the 100 year life - nhs england · 2018-09-19 · ageing better workshop: policy recommendations....
TRANSCRIPT
The 100 year lifeThe role of housing, planning and design
5 September 2018
Welcome and context
Ewan King
Director of Business Development and Delivery
Social Care Institute of Excellence (SCIE)
www.scie.org.uk
Context
Baby boomers retiring
More people with disabilities living into old age
By people’s late 80s, more than 1 in 3 people have difficulty
with 5 or more day to day activities
Leads to increased pressure on individuals, communities,
health and care systems
1 in 3 children born today can
expect to live to 100
The opportunity
Reason to innovate – not just celebrate
To ensure more people enjoy a good
later life, changes need to be made
Policy context:
• Grand Challenge on Ageing
• Green Paper on Care for Older
People: role of housing, technology
and design
• Focus on prevention
SCIE, Design Council and Centre for
Ageing Better workshop: policy
recommendations
Today’s session
1.30 Welcome and context Ewan King, SCIE
1.40 Role of mainstream housing in
improving later life
Rachael Docking, Centre
for Ageing Better
1.50 Making life better by design Ellie Runcie, Design
Council
2.00 Family carer perspective Dame Philippa Russell
2.15 Table discussions
3.15 Wrap up Ewan King
3.30 Close
The role of mainstream
housing in improving later lifeRachael Docking
Senior Evidence Manager, Centre for Ageing Better
www.ageing-better.org.uk
7
By 2025 there are projected to be 1.5 million households headed by someone aged 85 or over – an increase of 54% from 2015*
*Source: Ageing Better calculations based on: Department for Communities and Local Government (2016), ‘2014-based Household Projections: England, 2014-2039’.
Homes headed by someone aged 85 and over are the fastest growing household*
8
Only 3.2% of those aged 65 and over live in care homes*
80% of the homes we need by 2050 are already built**
More than 90% of older people live in mainstream housing
*Source: ONS, 2014; **Source: Boardman et al, 2005
9Source: Ipsos MORI survey of 1,389 people aged 50 and over. Later life in 2015 Centre for Ageing Better
A large proportion of people do not intend to move
10
The % of people who have difficulty with activities of daily living increases with age
By people’s late 80s, more than 1 in 3 people have difficulty with
5 or more day to day activities
475,000
11
Only 7% of homes meet basic accessibility features*
*Source: DCLG (2016), English housing survey 2014 to 2015: adaptations and accessibility of homes report
Current UK housing stock is not suitable, adaptable or accessible for people in later life
12
Home adaptations have been shown to improve the quality of life for 90% of recipients
*Source: Heywood, F. and Lynn, T. (2007). ‘Better outcomes, lower costs. “Implications for health and social care budgets of investment in housing adaptations, improvements and equipment: review of the evidence”’. London: Office for Disability Issues/Department of Work and Pensions.
Home adaptations improve people’s quality of life
£7000 V
£29,000
Minor adaptations
Repairs and home improvements
Person oriented
Timeliness (system delays and putting off installation)
People delay adapting home due to clinical appearance of adaptations and their association with vulnerability
System delays caused by lack of resource
Process so complex professionals struggle to navigate
Key findings on the role of home adaptations
Last spending review the DFG was increased
DHSC commissioned a review of the DFG
CLG Select Committee report on housing for older people
Social Care Green Paper due 2018
Industrial Strategy Grand Challenge: Healthy ageing
Improving health and care through the home: MoU
Government commitment to building new homes
What is happening externally?
Making life better by designEllie Runcie
Director, Growth and Innovation, Design Council
www.designcouncil.org.uk
© Design Council 2018
Economic
SocietalPlace
Housing numbers
Green belt versus
brownfield
Infrastructuredigital and physical
Economic growthPlanning as a balance of
conservation and growth
Teaching and learning
Employment
DemographicsPeople living alone and later
access to home ownership
Health and wellbeinginactivity in society
Ageing populationImpact on the built environment
Inclusivity and community engagement
Practice into policy?
Inclusively designed productsfor every day living
DESIGN COUNCIL SPARK
➢ Getting up & dressing
➢ Moving around
➢ Keeping active
➢ Easier bathing
➢ Kitchen support
➢ Managing health needs
Tru-Unity Door Handle
An ergonomic handle which
supports a natural grip and
twist motion.
Workey
A key turning tool that eases grasping and turning to aid
dexterity.
Elba London
A well-fitting bra that is
comfortable and easy to put on and take off
Handy Fasteners
An adaptive magnetic
alternative to traditional buttons
Ezi-Plug
A mains plug and socket
designed for people with
dexterity issues.
TickleFLEX
Place on the end of an insulin
pen to make self-injecting
safer and more comfortable.
DRINK
A wheelchair accessory that
carries a variety of glass
sizes and attaches to
almost anything.
© Design Council 2018
System design
or
problem redefine?
Shaping solutions….
Pro
ble
m D
efi
nit
ion
….before we explore the problem
A framework for innovation
Being people centered
Communicating visually
Collaborating & Co-creating
Iterate, iterate, iterate
DiscoverInsight into the problem
DefineThe area to focus upon
DevelopPotential solutions
DeliverSolutions which work
Problem definitionThis is a clear statement of the problem to be solved
ProblemThe design process begins with a problem, question or hypothesis
SolutionThe solution is an output that meets the requirement of the problem definition
Reducing Trips and Fall: Teignbridge?
- East Teignmouth has a higher than average ageing population, with 7% of residents aged over 85-years-old
- Trips and falls are the most common cause of death in the over-65s in the area
- Existing prevention solutions not working
1. Being people centred?
Capturing real stories
Improving
understanding
Evidence that a new
approach was
needed focusing on
prevention.
RangeRange Core
(Majority)
Extreme users
2. Communicating (visually)2. Communicating (visually)
3. Collaborate & Co-create?
4. Iterate, iterate, iterate…?
ADD IMAGEs OF PROTOTPYING
Outcome
1. Three service areas identified for development:• Online photo submission• Home assessment service• Volunteer support pack
2. Relationships between various health agencies resulted in greater collaborative working
3. Joint funding bid to embed this way of working
• Putting people at heart of this
process
• Collaboratively exploring the
problem with multiple
stakeholders
• Supports new ways of effective
engagement
• Testing alternative approaches
early and often to manage risk
• Breaking down complexity
The value of the design approach
Key challenge:
1. Scale up
2. Embed capabilities
Scale up
37
Six innovation briefs
1. Steps to a positive future
2. Mobility & Transport
3. Life Transitions
4. Caring about carers
5. Right information, right time
6. Making connections
2. Embedding capabilities
Epping Forest
District
Council
To reduce the volume of unnecessary A&E attendances
by the frail elderly ie. over 75s
Islington
Council
To understand the needs of frail individuals and identify/
test new solutions to support their independence
Bexley Council To create a co-production model to design and fund
Better Care Fund prevention and early intervention
projects
Southwark
Council
To tackle undiagnosed heart disease, which drives
premature death, health inequalities and healthcare
costs
Doncaster
Council
To redesign services to support self-management
across an integrated health and social care system
North Tyneside
Council
To utilise design principles that will facilitate the
engagement of inactive adults into physical activity at
scale
Stockport
Council
To find a new way of collaborating with VCSE partners
to coproduce social connection, reduce isolation and
build resilient communities
City of
Bradford
Metropolitan
District
Council
Creating a healthy, strong district harnessing the built
environment to support wellbeing across our
communities for the future
13 teams
30
organisations Public
Health
focus
New call for applications open –
deadline midday 21 September!
Are we ready for the 100 year life?
Partnership, Participation or Purdah?
A family carer perspectiveDame Philippa Russell DBE
Vice-President, Carers UK
The 100 Year Life: Transitions from institutional solutions to family life: Simon’s story and a personal journey
‘The ‘big conundrum’ – Why family carers matter: ‘We
need mature conversations’ about ‘co-producing’ 2lst century care and support’.
• 1 in 10 of the population will become a family carer - 4 million carers (840,000 dementia carers) – but anxiety amongst many families about sustaining care with personal and economic well-being and their own developing care needs. LSE/University of Newcastle (The Lancet Public Health, August 2018) notes that increasing long-term disability and care needs could ‘be unsustainable for family carers’.
• Increasingly complex and long-term nature of care – Major developments in past three decades around deinstitutionalisation and community participation – how can we sustain the progress and think ‘out of the box’ , learning from the families about what good care and support looks like.
The ‘Age-Old Question’ – a 2lst century perspective on the challenges ahead and a reflection on solutions
• The challenges for Simon and his family – we need to change our negative expectations of longer lives! [Royal Society for Public Health/Calouste Gulbenkian Foundation survey, 2018]
– 24% thought ‘all older people will get dementia sometime’.– 25% thought ‘it’s normal for older people to be depressed and sad’.– 24% thought that ‘’older people can never be really attractive’.– 64% of respondents did not have any friend with a 30 year age gap
from their own [general feeling that older people ‘not really part of society]
– ‘It’s a young world now, no place for older people. Social media has changed all that, I don’t know we can bridge the gap.’ [quote from respondent]
We need a ‘New Narrative on Ageing’ – a new narrative for ALL generations moving older people from ‘problems’ to ‘citizens’
• The ‘l00 Year life needs a new narrative on ageing – and one which can only be developed in partnership with older people themselves. In effect we need all our citizens to be ‘activists’ in reshaping the agenda – and reflecting on their own futures decades into the future.– Ageing is an inter-generational issue ‘ ‘We need to plan it like a
space mission not see older people and their families as ‘a demographic time bomb’!
– We need a personalised approach to ageing, not the ‘collective lumping’ of older people into negativity and problems
– Older people are active citizens AND a vital part of our ‘care and support system’ with assets to share – IF we ‘co-produce’ a different future.
‘Why we need to talk about caring - One in ten of us can expect to become a carer during out life-time – will we be able to carry on
caring in a 100 Year Life’?
• PSSRU (2017) A reminder that carers are a scarce resource! Demand for family carers for people over 65 expected to increase by over 1m in next three years.
• 1.3million carers are over 65 (often for more than one person). The number of carers over 65 is increasing more rapidly than in the wider population (the percentage of older carers has risen by 35% since 2011 as compared to 11% in general population).
• 45% of disabled people in the UK are over 65 – major implications for complex health needs.
Managing complexity in an ordinary life – understanding what makes a difference!
• Family carers people face increasingly challenging roles – number of people with 3 or more long-term conditions predicted to rise from 1.9 million to 2.9 million by 2018. Increase in dementia and ‘new survivors’ of younger people with very complex disabilities.
• ‘But WE did it!’ – Barbara and Malcolm’s story: Managing the ‘web of care’ and meeting the challenges of the 2lst century ‘100 Year Life’ and ‘making home work’.
Out-of-Hours
Doctors/Paramedics
GP
District Nurses
Social Worker
Malcolm &Barbara
ConsultantContinence
Adviser
Speech & Language Adviser
Dietician
CommunityDentist
OccupationalTherapist
Equipment Service
PhysiotherapistAlternating
Mattress technician
Wheelchair Service
Oxygen serviceDirect
PaymentsTeam; Rowan
Org.
Alzheimer’sSoc outreach
worker
Care team2 live-in carers (alternating weekly)Replacement carer[Some night nursing – Health]Emergency carers& Barbara
Managing
the Web of
Care
(Last 7 yrs)
Dementia
Advisory
Nurse?
‘We need to rebrand social and residential care and recognise housing as the ‘third pillar’ alongside health and social care; We need a range of options for
housing with care – for ALL generations. [Professor Paul Burstow, Commission on
Housing with Care, 2017]
• THINKING OUTSIDE THE BOX – WE NEED TO PERSONALISE CARE’ ‘Most of the residents in my mother’s nursing home are really frail and ill – I worried, would they get the healthcare they really needed, would their medication, their dressings be sorted properly. But with telehealth AND telecare, we all ‘sing from the same song-sheet’. Best of all, our mother says that she hasn’t gone into care (horrid phrase’, she has just changed her address for a place with a better garden!) The most important thing is that we talk about a HOME LIFE and where we an best enjoy it (and that can mean staying put with support or going away!)’
And looking into the crystal ball! Bridging the Inter-generational gap and creating more inclusive communities.
• ‘We need some myth-busting about ageing and caring’; Creating all-age partnerships (eg volunteering, mentoring, buddying)
• ‘ASK THE PEOPLE TOO! It’s going to be us one day!’ – Encouraging debates, discussions in across the age range about what creates inclusive communities.
• ‘It’s lonely out there sometimes but young people get lonely too!’ (eg Jo Cox Foundation initiatives to create peer support and improve community access for young and older people in today’s very mobile and often hurried communities)
Location, Location, Location – Recognising the importance of older people/carers as partners in change
• Creating accessible communities together! Older people and carers as a priority group in local/district plans – and involved as active citizens NOT demographic burdens!
• Thinking outside the box! Japanese town with oldest
population in country reversed the trend after local consultation by putting housing for older people in the town centre and moving younger people to more expensive suburbs!
• Developing the market! Remembering the ‘grey pound’ – why
must aids and equipment look so clinical and drab (and can we think social inclusion – seats in shops and please more accessible buses and toilets!).
And creating Digital Inclusion, the gateway to participation
• Care Act assessment and support for people needing support and for carers: we need to ensure that carers know about the possibilities of full range of assistive technology and who can give advice and offer ‘whole system support’ to local authorities and others (eg Carers UK).
• Using Personal Budgets and Personal Health Budgets more creatively (and not forgetting self funders).
• Work proactively with community and other groups to improve digital connectivity. We need to end the assumption that older people (and some disabled people) will never embrace technology. They can and do!
And some reminders….a new generation of adults like Simon with learning and other disabilities who for the first time are outliving
their parents and surviving into later life.
• ‘New survivors’ – ADASS (2018) identifies improved survival rate of people with learning disabilities as major pressure point for the future.
• But is the new longevity a problem if we adopt a ‘whole community’ approach to future planning, co-production and inter-dependence?
And a reminder about well-being, relationships and the experiences that enable us to find creative solutions and
develop new shared approaches to the 100 Year Life!
Table discussions2.15 - 3.15pm
Recommendations (1)1. Align housing, health and social care plans:
• Green Paper should highlight a common goal to align health, housing
and care systems around a shared objective of helping people to live
independently at home that is suited to their needs as they age.
Include inter-generational solutions to enable family members to
support each other (as full-time or part-time residents)
• Local leaders should work together to have a shared objectives and
single plan and budget for housing, health and social care.
Recommendations (2)2. Increase finance options
• Make it easier for older people to access funding to support themselves,
and encourage innovation in the marketplace.
• Led flexibly to people in later life: Increase age limit for lending
• Extend personal health care budgets to allow for cost of adaptations
• Use Disability Facilities Grant innovatively to drive new ideas to
market: e.g. remove means test for low-cost adaptations, repairs and
improvements
• Use Regulatory Reform Order that allows use of DFG for wider
purposes
• Extend terms of equity release: increase age limit for
mortgage/remortgage
Recommendations (3)3. Make communities age friendly and inclusive
• Set space standards e.g 90% of new homes to be built to accessibility
standards (accessible and adaptable dwelling) and 10% to be ‘wheelchair
user dwellings’ (eg London)
• Include design principles that create age-friendly environments (e.g.
planning authorities could make this a requirements in new
developments)
• Invest in skills and learn from age-friendly community approaches:
Government could invest in training on co-designing
• Apply evidence: housing developers should apply evidence of what
works to make homes adaptable and accessible as people age.
Recommendations (4)3. Use inclusive design and co-production
• Government should use the Industrial Society Challenge Fund to ensure
everyday products and services are designed to inclusive design
principles in areas such as independent living, home adaptations,
transport and mobility.
• Embed the principles and practice of co-production in the design of
products, services and places.
• Develop the knowledge and skills of policy-makers, commissioners,
planners, designers and housing professionals in the practice of co-
production
Table discussions
Discuss each of the 4 key recommendations:
1. Align housing, health and social care plans
2. Increase finance options
3. Make communities age-friendly and inclusive
4. Use inclusive design and co-production
Agree on:
• One positive that recommendation (Rose)
• One negative – or it could be a barrier to the recommendation (Thorn)
• One area of opportunity that could be explored/accelerate progress
(Bud)
Present back your Rose/Thorn/Buds for one of the four recommendations.
Respond to each table’s feedback.
Report available at
www.scie.org.uk