Safe Housing and Hospital Discharge

Question

Asked by

To ask His Majesty’s Government what steps they are taking to improve collaboration between integrated care boards and housing providers to address barriers to safe housing and support timely hospital discharge.

My Lords, the Government recognise that the availability of safe housing contributes to timely and effective hospital discharge. We published a new policy framework for the £9 billion better care fund in January. Integrated care boards and local authorities have to work together, with involvement from local housing authorities, to agree joint plans to deliver joined-up care. The £86 million uplift to the disabled facilities grant this year can provide around 7,800 additional home adaptations.

I thank the Minister for her Answer and welcome what she has said. It is absolutely clear now that the lack of supported housing is a major factor in delayed discharge from hospital and that integrated care boards are part of the solution. Can the Minister explain why, only last week, the Government made the shock announcement of a 50% cut to the core funding to these very boards? Surely they should be integral to creating solutions to this costly, damaging and seemingly intractable problem.

As the noble Baroness will be aware, this Government want to see provision and decision-making directed by local leaders. She and the House will be aware of the financial situation which we have inherited. I reiterate what I said about the £9 billion committed to the better care fund, which includes £5.6 billion to integrated care boards and around £3.3 billion to local authorities.

My Lords, 73% of delayed discharges from mental health hospitals are due to a lack of appropriate supported housing step-down services. With bed occupancy rates of 94%, the increasing pressure is driving up the inappropriate use of out-of-area placements. What plans do the Government have to ensure that there is enough supported housing to meet the demand for step-down services?

My noble friend made particular reference to mental health care. She will be aware of the discussions that took place at Second Reading and in Committee on the Mental Health Bill. I am sure we can all agree that an out-of-area placement is not ideal, although there are some circumstances in which it has to be the case. In the progress of that Bill, we will be attending to the point that she makes. I agree with her that the delays attributed to housing are significantly higher, at 17% for patients who are discharged from mental health settings. This remains a challenge that we are focused on.

My Lords, has the Minister considered the proposal from the Centre for Ageing Better for good home hubs, where older people whose homes are inaccessible, cold and unsafe can get all the advice and support they need on adaptations that can make such a difference—the stairlift, the walk-in shower, better insulation—thereby enabling them to live longer independently and to take the pressure off the NHS and care services?

The noble Lord puts the case strongly for the process of home adaptations. As I have already mentioned, we have provided an immediate in-year uplift to the disabled facilities grants of some £86 million, which will enable people to adapt their homes exactly in the way that the Centre for Ageing Better describes, and I welcome its work. I should say that it is the responsibility of local authorities to ensure that they are supporting applicants through the process of home adaptations as much as possible. We are always looking at ways to improve the process and share good practice, so I welcome the contribution of the Centre for Ageing Better.

Will my noble friend confirm that very few integrated care boards are either integrated or about care? Much of the work that should be going on is going on with health and well-being boards, which are a combination at place level of the relevant local authority and the health service at the point where delivery takes place.

My noble friend has given me an invitation to agree with him. As he knows, it would be quite inappropriate to suggest that integrated care boards are not integrated or about care—that is their focus—but I appreciate his view on the matter. I do agree with him that much good work is done on the health and well-being boards. This all says to me that local decision-making, and local provision for local populations with their particular dimensions and demands, is the best way forward. My final point on this question is that local systems have to agree plans to achieve more timely and effective discharge from hospital, and to work with local authorities to develop those plans.

My Lords, NHS data from last month revealed that there are about 13,800 people who are medically fit for discharge, which is up from 12,000 patients awaiting discharge on 1 December. As other noble Lords have said, we know that that causes a bottleneck in hospitals that is not good for patients while they wait to go home. As has been said, one way to reduce that bottleneck is the greater use of virtual wards, allowing people to stay in their home for longer, to be monitored in their home and to receive care. The Minister has answered this question to a certain extent, but can she tell us more about the Government’s overall plan for virtual wards, not just in this case but for physical and mental health care, in order to ensure that we can get more patients out of hospital beds and into their homes, where they can receive the care they deserve and be constantly monitored?

I am glad that the noble Lord shares my enthusiasm for virtual wards. I shall expand on what they are: they allow people to be not in hospital but in their own home, whether it is their personal home or whether their home happens to be in a care home or some other setting, by the use of technology that allows them to be monitored. I recently saw an excellent example of that, and the liberation that it provides for individuals who would much rather not be in hospital is key. The noble Lord will know that, in the 10-year plan, the move from hospital to community is a key pillar, and we will soon be reporting on that. I certainly share his enthusiasm.

My Lords, the VCSE sector plays a critical role in discharge planning. The Minister may know of a project in Warrington, where a social prescribing link worker and the VCSE team are integrated into the discharge team, and are therefore able to support people on discharge. The pilot has been positive, not least in that it has reduced readmission into hospital. Could the Minister say what support the Government are giving to integrated care boards so that they can enable this type of innovative provision? Can she reassure us that the aspiration to cut the ICBs by 50% will not impact on that potential?

I very much commend the innovation and the commitment of people locally in the way that the right reverend Prelate describes. ICBs would be wise to work closely with the third sector in order to provide support and to tackle the very real challenges. With regard to decisions on how they use their funding, it is for ICBs to take into account the needs of the population and provide accordingly. As I say, it would be a wise ICB that took advantage of the innovation and the commitment in its local area.

My Lords, does the Minister think that there is a case for further guidance or even legislative change to ensure that ICBs—those left standing anyway—are actively improving integration between the NHS and other stakeholders, such as housing and local government? We all understand that social care is vital to successful discharge plans. Is the Minister able to say how many ICBs have senior representation from social care or local government on their boards?

As the noble Baroness is aware, ICBs bring together local government and local health services. While I cannot be as specific as the noble Baroness asks, I will be very happy to look into that. There is not just an expectation but a requirement, as I said, to agree plans locally, which means more timely and more effective discharge. Certainly, the better care fund is crucial, so I feel that we are going in the right direction. This is a matter that we constantly have under review, and we are always looking for ways to improve delivery.