How would you spend £250,000 on health and care?

This blog by Paul Smith was originally published in Health MJ magazine


Home Improvement Agencies (HIAs) operate across most of England. Their role is to work with people to help them to make adaptations or repairs to their homes so they can continue to live there in safety, warmth and comfort. This can be anything from fitting a grabrail, to replacing a broken boiler or even project managing a fully wheelchair accessible home extension. Whatever the solution, the idea is to work with the customer to deliver the best outcomes for them.

HIA are generally commissioned and funded by different part of the health and social care system. As the government appointed national body for HIAs, Foundations was keen to compare and contrast these different types of commissioner at our recent national conference in Manchester. So we invited a director of public health, and commissioners from a county council and a clinical commissioning group (CCG) to form our own Dragons’ Den. Each were given a notional £250,000 to invest in service ideas pitched by delegates.

The first noticeable difference was financial. The average budget for a CCG in England is over £300m, so £250,000 represents a relatively small contract, whereas public health departments in England have an average budget of around £23m making a £250,000 investment much more significant decision. With an average budget of around £112m social care departments fall somewhere in the middle. Whatever the budget, and it could be argued that CCG and social care budgets are particularly challenged by statutory duties, the key is to prevent the need for other more expensive services.

Prevention is seen as critical to the vision of the Care Act – requiring new care and support systems to actively promote wellbeing and independence and aim to prevent need, not just wait to respond when people reach a crisis point.

The Care Act describes prevention in terms of three general approaches:

  • primary – interventions to prevent development of needs e.g. advice, befriending aimed at individuals who have no current particular health or care needs;
  • secondary – targeted interventions aimed at individuals who have an increased risk of developing needs, where the provision of services, resources or facilities may help slow down or reduce further deterioration or prevent other needs from developing; and
  • tertiary – interventions aimed at minimising the effects of disability or deterioration for people with established or complex health conditions, supporting people to regain skills/manage or reduce need where possible.

A simplistic analysis would suggest the public health is about primary prevention, social care provides secondary prevention and CCGs tertiary. However, our commissioners were more interested in the outcomes of the prevention than defining the level of the approach. For example, the social care commissioner was particularly interested in services that could delay or prevent people needing to move into residential care.

The really interesting part for HIAs is that their services deliver across all three levels of prevention. That's the case regardless of whether agencies are based in local authorities, housing associations or they are stand alone organisations. They offer advice and information services for all, help with repairs and minor adaptations that enable older people to remain independent and also arrange major adaptations for people with disabilities. This was illustrated by our dragons offering to jointly fund a handyperson service that carries out home safety checks and fits simple assistive technology (‘gadgets and gizmos’) like remote control switches and door intercoms.

Earlier in the conference we launched our new vision for the HIA sector; suggesting that agencies work collaboratively with other service providers in their area to deliver truly person centred services. The dragons' den session showed how commissioners can also collaborate to jointly fund services that meet their individual objectives but much more effectively than they could in isolation. It also demonstrated that HIAs, as the only all-tenure providers of housing services, are ideally positioned to provide the gateway for health and social care to engage with the wider housing sector.