Unlocking the potential of housing for health

We really appreciate the opportunity to do this week’s leadership message so that we can share with you the journey we are on to create sustainable housing and health partnerships across West Yorkshire and Harrogate.

We know that there are a lot of great partnerships already taking place across the area in Bradford District and Craven; Calderdale, Harrogate, Leeds and of course in Kirklees and Wakefield and we are keen to share good practice and replicate approaches to build and strengthen the integration of services.

I (Jacqui) am very proud to be the Chief Executive of Kirklees Council. As the nominated CEO Lead for Housing and Health across the West Yorkshire and Harrogate Partnership my role is to facilitate the sharing of good practice whilst bringing housing partners to the table with new ideas. Sarah will be supporting me as the Health and Housing Strategic Lead and together we hope to harness the potential of all our housing partners across the whole of the area.

It is now widely recognised that the right home environment is essential to health and wellbeing; good quality housing is critical to a healthy community. The availability of affordable healthy food is often determined by where people live, and these factors help enable people to manage their wellbeing better.

The Kings Fund produced a report this year ‘Housing and Health Opportunities for Sustainability and Transformation Partnerships’ urging Partnerships such as ours in West Yorkshire and Harrogate (also known as an STP or an integrated care system) to work more closely with the housing sector.

The Five Year Forward View and the Next Steps on the Five Year Forward View highlights the important role of housing in improving health and wellbeing. It is widely evident that addressing wider determinants of health can result in a positive impact on the demand for primary and acute services, such as hospitals – whilst importantly improving people’s wellbeing.

Safe and warm housing is a fundamental basic need. A good quality affordable home that is tailored to the needs of households is important for everyone’s wellbeing.

Worryingly a new report produced by the Northern Housing Consortium identifies that sub-standard private housing is a major problem in the North. Yet the issue is overlooked and rarely discussed. Nearly 1m owner-occupied homes in the North fail to meet the decent homes standard in addition to 354,000 private rented homes. 

We also know that fuel poverty is on the rise. For example in Wakefield alone there are 15,000 households, or 10% living with fuel costs which put their income below the poverty line. It can also mean that people have to face a difficult choice between heating and eating.

And winter is on its way…

Poor housing and the impact on health is one area we have pledged to tackle together across West Yorkshire and Harrogate; it costs the NHS £1.4bn a year but by reducing excess cold to an acceptable level, we could save £848m nationally, more importantly we could improve people’s lives. 

There are 2.5million homes provided by Housing Associations in England. These house more than5million people who typically have greater social or health needs than the general population.

This makes housing associations critical to the creation of ‘healthy places’ and in providing care closer to home. Since 2010 Housing Associations and local councils have invested billions into the housing sector, improving stock and building new affordable homes - making these properties a valuable health asset. 

Housing officers are often the first household contact with services. This can place the sector in a prime position to identify issues such as drug, alcohol abuse and mental health problems early on.

Therefore, partnerships with housing are essential if we are to meet the requirements in the Five Year Forward View and the ambitions of our local and West Yorkshire and Harrogate plans.

WDH have a history of working closely with health partners. We house a quarter of the Wakefield population and place great value on the health and wellbeing of our tenants. We want to see tenancy sustainment in good quality homes that will lead to better health outcomes across the district. It’s a ‘win win’ – and most importantly better for those we collectively serve, which after all is what it’s all about.

Last year our partnership was taken to the next level when I (Sarah) was seconded to work at Wakefield Clinical Commissioning Group. The aim was to fully integrated housing into the new ways of working across the health and social care system in Wakefield. You can read more about the work we have done together across Wakefield District in this NHS England Blog written by Jo Webster, CEO for the Clinical Commissioning Group, titled ‘Serving up healthy housing’. We also even managed to get our Wakefield Housing Partnership mentioned in the Yorkshire Post.

At Kirklees, we have been working very hard to integrate the housing, health and social care agenda and a good example of this is the strong working relationship between the Council’s Housing Solutions Service and the Huddersfield Royal Infirmary MADE (Multi Agency Discharge Event).  This is all about complex hospital discharges and supporting people to leave hospital quickly when safe to do so, and back home where possible to regain their independence. 

In Wakefield we have established a housing, health and social care partnership to sit under the wider architecture of the Health and Wellbeing Board. The partnership was established with representation from the clinical commissioning group, Wakefield Council, WDH, West Yorkshire Fire and Rescue Service and the voluntary and community sector. Over the last twelve months we have improved the connectivity and visibility of housing and its potential as a health asset.

In Kirklees, the Health and Wellbeing Board includes the Council’s Cabinet Member Lead for Housing and the housing director. This ensures that the housing perspective is very firmly on the health agenda at a strategic level. This is recommended as good practice within the Government’s recent Rough Sleeping Strategy. Our head of housing also sits on the Safeguarding Board for Adults, the Integrated Commissioning Board, and the Better Care Fund.

So with this in mind we would like to share some of our achievements in both Kirklees and Wakefield with you.

018-sf-wdh-baileygate-ils.jpgHousing advice and support at an early stage in a person’s health journey can support the reduction of unnecessary days spent in hospital. Poor housing health also has a huge impact on hospitals nationally which report a yearly 110,000 bed days lost to the NHS due to delayed discharges from hospital due to a housing related issue.

South West Yorkshire Partnership NHS Foundation Trust and WDH agreed to run a pilot and test the effectiveness of a housing coordinator, seconded to work at Fieldhead hospital to provide housing advice and support at the earliest opportunity for people. The results have been pleasing and in the last six months we have supported 46 people, including those who were homeless, by reducing their length of stay in hospital.

This approach has now been replicated with our colleagues at Mid Yorkshire Hospital and in September a housing coordinator joined the hospital discharge team. We also have a team of mental health navigators who work with housing colleagues to prevent the breakdown of tenancies by providing support at the earliest opportunity for people with mental health problems.

In Kirklees we are working in partnership with government and others to invest £6.6m to support people with vulnerabilities into independent living by addressing and combating issues that affect their health and wellbeing, such as domestic violence or substance misuse. We have recently worked in partnership with NHS England, the Transforming Care Partnership (Kirklees, Wakefield, Calderdale and Barnsley) and two other councils, a housing association and a care provider to develop a new service to provide bespoke housing to enable the discharge of six people with very complex learning disabilities from hospital where they have been for over 10 years.

We have integrated our Care Link telecare service with Wakefield Council’s Reablement Service and provided telecare free of charge to anyone who has a package of reablement care. The service has also partnered with Age UK Hospital to Home Transport Service to provide ongoing support 24/7. We know from our current Care Link customers that ambulance call-outs have been mitigated in up to 42% of fall incidents.

Promotional campaigns have raised the awareness of grant funding available to tackle fuel poverty and poor housing conditions in the private sector and this has seen an increase in the number of referrals to the council’s service. Fuel poverty training was also delivered to West Yorkshire Fire and Rescue and Public Health Wakefield.

We have continued to build on the fantastic work of the Enhanced Care Home Vanguard by tackling loneliness for older people living in independent living and extra care schemes. Going back to 2014/15 we identified that 38% of tenancies terminated at one of our extra care scheme in Ossett were due to residents moving into residential or nursing care. After working alongside a Community Anchor to increase the tenants’ access to social activities the number of people the following year for the same reason had reduced to 14%, a further year on this figure had dropped to zero. The results for this work are so significant that we were delighted to be able to roll out the work to six more schemes.

Kirklees also see the value that extra care makes to maintaining the independence of older people and the Specialist Accommodation Project Board, comprising of senior managers across housing, social care and the clinical commissioning group steers the development and delivery of a pipeline of 500 new beds of extra care to complement the existing three extra care housing developments already in place.

The Kirklees Accessible Homes Team comprises of housing, health and social care professionals providing assessments and adaptation from one multidisciplinary team.  There are a range of disciplines including occupational therapists, surveyors, housing grants officers and support staff. The team also has medical advisory officers who work with people to enable them to move home because of disability or long term health condition, to a more suitable property. This is nationally recognised as a good practice model.

We both believe very strongly in the importance of housing in delivering better health outcomes and this cannot be overplayed. Spreading these approaches and other good areas of work taking place across West Yorkshire and Harrogate is key to our Partnership ambitions – better health and care for everyone, everywhere.

Have a good weekend

Jacqui and Sarah

What else has been happening this week?


Karen Poole, our Programme Lead for the Local Maternity System Board attended an Academic Health Science Network event to present information on the work taking place on safer maternity care. This included a conversation with Dr Aidan Fowler, National Director of Patient Safety. Work continues with our hospitals around the ambition to build one system, where every woman receives the same level of quality care and attention. Our work with Yorkshire Ambulance Service also continues to ensure we learn together and share good practice. Work has started to look at capacity and service demand across West Yorkshire and Harrogate. The next Board meeting takes place on the 12 November.

National Partnership and clinical leads meeting

National Partnership and clinical leads (also known as STP and integrated care systems) met on Monday. It was high turnout with different colleagues in the room – from social care, to nursing, allied health professionals and medical directors. There were discussions on multi-disciplinary leadership; operating models; joined up health and care approaches in place across England; and an overview on the latest Kings fund report launched last week called ‘A year of integrated care systems: reviewing the journey so far’.

You can find out more about these partnerships on these web pages exploring in detail the first integrated care systems and what they have done for local areas; and there are also the latest integrated care case studies which explore how integrated care changing and developing to better meet people’s needs

Improving planned care and reducing variation

Work continues around a key number of areas for this programme - including the Musculoskeletal (MSK) pathway (joints, muscles, bones) and commissioning policies to improve access and reduce the difference in care people receive across the area. We are also undertaking an eye health capacity review so we better understand the demand for eye care service and also how we can make the best use of skills and expertise to meet this. The next programme board meeting, Chaired by Dr Matt Walsh, will take place on the 20 November. 

The building health care partnership event also takes place on the 20 November. This is about working with community organisations that specialise in eye care and MSK work.

West Yorkshire and Harrogate Cancer Alliance Board

Our West Yorkshire and Harrogate Cancer Alliance met this week. Topics for discussion included:

  • Extensive work being undertaken at local and system-wide level, progress and current position in West Yorkshire and Harrogate against cancer waiting times standards, working with West Yorkshire and Harrogate Association of Acute Trusts (WYAAT) and the Strategy and Operations Group
  • The current position on the allocation of national cancer transformation funding and conditionality on performance against the 62 day cancer waiting times standard. Our Alliance is one of only two in the north to have their anticipated reduced funding position revised upwards to take account of a spike in prostate cancer referrals; however our aggregate performance still resulted in the withholding of 25% of our anticipated funding for the second half of the year.
  • Issues for inclusion in the three-monthly highlight report to the West Yorkshire and Harrogate Health and Care Partnership Oversight and Assurance Group (SOAG), potentially requiring input from or management through the wider partnership.
  • Outcomes from the collaborative work between the Alliance and Health Education England to evaluate the ability of the  training ‘pipeline’ to support ongoing recruitment and expansion to meet expected demand in the workforce groups identified as key to delivery of the national cancer strategy – histopathology, clinical  oncology, medical oncology, radiology, gastroenterology and diagnostic/therapeutic radiography – and actions required
  • The inclusion of a specific Alliance-wide data sharing agreement in the system-wide work in this area being progressed by the Partnership
  • Plans to develop an organisational development offer to support the needs of the Cancer Alliance  programmes in delivering mutual accountability, and to clarify the role of Board members in this context
  • Update on proposals to develop Alliance support for quality improvement and patient experience across the patch.

The next Board meeting will be held on 23rd January 2019.

Wakefield Health and Care Review – Peer Review Challenge Pilot

Wakefield as part of The West Yorkshire and Harrogate Health and Care Partnership recently undertook a pilot Peer Review Challenge. Organised by the Local Government Association, NHS Providers, NHS Commissioners and NHS Confed, the review took place from 23rd to 25th October. It provided an opportunity to showcase the area’s innovation across the health and social care system.  The review was led by a peer team with representation from senior leaders both nationally and from across the area. Positive feedback included the strength of collaboration between Wakefield and the wider Partnership; the development of alliances, the Connecting Care Hubs and enabling a stronger focus on preventing ill health and early intervention at scale.  

Areas for further consideration included ensuring Wakefield’s current model is consistent with the Partnership’s ambition to prevent ill health and encourage self-care. The peer team will revisit Wakefield and provide final feedback later this month.

Consideration will be given to whether the peer review approach will be rolled out across our other five local places (Bradford District and Craven; Calderdale, Harrogate, Kirklees and Leeds).

What’s happening next week?

  • The Shadow System Leadership Executive Group meets on Monday.
  • West Yorkshire and Harrogate Healthy Hearts communication group meets on Monday.
  • The West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups (CCGs) meet in public on Tuesday.  The Committee, which is part of our Partnership, has a shared health programme of work that aims to further improve the health and wellbeing of the 2.6 million people living across the area. You can find out more here.
  • The Clinical Forum meets on Tuesday this is chaired by Dr Andy Withers.
  • The West Yorkshire and Harrogate Health and Care Partnership System Executive Leadership Group meet on Tuesday.