My Lords, I rise to speak to the two amendments in my name and in the names of the noble Lord, Lord Hunt, and the noble Baronesses, Lady Eaton and Lady Barker. These amendments are carried forward from five which I tabled in Committee, all of which sought to give more prominence in the Bill to housing. I declare my interest as chairman of the Hanover Housing Association, which works exclusively for older people, and as president of the Local Government Association.
The overarching case for these amendments is that everyone's care needs are inseparably connected to the place where they live and where, for most older people, they spend all their time. The right accommodation can sustain our independence and well-being even if we face the illnesses or long-term conditions that afflict many of us in older age. The right accommodation can pre-empt and prevent the need for domiciliary and residential care and hugely reduce costs to the NHS and local authority social services. For younger adults with care needs, the right accommodation can enable a fulfilling life within the community, not hidden away in an institutional setting. The wrong accommodation can cause accidents and, indeed, mental health problems; keep people in hospital because their home will not have them back; and can force people into costly residential care.
This Bill is the chance to incorporate housing into the health and care equation so that these three interlinked dimensions can really work together. The noble Earl has worked hard over the recess to bring back improvements to the Bill. In relation to the housing issues, the noble Earl has noted that our concerns are shared by a number of Peers who feel that the Bill gives insufficient emphasis to the question of housing. He fully accepts the integral role of housing in helping meet care and support needs, and has told us that he sympathises with the arguments he has heard. I am very grateful to the noble Earl for the two amendments he has tabled to give greater prominence to the link between health, social care and housing. His response will be greatly welcomed by the Care and Support Alliance and, within that group, the National Housing Federation, which drafted the original amendments.
Government Amendment 28 to Clause 6 extends the duty of local authorities to co-operate with partners so that this duty will encompass housing associations—registered providers of social housing—which is a very significant step in absolutely the right direction. Government Amendment 12 to Clause 3 ensures that, in terms of the integration of services, housing will be classified as “health related” and will therefore be
taken on board by clinical commissioning groups and the NHS Commissioning Board, NHS England. Both these changes are really positive and I congratulate the noble Earl for his farsightedness, once again, in improving the Bill in these two ways.
At the risk of appearing slightly churlish, however, perhaps I could press the noble Earl on the two issues that remain outstanding and are covered by the two amendments in my name, which have support from all parts of the House. In relation to advice, Amendment 15 to Clause 4 would ensure that people have access to good information on the options available to them in relation to housing requirements, spelling out both ways in which their current home could be made more suitable and the choices that they could make about a move to supported or retirement accommodation, such as assisted living and extra care housing.
Although the Bill ensures that advice on care services will be made available, the Joint Committee on the draft Bill strongly recommended that advice on housing options also be included. So far, this recommendation has not been taken on board. It is not an onerous extra requirement to include housing advice in the mix, particularly given that many local authorities already ensure that people get this advice. Indeed, the Local Government Association supports this amendment. The Minister pointed out in Committee that information and advice on specialist housing options should be included when housing information is supplied. This amendment adds the prompt for such housing advice also to be included when guidance is given on care matters.
A move to a more suitable place can be suggested for a younger adult with care requirements. Sources of support for helping an older person to downsize, perhaps in decluttering the attic or sorting out the garden shed, can be recommended. For those who stay put, there is often so much to be done of a practical nature in making life easier for an older person and reducing their dependency on paid carers or family carers. From replacing hard-to-turn taps with long-handle lever taps for someone with arthritic hands, or fitting firm banister rails to the stairs, right through to converting the bathroom to fit a walk-in shower or installing a stair lift, all such adaptations can delay or prevent the need for more intrusive and expensive care provision. With good advice, paying for those adaptations can be covered by disabled facilities grants or equity loans, just as advice for a younger adult with care needs can be given on how the costs of renting a more suitable home can be covered.
Last Friday, I had the great pleasure of visiting the brilliant Centre for Independent Living in Knowsley, jointly funded and staffed by the health, social care and housing services in this borough. The centre brings together all the key elements of a truly holistic service. The occupational therapists are there, as are the care and repair team who can organise reliable builders and advise on grants, the wheelchair and aids teams, and the handy persons who do small improvement jobs. All the different disciplines and specialisms come together in Knowsley’s centre. It helped some 5,700 people last year. About half were referred by GPs, and health needs are therefore often the trigger, but the solution may well be in meeting the individual’s requirements
within their home or, indeed, in pursuing a housing solution elsewhere, such as a move to extra care. So when a local authority gets it right, as in Knowsley, it really can do a fantastic, joined-up health, care and housing job. Good advice that covers the housing dimensions is the start of this process.
Amendment 23, the second amendment in my name and those of the noble Lord, Lord Hunt, and the noble Baronesses, Lady Eaton and Lady Barker, would complete the picture. This amendment again does not add significantly to the burden of responsibilities for local authorities. It falls within the “have regard to”, not the “must”, part of Clause 5, but would mean that in seeking to manage the market for care provision, local authorities should have regard to the housing situation facing those with care needs in their area. It raises the profile of housing in this context so that the different parts of local government all take it into account in their policies and strategies.
The amendment would mean that those within local councils responsible for social care would concern themselves with housing requirements, no doubt by feeding the necessary information into the planning system to influence future housing provision. In devising their strategies, health and well-being boards would consider whether more and better housing should be a priority, whether more disabled facilities grants or support for home improvements could play a greater part in preventing the need for intensive personal care, or whether extending a handy person service would not pay for itself almost instantly. This amendment would mean integrating housing considerations into the shaping of care markets, as well as integrating care considerations into the shaping of housing markets. That would benefit everyone.
I congratulate the Minister on the two important government amendments which give added emphasis to housing. I hope that he is able to go further and take on board these relatively modest but entirely sensible additional changes to the Bill.
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