1 July 2016
Local NHS areas have been tasked to submit convincing strategies known as Sustainability and Transformation Plans (STP) to dramatically improve healthcare whilst saving money. This will primarily be achieved by developing an effective out-of-hospital care system that reduces demand on hospital beds – particularly in acute hospitals.
It is expected that each of the 44 STP footprints will work with local government and communities, possibly through the Health and Wellbeing Boards, to develop these plans. Most are heavily NHS led, and in two-tier areas where local government is involved, it is the county council and not the district councils that are working with the NHS.
Obviously the integration of health and social care needs to be a necessary part of the STP, but we will never create an effective out-of-hospital care system by excluding the housing authority. District councils are, therefore, the vital missing piece of this complicated healthcare jigsaw.
District councils play a crucial role in preventing hospital admissions. The most obvious and well known function is through their Disabled Facility Grant (DFG) work. This involves adapting homes to help prevent trips and slips – a major cause of hospital admissions amongst older people. By being proactive district councils are already preventing large numbers of hospital admissions. However, hospitals could work even closer with their DFG team to prepare homes for patients while they are in hospital, so they can be discharged earlier.
Linked to DFGs is fuel efficiency that district councils are also hugely involved in. Keeping people warm not only keeps them healthy but helps to prevent falls – as people are more likely to fall when cold.
DFGs are simply the tip of the housing iceberg as a major public health tool. A good housing policy is essential to increasing wellbeing amongst local residents. By understanding the needs of the local population Housing Authorities can increase supply of purpose built older persons accommodation which in turn frees up family homes. This also helps reduce over-crowding – another cause of yet more health issues.
Housing Authorities can encourage older people to down-size into more suitable accommodation (whether they live in privately owned or social housing). Often older people are willing to move to a purpose built home nearby but are afraid of the process and need a little hand holding.
An important housing tool (that is currently not understood by the government) is a local connections policy or priority for all affordable homes. By keeping families and communities together older people are less likely to suffer from loneliness, which is not only hugely detrimental to their own health and wellbeing, it is a massive burden to the health service. As an aside, homes for local people are often more palatable to residents thereby making the planning process significantly easier.
Debt, usually caused by rent or mortgage arears, is often the start of a homelessness journey but at the very least causes stress and anxiety. District councils often have debt advice teams – even if it is simply through funding and referrals to the Citizens Advice Bureau. Either by preventing homelessness by nipping debt in the bud early or homing someone after they have been made homeless – District councils again play an important role in the out-of-hospital care system.
Even with just their housing role district councils are vital to the STP process. Of course their public health toolbox only starts with housing. They are also the planning and licensing authority, responsible for Environmental Health and leisure, have an economic development and community safety role, as well as having strong links with the voluntary and business communities. When used holistically and strategically district councils are in a critical position to promote general wellbeing and prevent hospital admissions.
Given the role that district council’s play every day in promoting an out-of-hospital care system it is vital they are given a seat at the STP preparation and implementation table; as they really are the missing piece of the public health jigsaw.
