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The extra bit of care...

2nd January 2017

Our country is getting older, observes Richard McCarthy...

We’re all getting old. Really old. Ten million of us are over 65, and 5.5 million more are due by 2020. By 2050 one in four of the UK population will be over 65.

It’s hard not to recall Python’s ‘Hell’s Grannies’ with its warped vision of crochet-addicted “layabouts in lace” and young families protesting forlornly about their nice communities being ruined “once the old ladies started moving in”. But as an industry we should put aside worries about the soaring price of tea and grab the opportunities it presents.

The ageing population has huge repercussions for our society. Hospitals are already under pressure as we know. Then there’s the looming spectre of the 600,000 new hospital bed spaces required by 2030 to cope with our ageing citizens.

The ageing population will also impact upon local authority and housing association stock as houses require adaptation and improvement to meet the needs of people seeking to stay in their homes with domiciliary support. While the provision for older people has improved out of all recognition since Barbara Robb’s Sans Everything report in the sixties, which detailed the cramped accommodation and poor facilities suffered by many older people at the time, many people’s views of what is available in retirement is shaped by those memories. Often this is still seen as a better choice than moving into much of the current provision in care homes and sheltered housing, so investment is going into developing alternative models of housing for older households.

Progress is being made but it is slow. Yet already there are signs of change. Some NHS Trusts are approaching these challenges by taking a whole system redesign approach, integrating innovative models of care, estate reconfiguration, and emerging technology in new and exciting ways. Meanwhile, local authorities and housing associations are developing partnerships to create new models of provision.

With industry analysts Monitor suggesting that integration of health and social care could save £4bn-£6bn, a sub-sector - extra care housing - has evolved that sits neatly between housing and healthcare, and which will provide a huge opportunity for the design and construction industry.

Extra care housing could mean anything from supported bungalows for those with the early onset of dementia, to vast care villages where the inhabitants lead near fully independent lives. The innovative models of provision being developed include the “co-housing” promoted by registered provider Hanover where independent homes share a communal living dining area for meals and support. Other examples worth contemplating are multi-generation community housing projects such as the LILAC cooperative in Leeds and an innovative model being developed near Burnley by Evermore Wellbeing.

The new build market for extra care housing is estimated to be £3bn a year with a further £1.2bn to be spent on refurbishment of existing properties. This presents an array of opportunities for the industry but it also highlights the need to embrace innovation and technology.

Innovation is required to learn from projects and develop design concepts in response to feedback from occupiers. For example, Extra Care Charitable Trust uses a limited panel of constructors who are challenged through a “lessons learned” exercise following completion of each project to identify ways to improve outcomes and reduce delivery times.

Technology is a critical tool for ensuring that no resident is left without support and that resources are deployed effectively. Although there is a concern that in-house technology generates an Orwellian sense of supervision, it does enable resources to be managed and directed effectively, a vital concern in the days of 15-minute care visits.

A critical issue in developing the sector is the availability of funding for personal, social and health care to secure investment in new schemes - for example, there needs to be confidence that the local authority will provide a long-term commitment to fund the care required by households in rented accommodation. The debates about how adult social care should be funded, and the means tests and caps, present a confused and confusing landscape against which investment decisions are made.

This is an issue for professionals as projects can stall at the point the revenue budget is generated and the shortfall crystallises. One of the responses is to think through how to make it as easy for someone to live in a property and care for themselves as possible, as well as all the other design considerations.

Delivering both the quality and volume of accommodation required is a challenge, the construction industry can assist this by thinking through the models of accommodation that will appeal to today’s retired and allow them to enjoy their lifestyle in the type of accommodation I know that I will want in retirement.

Richard McCarthy is executive director, central government, at Capita

This article first appeared in Building magazine.

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