20 February 2018
It is great to see the two big headline changes in the Prime Minister’s reshuffle. Closer collaboration between health and social care can only benefit patients and prevent them from falling through the cracks. The new emphasis on housing at the newly named Housing, Communities and Local Government (HCLG) is also positive provided the new weight placed on housing is more than just building more.
Now that social care is completely removed from the newly created HCLG and joined with the other down stream health service will it lose any focus that it had on preventative health? Will the new HCLG focus on housing in the wider sense including housing and housing policy as a major preventative tool that prevents GP visits and hospital admissions while speeding up hospital discharge times?
Health and social care traditionally are not preventative care systems, but are a means of caring for people after they become ill or can no longer care for themselves for whatever reason. The synergies that could be created in Jeremy Hunt’s new Green Paper are very exciting – further developing ways that social care can help take the pressure off the health service with less acute care and home visits. But let’s not kid ourselves that it is prevention.
Housing, planning, environmental health, licensing, community safety, economic development and leisure are our preventative health tools. They are the tools that Victorian councils used to eradicate cholera and they are the same tools that can be used today to promote wellbeing and prevent ill health. They need to be used strategically and holistically together and they need to work with the Health Service. Under the new government arrangements these tools sit under HCLG with a Secretary of State focussed almost entirely on building new homes to solve our housing crisis.
Hardly ever spoken about but up and down the country local government, particularly districts, are using their preventative health tools to build healthy towns and villages with an emphasis on ageing well and independent living, fighting obesity and creating environments conducive to mental wellbeing. Whether they are creating dementia-friendly towns and villages that will also be age-friendly and child friendly by default; whether they are fighting loneliness (a cost to the NHS of at least £10bn per year) with their housing policies and community work; and that’s without the range of leisure activities being promoted that helps fight obesity and mental ill health.
Sevenoaks District Council is working with all its local hospitals with its home adaptations team. While people are in hospital, the team are adapting their homes, so they can be discharged as soon as they are clinically ready. This is resulting in huge pressures being taken off hospital beds at the busiest time of year. This service has evolved further into housing advisors working with GP surgeries to identify people most at risk of falling and making the home adaptations and any referrals to suitable exercise classes in order to prevent falls in the first place.
The Housing Advisors are a holistic service that aims to fix the causes of peoples’ problems and not just the symptoms. They help with loneliness, debt, unsuitable housing, weight issues and any repeat visits to the GP where the underlying cause is not medical. The housing advisors are funded from public health and are called One You advisors in line with the new branding, but they are accountable to Sevenoaks District Council’s Housing and Health team.
Councils are creating healthy towns and villages along the lines of the new NHS healthy towns across the country and it will all help to prevent GP visits and hospital admissions. There needs to be collaboration between the new departments of Health and Social Care and HCLG. Hopefully the new Green Paper will include input from HCLG and local government on prevention as well as social care.
Housing and housing policy is so critical to preventative health whether it is building more purpose built older peoples accommodation, adapting existing homes; to tackling over-crowding, under-occupying and the issue of more affordable housing that is suitable for habitation. Health and housing really do go hand in hand and the constant emphasis of health and social care, although important, is only part of the solution.
So will prevention be the result of the new cabinet reshuffle? At this stage it is not clear. It will depend on the collaboration between the Health & Social Care department and HCLG. It is a shame that the reshuffle missed the opportunity of appointing a shared public health minister accountable to both departments. It will depend on how ambitious Jeremy Hunt’s new Green paper is and how widely Sajid Javid interprets his housing brief. The reshuffle offers huge opportunities to really start taking the pressure off the health service – let’s hope we all grasp them with both hands.
