Ready for Ageing? - Select Committee on Public Service and Demographic Change Contents

Annex 16: Housing provision (see paragraph 37 of the report)

Preserving independence

262.  If preserving independence is to be a central goal, appropriate and safe housing will become increasingly important.[462] Well-designed housing can also be cost-effective. For example, by providing a warm environment or making adaptations to prevent falls, investment in housing can reduce hospital admissions.[463]

263.  Services that help older people adapt their own homes to allow them to live there for longer will become more important in the coming decades as the population ages. We heard impressive claims from Care & Repair Cymru about the cost-effectiveness of their Rapid Response Adaptations scheme, which makes small adaptations to housing to keep people out of hospital, or get them discharged more quickly, following referrals from professionals. Chris Jones, Managing Director, Care & Repair Cymru, told us that they had calculated that in Wales over the past 10 years, "the scheme has saved the NHS around £100 million through the reduced cost of hospital stays and hospital beds, and stopping accidents, which equates to £7.50 saved for every £1 spent".[464] The work done by housing adaptation and repair services such as Care & Repair Cymru is commendable and must be supported.[465] Similar schemes should also be made accessible across England: currently only around 85% of residents in England have access to a home improvement agency.[466] Government, including local government, also have a role to play in providing advice on how to access housing adaptation services.[467]

264.  The Government can incentivise older people to adapt their homes by simplifying funding options such as the Disabled Facilities Grant process. There is currently some concern that the process for accessing Disabled Facilities Grants is too long and bureaucratic.[468] The Government should support the development of housing adaptation services across England and Wales, both by ensuring adequate public funding and by encouraging the growth of a secure and easy-to-understand equity release market that can unlock funds to pay for housing adaptations (see Annex 7).

265.  The Government could also support research into initiatives such as life-long homes and the use of technology in the home to support older residents.[469] New assistive technologies can, for instance, monitor older people remotely for falls. Telecare products (also discussed in Annex 14) can help people keep on track with complex medication regimes. Independent Living suggested that such schemes could save local authorities and the NHS significant amounts of money.[470] Age UK agreed.[471] Professor Anthea Tinker of King's College London (KCL) related how "quite small" changes to the home can be cost-effective, and improve the lives of older people. These might include simple aids and devices to support both older people and their carers, such as small and easy-to-lift kettles and easy-to-use tin openers.[472] While local authorities should consider assistive technologies as part of their preventive care strategies, they should not lose sight of less expensive adaptations that could bring cost benefits. In addition, local and central government should support schemes such as Neighbourhood Watch and Meals on Wheels that mobilise local people, many of them older people themselves, to assist and keep an eye on frail elderly people in their own homes.[473]

Ensuring adequate housing provision

266.  According to Care & Repair England, while the majority of older people's homes are in a reasonable state, poor housing conditions remain. This is especially true for the 'older old'; low-income, long-term resident homeowners; and private tenants. Falling property values (outside London, parts of the South East and a few high-demand areas), combined with a stagnant market due to lack of mortgage availability and rising unemployment, will impact on 'moving on' or 'downsizing' options.[474]

267.  Some local authorities and private housing developers provide staffed 'extra care housing', which offers more assistance than traditional 'sheltered housing'.[475] While cost-effective, this type of housing usually requires support or funding from other agencies. Encouraging stronger links between social care authorities and health providers such as home nurses could help to ensure that there is enough funding and service provision to meet care needs. In addition, private developers might ask users to 'buy in' using capital freed from selling their old home, or from other sources.[476] Housing associations potentially have a major role to play in providing access to extra care housing. Those associations that take on residents could likewise use the housing capital that has been released by the tenant moving from their own home. Or they could acquire the resident's property, manage it and collect rental income in order to pay for long-term care needs.[477]

268.  At present there is little scope for housing associations to get involved. In countries that have direct, person-based long-term care and social health insurance (the Netherlands for example), not-for-profit housing agencies can enter this market because the individual has an assured flow of cash once they are independently assessed to be in need of a certain level of care.[478] Budget constraints and uncertainty about the levels of care provision that English local authorities can offer mean that promises made by authorities to fund tenants' long-term care may carry commercial risks. This is likely to become especially true as the overall demand for care rises as the population ages. Not-for-profit housing associations are unable to provide the necessary levels of care when faced with such liabilities. Individualised budgets and a national pattern of assessment may change this situation, but fragmented care provision and funding uncertainty make this unlikely.[479]

Stimulating the market in housing for older people through better planning

269.  Many localities have a need for greater provision of more suitable housing for older people, with more support services.[480] The 2006 Wanless Social Care Review reported that 27% of older people would consider specialist housing if it were available.[481] In February 2012, a YouGov poll for Shelter concluded that 33% of people over 55 were interested in specialist housing, which equates to more than six million people.[482]

270.  Despite growing demand for specialist housing and the substantial wealth held by some older people (see Annex 7), there is a gap in the market.[483] There are just 106,000 units of specialist housing for home ownership and 400,000 units for rent in the UK as a whole. Build rates are lower now than in the 1980s. In 2010, just 6,000 units for rent and 1,000 for ownership were built, whereas in 1989, 17,500 units for rent were built as well as 13,000 for ownership. These figures do not compare well with other countries. Just 1% of over-60s in the UK are estimated to live in retirement homes compared to 17% in the United States and 13% in Australia.[484] Shelter noted that if demand for retirement housing remained constant, supply would have to increase by more than 70% in the next 20 years.[485] McCarthy & Stone told us that "This is not going to happen without reform of the planning system".[486]

271.  This is an issue not just for older residents but for the whole population. The Government have made efforts to improve access to housing for younger people, but if the country had an adequate supply of suitably located, well-designed, supported housing for older people, this could result in an increased release onto the market of currently under-occupied family housing, expanding the supply available for younger generations. Central and local government, housing associations and house builders need urgently to plan how to ensure that the housing needs of the older population are better addressed and to give as much priority to promoting an adequate market and social housing for older people as is given to housing for younger people.[487]

272.  Major developers have not geared up for delivering developments of specialist housing for older people.[488] Gary Day explained that there are major barriers to entry into this market, and that "Public policy does not proactively encourage innovation and increasing supply in this sector".[489] Developers working in the market often lose out to businesses such as supermarkets and car park operators when applying for planning permission.[490] An efficient and trusted equity release market could provide some of the capital needed to stimulate the market in housing for older people, but many consumers do not have confidence in equity release schemes (see Annex 7).

273.  Local government should signal their intention to ensure better housing provision for older people by insisting that local planning agents both encourage the private market in housing provision for older people, and by making specific mention of older people's needs when drawing up their planning strategies.[491] Developers of housing for older people would also benefit from a more favourable regulatory environment. Gary Day told us that the Community Infrastructure Levy (CIL) and Code for Sustainable Homes have serious cost implications. He argued that home builders were competing for sites against others who were not subject to the same obligations: for example, supermarket developers did not have enhanced building costs, because there was not an equivalent sustainability code for supermarkets, and did not have an obligation to provide affordable housing. He pointed out that in some instances supermarkets' CIL charges were lower, because the local authority wanted to encourage retail activity. This illustrated that housing developers were not operating on a level playing field for land acquisition, despite the growing need to ensure specialist housing supply.[492] Anchor, a care homes provider, told us that "new housing for older people should be exempt from the planning restrictions that apply to mainstream housing".[493]

274.  Sites for older people's housing are best located either in urban centres, or at least in non-remote areas that have easy access to town or city centre amenities and activities.[494] The National Planning Policy Framework of March 2012 signalled that it is important to consider future demographic change when making planning decisions.[495] The Framework said that it is also crucial to "address the needs of people over retirement age, including the active, newly-retired through to the very frail elderly, whose housing needs can encompass accessible, adaptable general needs housing for those looking to downsize from family housing and the full range of retirement and specialised housing for those with support or care needs".[496] However, the Committee heard that the Framework's mention of older people's housing needs was too vague to address the demand for suitable housing provision.[497] Central and local government should jointly review how the National Planning Policy Framework's suggestions might be clarified and tightened to do more to ensure sufficient housing provision for older people.

275.  Bad housing has knock-on costs for the NHS. We heard from Care & Repair England that the costs to the NHS of poor housing are over £600 million per year. Many of the chronic health conditions experienced by older people have a causal link to, or are exacerbated by, particular housing conditions. The housing-health link becomes more important with age, they suggested, as people become more prone to trips and falls and more susceptible to cold or damp-related health conditions, while poor thermal standards are a quantifiable contributor to excess winter deaths.[498] Professor Anthea Tinker concurred, arguing that damp housing can cause, or, exacerbate breathing and other health problems, inadequately heated homes can lead to hypothermia, and badly maintained homes can cause accidents.[499] Health and Wellbeing Boards, on which local planners should be represented, should draw up plans for how communities can prepare themselves for older populations and involve housing associations and private developers to ensure that there is enough specialist housing, adequate transport and other easily accessible facilities for older people. Health and Wellbeing Boards should consider housing in tandem with health and social care provision because well-designed housing, as well as older people's capacity to avoid social isolation, are strongly linked to better health outcomes.[500]

462   Q 170 Back

463   Home Instead Senior Care; Policy Fen; Anchor.  Back

464   Q 202 Back

465   Central Government (DoH, DWP and DCLG), written evidence; Care & Repair England. Back

466   The website of Foundations, the (English) national body for home improvement agency and handy person services (  Back

467   Central Government (DoH, DWP and DCLG), written evidence; Central Government (DoH and DWP), supplementary written evidence. Back

468   Q 170 Back

469   In their written evidence, Carers UK urged the establishment of a 'Health and Care Technology Taskforce'. Back

470   Independent Living. Back

471   Age UK. Back

472   Professor Anthea Tinker, KCL. Back

473   Torbay Unitary Council, Q 558, Q 564, Q 415. Back

474   Care & Repair England. Back

475   Care Services Improvement Partnership, The extra care housing toolkitBack

476   Care & Repair Cymru; Central Government (DoH, DWP and DCLG), written evidence; Housing21; National Housing Federation; ILC-UK; McCarthy & Stone; Professor Anthea Tinker, KCL. Back

477   Such a scheme was described by Jon Bright, Director of Homelessness and Support, Building Regulations and Climate Change, Department for Communities and Local Government, Q 60. Back

478   OECD, Help wanted? Providing and paying for long-term care, June 2011. Back

479   Draft Care and Support Bill, July 2012. The draft Care and Support Bill (Cm 8386) provides specifically for personal budgets and is expected to be amended to implement the 'cap' on care costs, announced as part of care and support funding reform. This will require the creation of individual 'care accounts', so that costs towards the cap can be measured over time. The draft Bill also places the assessment of needs for both carers and the person cared for on a statutory footing, and makes provision for regulations to establish eligibility criteria. The Department of Health has said that its intention is to use these regulations to establish a national minimum threshold for care and support provision for all individuals, Back

480   Professor Anthea Tinker, KCL. Back

481   McCarthy & Stone; The King's Fund, Servicing Good Care for Older People: Taking a long-term view, D. Wanless, 2006. Back

482   McCarthy & Stone; Shelter, A better fit? Creating housing choices for an ageing population, 2012. Back

483   Q 174 (Ilona Haslewood, Programme Manager in the Ageing Society Team, Joseph Rowntree Foundation). Back

484   McCarthy & Stone. Back

485   McCarthy & Stone; Shelter, A better fit? Creating housing choices for an ageing population, 2012. Back

486   McCarthy & Stone. Back

487   Q 190 (Ilona Haslewood). Back

488   Q 169 Back

489   Q 169 Back

490   Q169, Q176, Q180 Back

491   See Q 169, Q173, Q 176, Q 181, QQ 186-188 (Gary Day).  Back

492   Q 188 Back

493   Anchor. Back

494   Q 172 Back

495   Department for Communities and Local Government, National planning policy framework, p.13; Central Government (DoH, DWP and DCLG), written evidence. Back

496   Department for Communities and Local Government, National planning policy framework, p.54. Back

497   WISE, supplementary written evidence. Back

498   Care & Repair England. Back

499   Professor Anthea Tinker, KCL. The Department of Health has made available to the Homes and Communities Agency a sum of £160 million capital funding over five years from 2013/14 to create a 'Care and Support Specialised Housing Fund'. Department of Health and Homes and Communities Agency Care and Support Specialised Housing Fund prospectus, October 2012. Back

500   Q 163 (Jake Eliot, Policy Leader for Care and Support, National Housing Federation). Back

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