile is telling.

We also need to make sure that we walk the talk by working in partnership with our colleagues in housing. I am glad we are already doing this with the National Housing Federation itself and SITRA, for example.

See the whole person

As you can see, I have a personal interest in wanting to make this work better but for all the Alisons and Adrians out there, it’s important that everyone commits to making a difference — to see the whole person not just our own sector’s narrow focus.


Originally published at www.cqc.org.uk.

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