THE ESSENCE PROJECT

Housing Learning and Improvement Network (LIN)

Evidence containing data sourced from Housing Learning and Improvement Network (LIN)

A Cost Comparison of Supported Living in Wales: A Swansea Case Study
Nash P, Farr A, Phillips C Centre for Innovative Ageing, Swansea. 2013

The key findings from the data are: •The least expensive environment for delivery of care is in service users’ own homes with the most expensive being residential care. Caveats to this are that residential care supports older adults with higher levels of care needs, so type of care needs to be considered. Further, residential care includes housing costs where neither Extracare nor community based care include rent or mortgage payments, as these are not costs incurred by Social Services (Section 4.2). •The lowest equipment/modification costs were incurred by residents in Extracare with the highest by those receiving care and support in the community. This is reflective of the age of housing stock and support infrastructure, with Extracare having communal aides and ready modified flats, whereas this is not the case for community properties (Section 4.3) In-patient costs were significantly higher in residential care than in Extracare, again reflective of the underlying care need of older adults in each environment. The highest costs were associated with those in receipt of care in the community, which is likely because of delays in enacting assessments, re-ablement and new community support care packages (Section 4.4). •Outpatient admissions and A&E costs were relatively stable across each of the care environments (Section 4.5) •The most common GP services utilised by residents in each of the care environments were telephone consultations, home visits and GP surgery consultations (Section 4.7). •Overall, Residential care appears to be the most expensive for all costs relating to GP activity (Section 4.8).

Analysis of Outcomes from the Bracknell Forest Homes Major Works Investment Programme
Musson S and Bowlby S University of Reading, Berkshire. 2013

Home improvements can increase wellbeing according to research by the University of Reading for Bracknell Forest Homes into the social value of their £61m home improvement programme. They found that communities not only benefitted from physical improvements to homes but also benefitted from social and psychological wellbeing benefits.

Better Housing, Better Health in London Lambeth: The Lambeth Housing Standard Health Impact Assessment and Cost Benefit Analysis
Ambrose A, Bashir N, Foden N, et al Centre for Regional Economic and Social Research, Sheffield. 2018

Main message: Our indicative cost-benefit analysis shows that Lambeth’s Housing Standard (LHS) investment programme will have a major impacton the health and quality of life of council tenants, with wider monetised benefits of £227million for individuals, for the National Health Service,social care services, the Criminal Justice System and the local economy

Boiler on Prescription Trial
Burns P and Coxon J GENTOO Group, Sunderland. 2016

The report finds a 60% reduction in the number of GP appointments needed by patients taking part in the boiler on prescription trial in Sunderland between Gentoo and the local Clinical Commissioning Group.

The trial took place after it investigated the impact of domestic thermal efficiency works on the health and wellbeing of NHS patients.

It found:

A&E attendances reduced by 30%
emergency admissions to A&E departments reduced by 25%
It also appears that the patients’ ability to self-manage their condition has increased, which has reduced the number of appointments they have needed at their local GP practice.

Connecting with Health and Care
Foundations and Housing Learning and Improvement Network, London. 2009

In Autumn 2007 Foundations, the National Body for home improvement agencies, was commissioned by Communities and Local Government to carry out research and produce a report examining the options for the future delivery of home improvement agency (HIA) services. The report draws on examples from within and outside the HIA sector to highlight possible areas for development. It does not present a ‘one-size-fits-all’ model, but a series of options that may be appropriate depending on the identified needs of the local population, taking account of other services already in place.

Demonstrating the Health and Social Cost-benefits of Lifestyle Housing for Older People
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2017

This report, commissioned by Keepmoat Regeneration/ENGIE, sets out the evidence for the benefits of developing specialist retirement housing for people aged over 55, including cost savings. It focuses on the benefits of age restricted retirement housing or sheltered accommodation, care villages and specialist extra care housing with services and care on-site. Part one lists key facts and figures on the health and social care cost-benefits of lifestyle housing for older people. Part two provides more detailed findings of the potential benefits including the areas of: social connectedness and reducing loneliness; life expectancy, keeping couples together and supporting informal carers, financial savings in adult social care and the NHS, and preventing the need for institutional care. References and links are listed at the end of the document.

Developing your Local Housing Offer for Health and Care
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2016

Updated in 2016, this tool acknowledges the significance of housing as a partner and contributor to achieving the aims of health and social care services. With references to latest policy and practice, it is aimed at helping housing and support articulate and demonstrate the value of their services in terms of their partners’ targets and outcomes.

Falls Prevention: Cost-effective Commissioning
Public Health England Public Health England, London. 2018

A resource to help commissioners and communities provide cost-effective falls prevention activities.

Financial Benefits of Investment in Specialist Housing for Vulnerable and Older People
Frontier Economics Frontier Economics, London. 2010

This report recommends that the HCA should continue to prioritise investment in specialist housing provision, to include making the best value of existing stock. In addition, it states that the needs of vulnerable and older people should be embedded in the Agency’s Local Investment Planning process and that older and vulnerable people should be considered contributors to, and customers of initiatives and programmes outside of specialist schemes

Get Well Soon
Studdert J, Stopforth S, Parker S, et al New Local Government Network, London. 2016

This report from New Local Government Network (and supported by Midland Heart) argues that the health service in its current form is not sustainable, and sets out a new plan for shifting the system to focus on preventing illness, shorten stays in hospitals and help people live independently for longer.

It makes a number of references to housing interventions and the care efficiencies that can be achieved and recommends that any new resources for health announced by government should be designated to support a transition to place-based health and a renewed focus on people’s wellbeing to drive a reduction in health inequalities.

In addition, with devolution in mind, it calls for metro mayors and council leaders to be in charge of pooled budgets and other financial models that ensures places rather than institutions are held to account for health.

Health at Home: A New Health and Wellbeing Model for Social Housing Tenants
Peabody Peabody Group, London. 2018

The report from Peabody is based on research with some of their general needs residents aged 50 and focuses on helping them to improve their understanding and confidence around managing their own health. It looked at how:

services can be delivered effectively at lower cost?
self-care can be encouraged for the most vulnerable customers and reduce dependency on direct support?
partnerships with other agencies can ensure a coordinated response to support residents’ complex and multiple health needs?

The report shows how housing associations can play an important role in empowering residents to stay healthy and also demonstrated the value of a person-centred approach to build more system resilient.

Health Begins at Home
Family Mosaic Family Mosaic, London. 2013

This new pamphlet provides interim results at 6 months from a fascinating Family Mosaic research project being undertaken by the London School of Economics. It seeks to measure and test out the impact of their services, both as a social landlord and as a provider of housing-related care and support services, and ways in which they can improve the health and wellbeing of older residents whilst at the same time help reduce NHS costs in the areas they operate in. Initial findings suggest an annual saving of £860,000 to local health economies for the 597 participants alone. With a range of useful information and examples of prevention and reablement at work, read below.

Home from Hospital: How Housing Services are Relieving Pressures on the NHS
Copeman I, Edwards M, Porteus J National Housing Federation, London. 2017

This report shows how housing services are helping to relieve pressure on the NHS by reducing delays in discharging people from hospital and preventing unnecessary hospital admissions. It features 12 case studies to show the positive impact these services have on people’s lives and the cost benefit to the NHS. The case studies highlight services that will benefit people most at risk of delayed discharge, such as older people, people with mental health problems and people experiencing homelessness. The case studies also demonstrate a diversity of housing and health services including: ‘step down’ bed services for people coming out of hospital who cannot return to their own home immediately; hospital discharge support and housing adaptation services to enable timely and appropriate transfers out of hospital and back to patients’ existing homes; providing a new home for people whose existing home or lack of housing mean that they have nowhere suitable to be discharged to; and Home from Hospital services to keeping people well at home who would otherwise be at risk of being admitted or readmitted to hospital. The report also considers the impact and additional savings that could be made by housing providers if this work were to be scaled up.

Home Solutions to our Care Crisis
Papworth Trust Papworth Trust, Basildon. 2012

Research findings by the Papworth Trust that unsuitable housing costs the public purse and that too many disabled and older people suffer stress, accidents or health problems because their homes are not suited to their needs. They recommend a radical shake up of the adaptations system to enable people to live healthy and independent lives.

Homes and Ageing in England. Briefing Paper
Garrett H and Burris S Building Research Establishment (BRE) on behalf of Public Health England, London. 2015

The BRE paper outlines how simple changes made to the homes of older people could save the NHS more than £600 million a year. Using data collected by the English Housing Survey, and the methodology from the earlier report, ‘The Cost of Poor Housing to the NHS’ (opens new window). the findings show that there are over a million homes occupied by those over 55 where there is a significant risk to health (for example, excess cold or of injury from falling on poorly designed steps, both inside and outside the home). It estimates that treating these avoidable illnesses and injuries costs the NHS over £600 million a year and offers a selection of case studies.

Housing, Prevention and Early Intervention at Work: A Summary of the Evidence Base
Porteus J Housing Learning and Improvement Network, London. 2011

This Viewpoint provides an overview of the evidence base and personal account of the key housing and housing with care and support issues relating to prevention and early intervention. It was written to help inform priority area 4 of the Department of Health’s Caring for our Future: Shared ambitions for care and support consultation and the work of the NHS Future Forum

How can Local Authorities with Less Money Support Better Outcomes for Older People?
Centre for Policy on Ageing Joseph Rowntree Foundation, York. 2011

Research shows that older people want and value low-level support – ‘that bit of help’ – but the benefits of investing in this are realised over many years, making it harder to prove impact and protect funding in the face of severe pressure on spending.

This ‘Solutions’ published by Joseph Rowntree Foundation provides examples of imaginative, affordable and effective ways of supporting older people’s health, well-being, social engagement and independence. It highlights projects with some local authority involvement whether as lead commissioner, subsidiary partner, or through small grants or seed-funding.

The projects demonstrate the importance of:

involving people who use support and services in shaping them;
investing in collective solutions, small grants or seed-funding for self-help groups, and developing local markets to provide the support people want and value;
greater emphasis on the assistance that older people need and choose, and their experiences rather than on conventional social care and/or services;
developing place-based approaches that reflect the whole of people’s lives, and delivering value for money, for example by including transport

Improving Housing with Care Choices for Older People: An Evaluation of Extra Care Housing
Netten A, Darton R, Bäumker T, et al Personal Social Services Research Unit and Housing Learning and Improvement Network, London. 2011

This report summarises the results of a
Department of Health (DH) funded evaluation
of 19 extra care housing schemes that opened
between April 2006 and November 2008, and
which received capital funding from the
Department‘s Extra Care Housing Fund. Key
findings on delivering outcomes, costs and costeffectiveness, and improving choice were that:
Delivering person-centred outcomes
• Outcomes were generally very positive, with
most people reporting a good quality of life.
• A year after moving in most residents enjoyed
a good social life, valued the social activities
and events on offer, and had made new friends.
• People had a range of functional abilities
on moving in and were generally less
dependent than people moving into
residential care, particularly with respect
to cognitive impairment.
• One-quarter of residents had died by the
end of the study, and about a third of
those who died were able to end their lives
in the scheme.
• Of those who were still alive at the end of
the study, over 90 per cent remained in
the scheme.
• For most of those followed-up, physical
functional ability appeared to improve or
remain stable over the first 18 months
compared with when they moved in.
Although more residents had a lower level
of functioning at 30 months, more than a
half had still either improved or remained
stable by 30 months. • Cognitive functioning remained stable for the
majority of those followed-up, but at 30
months a larger proportion had improved
than had deteriorated.
Costs and cost-effectiveness
• Accommodation, housing management and
living expenses accounted for approximately
60 per cent of total cost. The costs of social
care and health care showed most variability
across schemes, partly because most detail
was collected about these elements.
• Comparisons with a study of remodelling
appear to support the conclusion that new
building is not inherently more expensive than
remodelling, when like is compared with like.
• Higher costs were associated with higher
levels of physical and cognitive impairment
and with higher levels of well-being.
• Combined care and housing management
arrangements were associated with lower costs.
• When matched with a group of equivalent
people moving into residential care, costs
were the same or lower in extra care housing.
• Better outcomes and similar or lower costs
indicate that extra care housing appears to
be a cost-effective alternative for people with
the same characteristics who currently move
into residential care.
Improving choice
• People had generally made a positive choice
to move into extra care housing, with high
expectations focused on improved social
life, in particular. • Alternative forms of housing such as extra
care housing are seen as providing a means of
encouraging downsizing, but although larger
villages appeal to a wider range of residents,
different expectations among residents can
create tensions and misunderstandings
about the nature of the accommodation and
services being offered.
• While the results support the use of extra care
housing as an alternative to residential care
homes for some individuals, levels of supply
are relatively low.
• Funding of extra care housing is complex and,
particularly in the current financial climate, it is important that incentives that deliver a
cost-effective return on investment in local
care economies are in place if this is to be a
viable option for older people in the future.
• More capital investment and further
development of marketing strategies are
needed if extra care housing is to be made
more available and more appealing to
more able residents. Without continuing
to attract a wide range of residents,
including those with few or no care and
support needs as well as those with higher
levels of need, extra care housing may
become more like residential care and lose
its distinctiveness.

Improving Housing with Care Choices for Older People: Evaluation of the Extra Care Housing Initiative
Darton R, Bäumker T, Callaghan L, et al Personal Social Services Research Unit, Kent. 2011

The Personal Social Service Research Unit (PSSRU) and Housing LIN have jointly published the evaluation of the Department of Health’s Extra Care Housing Fund.

Innovative Funding and Delivery Options in Extra Care Sheltered Housing
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2012

Housing LIN ‘Get Smart’ Guide – Public sector capital investment constraints necessitate the need for innovation and radically different ideas to come forward to meet the proven need for new older peoples housing. The guide seeks to summarise and assess new financial options available to local public sector and not for profit organisations that may be available for new build extra care accommodation arising from Housing Revenue Account reform; the anticipated introduction of Real Estate Investment Trusts; Tax Incremental Financing; and other options. ‘Get Smart’ brings together a number of experts involved in procuring, designing, constructing, funding, costing and developing extra care housing and captures their personal views to drive inward investment and innovation in the sector. They include:

Extra care: unlocking the market potential by Melville Knight, Castleoak
Private sector investment into older persons housing by David Dent, Elliott Dent
A long-term game for an old age problem by Darren Crocker, Gleeds
Extra care housing – financed by institutional investment by Niall Henderson, independent consultant
Funding structures for extra care housing by Coralie Foster, PKF Accountants
Delivering extra care housing – the Local Authority route? By Steve Partridge, Chartered Institute of Housing
Innovation in extra care housing – capital investment by Charlotte Cook, Winkworth Sherwood LLP, and
Extra care housing: innovative funding approaches & support for development by Tina Hothersall, Homes and Communities Agency

Integrated Homes, Care and Support
Holland C, Garner I, O’Donnell J et a Extra Care Charitable Trust, Coventry. 2019

This report provides an overview of the research findings from the collaborative research project between Aston Research Centre for Healthy Ageing (ARCHA) and the ExtraCare Charitable Trust, collated by Professor Carol Holland, Centre for Ageing Research (C4AR), Lancaster University. This report extends the findings of the 2015 report, covering the period from 2012 to 2018. Throughout the report, the focus is on the benefits to residents generated through ExtraCare villages and schemes, including sustained improvements in markers of health and well-being for residents and subsequent cost implications for the NHS.

Living Well for Longer: The Economic Argument for Investing in the Health and Wellbeing of Older People in Wales
Edwards RT, Spencer LH, Bryning L, et al Centre for Health Economics and Medicines Evaluation, Bangor. 2018

This report by the University of Bangor makes the economic argument for investing in prevention at different stages of the life course, in particular, older people.

Commissioned by Public Health Wales, it brings together robust international and UK evidence on the relative cost-effectiveness and return on investment of devoting public sector resources to programmes and practices supporting older people.

In relation to housing, it notes that the Welsh Government spends around £50 million per year on adapting the homes of older and disabled people, helping them to live safely and independently.

For every £1 invested in Care & Repair there is £7.50 savings to the taxpayer. It comes to the conclusion that it is cost-effective to improve housing by providing heating and insulation for high risk groups of over 65s.

Local Area Impact Assessment of Retirement Living and Assisted Living Developments
Institute of Public Care at Oxford Brookes University McCarthy & Stone, Bournemouth. 2014

This report by the Institute of Public Care at Oxford Brookes University considers a local area economic impact assessment of Retirement Living and Assisted Living Extra Care developments across England, Wales and Scotland. Commissioned by McCarthy and Stone, is aims to provide independent, objective and robust evidence about the extent to which there is a case for Retirement Living and Assisted Living Extra Care schemes in terms of the local economic and wider social impact of these schemes.

Reducing Delayed Transfer of Care through Housing Interventions: Evidence of Impact. Case Study
Adams S Care and Repair England, London. 2016

A case study and independent evaluation of a housing intervention designed to help older patients to return home from hospital more rapidly and safety. The initiative is delivered by West of England Care & Repair (WE C&R), who organise clutter clearance/deep cleaning; urgent home repairs, emergency heating repairs and essential housing adaptations for older people in hospital. The evaluation examined all case records, interviewed 15 hospital staff and undertook an in depth analysis of a sample of 4 cases. Analysis of the case records estimated a saving in hospital bed days of £13,526. The cost of housing interventions was £948, resulting in a cost benefit ratio of 14:1. Additional savings in hospital staff time amounted to a further £897. A short case study illustrates how the service was able to help one woman return home from hospital. It concludes that the small scale evaluation is indicative of the potential savings that a practical and effective home from hospital housing intervention service can generate for the health service

Safe at Home: A Preventive Handyperson Service in Devon
Evans S Housing Learning and Improvement Network, London. 2011

This case study showcases a successful handyperson scheme in Devon. It describes how the scheme was established and its subsequent evolution in the face of changes in the organisational and financial landscape. A range of Evaluation data are included to demonstrate the value of the scheme in promoting independence and reducing risks at home for older people and children and families across the community. Publication of this case study follows the launch of the national evaluation of the government funded handyperson programme by York Health Economics Consortium and the Centre for Housing Policy at the University of York.

The Business Case for Extra Care Housing in Adult Social Care: An Evaluation of Extra Care Housing schemes in East Sussex
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2013

This Housing LIN Case Study no 78 provides a synthesis of the detailed evaluation of extra care housing schemes undertaken by East Sussex County Council to inform future decisions related to financial investment in extra care housing. In particular, to ascertain whether extra care housing:

acts as a preventative model, supporting independence and avoiding admissions into residential care; and
is a more cost effective model of care delivery than other models, including residential care and care in the community

The resultant findings revealed that the financial impact of the findings was considerable, with the evaluation indicating that the cost of extra care housing was on average half the gross cost of the alternative placements. This has given pause for thought about the future strategic direction of extra care housing and has helped inform growth plans.

The Cost-benefit to the NHS Arising from Preventative Housing Interventions
Garrett H, Roys M, Burris S, et al IHS BRE Press, Bracknell. 2016

BRE (Building Research Establishment) is an independent, research-based consultancy, testing and training organisation, operating in the built environment and associated industries.

In 2014 a ‘Bletchley Day’ workshop was organised by Care & Repair England. BRE was tasked with considering ways to demonstrate the investment value of home adaptations and modifications.

BRE researched some of the cost-benefits to the NHS of undertaking preventative home interventions for households with a long-term sickness or disability, where the risks of accidents in their home are worse than the national average. This identified the need for preventative work in around 3 million households who have a long-term sickness and disability. This work would make their homes safer and warmer and so would reduce the likelihood of NHS treatment and the need for a Disabled Facilities Grant (DFG) adaptation required as a result of injury.

On 29 April 2016, BRE published The cost-benefit to the NHS arising from preventative housing interventions (FB82) by Helen Garrett, Mike Roys, Selina Burris and Simon Nicol.

The Economic Value of the Adult Social Care sector -England
Kearney J and White A Skills for Care, Leeds. 2018

Key findings

Sector characteristics

An estimated 45,000 sites were involved in providing adult social care in the UK in 2016. Most of these sites provided residential care. A further 72,000 individuals receive direct payments and employ Personal Assistants (PAs);
There were an estimated 1.6 million jobs in the adult social care sector in the UK in 2016. Most of these jobs were involved in providing domiciliary care. There were a further 151,300 jobs due to individuals employing PAs, meaning there were a total of 1.8 million jobs in the adult social care sector in 2016;
There were an estimated 1.2 million Full-Time Equivalents (FTEs) in the adult social care sector in the UK, and a further 69,500 FTEs employed as PAs;
Most of the adult social care workforce providing regulated services were employed at sites run by private sector providers (845,200);
The level of employment in the adult social care sector represents 6% of total employment in the UK; and
The average earnings in the adult social care sector in the UK was estimated to be £17,300.

Economic value of the sector

It was estimated that in 2016, adult social care sector GVA was £23.6 billion (using the income approach). Most of this was estimated to be in domiciliary care (£7.0 billion, 30%);
This represents 1.4% of total GVA in the UK; and
It was estimated that the average level of productivity (GVA generated per FTE) in the adult social care sector was £19,200.

Indirect and induced value of the sector

The indirect effect of the adult social care sector (resulting from the purchase of intermediate goods and services by the adult social care sector in delivering its services) was estimated to contribute a further 603,500 jobs (424,800 FTEs) and £10.8 billion of GVA to the UK economy;
The induced effect of the adult social care sector (resulting from purchases made by those directly and indirectly employed in the adult social care sector) was estimated to contribute a further 251,300 jobs (176,100 FTEs) and £11.1 billion of GVA to the UK economy
The total direct, indirect and induced value of the adult social care sector in the UK was estimated to be 2.6 million jobs (1.8 million FTEs) and £46.2 billion.

The Economic Value of the Adult Social Care sector -UK
Kearney J and White A Skills for Care, Leeds. 2018

Key FindingsSector characteristics■An estimated 45,000sites were involved in providing adult social care in the UKin 2016. Most of these sitesprovided residentialcare. A further 72,000 individuals receive direct payments and employ Personal Assistants (PAs);■There were an estimated 1.6 millionjobs in the adult social care sector in the UKin 2016. Most of these jobs were involved in providing domiciliarycare. There were a further 151,300jobs due to individuals employing PAs, meaning there were a total of 1.8 millionjobs in the adult social care sector in 2016;■There were an estimated 1.2 millionFull-Time Equivalents (FTEs) in the adult social care sector in the UK, and a further 69,500FTEs employed as PAs;■Most of the adult social care workforce providing regulated services were employed at sites run by private sector providers (846,600);■The level of employment in the adult social care sector represents 6% of total employment in the UK; and■The average earnings in the adult social care sector in the UK was estimated to be £17,300.Economic value of the sector(using the income approach)■It was estimated that in 2016, adult social care sector GVA was £24.3billion. Most of this was estimated to be in domiciliarycare (£7.6billion, 31%);■This represents 1.4% of total GVA in the UK;and■It was estimated that the average level of productivity (GVA generated per FTE) in the adult social care sector was £19,700.Indirect and induced value of the sector(using the income approach)■The indirect effect of the adult social care sector (resulting from the purchase of intermediate goods and services by the adult social care sector in delivering its services) was estimated to contribute a further 603,500 jobs (424,800FTEs) and £10.8billion of GVA to the UKeconomy;■The induced effect of the adult social care sector (resulting from purchases made by those directly and indirectly employed in the adult social care sector) was estimated to contribute a further 251,300jobs (176,100FTEs) and £11.1billion of GVA to the UKeconomy; and■The total direct, indirect and induced value of the adult social care sector in the UKwas estimated to be 2.6million jobs (1.8 millionFTEs) and £46.2billion in 2016.

The Economic Value of the Adult Social Care sector -Wales
Kearney J and White A Skills for Care, Leeds. 2018

Key FindingsSector characteristics■An estimated 2,070sites were involved in providing adult social care in Walesin 2016.Most of these sites were provided nursing care.A further 1,700 individuals receive direct payments and employ Personal Assistants (PAs);■There were an estimated 79,800jobs in the adult social care sector in Walesin 2016.Most of these jobs were involved in providing residential care.There were afurther 3,600 jobs due to individuals employing PAs,meaning there were a total of 83,400 jobs in the adult social care sector in 2016;■There were an estimated 60,000 Full-Time Equivalents (FTEs) in the adult social care sector in Wales,and a further 1,600 FTEs employed as PAs;■Most of the adult social care workforce providing regulated services wereemployed at sites run by private sector providers (44,500);■The level of employment in the adult social care sector represents 6% of total employment in Wales; and■The average earnings in the adult social care sector in Wales was estimated to be £16,900.Economic value of the sector(using the income approach)■It was estimated that in 2016, adult social care sector GVA was £1.2billion. Most of this was estimated to be in residential care (£328 million, 28%);■This represents 1.9% of total GVA in Wales;■It was estimated that the average level of productivity (GVA generated per FTE) in the adult social care sector was £18,700; and■The estimated GVA in the adult social care sector in Wales is estimated to be higher than the Agriculture, forestry andfishing, Arts, entertainment andrecreationand Water supply; sewerage andwaste managementsectors.Indirect and induced value of the sector(using the income approach)■The indirect effect of the adult social care sector (resulting from the purchase of intermediate goods and services by the adult social care sector in delivering its services) wasestimated to contribute a further 31,200 jobs (23,000 FTEs) and £554million of GVA to the Welsh economy;■The induced effect of the adult social care sector (resulting from purchases made by those directly and indirectly employed in the adult social care sector) wasestimated to contribute a further 12,200 jobs (9,000 FTEs) and £543 million of GVA to the Welsh economy;and■The total direct, indirect and induced value of the adult social care sector inWales was estimated to be 126,800 jobs (93,600 FTEs) and £2.2 billion in 2016.

The Economic Value of the Adult Social Care Sector in England
ICF GHK Skills for Care, Leeds. 2013

Skills for Care is part of the Sector SkillsCouncil, Skills for Care and Development. It is responsible for improving qualifications, training and development for alladult social care workers in England. Skills for Care had identified a need to establish the economic contribution of the activitiesprovided by the sector, measured as the economic value of the sector. However, the adult social care sector in England has historically been difficult to assess in terms of its economic value, as distinct from the children’s workforce and the wider UK workforce.Skills for Care has recently generated estimates of the number of employers, enterprises and employees in the sector, through its work on the National Minimum Dataset for Adult Social Care (NMDS-SC). ICF GHK was commissioned by Skills for Care to build on this work and to assess the economic significance of the adult social care sector in England to the wider economy.This study was commissioned in support of further policy development towards the sector including consideration of a broader case for investment in skills in the sector. The purpose of the study was to establish the economic contribution of adult social care servicesin England(defined in terms consistentwith the UK national accounts)and provide estimates of:■the annual GDP andGVAgenerated directly by the adult social care sector in England (including the public sector activities within the sector as well as the independent sector) (direct impact);■productivity -GVA per worker for the adult social care sector in England;■the supply chain multiplier for the adult social care sector in England (indirect impact);■the wage multiplier for the adult social care sector in England (induced impact)

The Home Cure
Wood C and Salter J Demos, London. 2012

A report by Demos that describes the policy background and current evidence about cost effectiveness of reablement services. Based on research with Midland Heart Housing Association it makes recommendations for improving outcomes by engaging housing providers in reablement. In particular it suggests ways to ensure that the reablement process can continue for those who need more than 6 weeks support and that more attention is given to regaining independence outside the home.

The Long Term Care Revolution
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2013

This Housing LIN Report comprehensively outlines the case for a revolution in long term care and captures some of the supporting material that has aided the development of the TSB’s Assisted Living Innovation Platform’s, ‘Long Term Care Revolution’ programme.

It sets out a vision for an alternative to institutional care, drawing on substantial evidence about the views of older people and their carers in the UK, lessons from abroad, the implications for industry/providers and makes recommendations to government and industry leaders on key factors for revolutionizing long term care for older people, including mainstream and specialist living environments.

The Social Value of Sheltered Housing: Briefing Paper
Wood C Demos, London. 2017

In February 2017, Demos carried out research to explore and quantify thesocial value of sheltered housing, as a form of housing for older people distinct from other housing with care or generic retirement housing options. This was to help Anchor,Hanover and Housing andCare 21consider the implications of the proposals put forward by the Government, that by 2019, the core rent and service charges for a variety of forms of supported housing will be funded through Housing Benefit or Universal Credit up to the Local Housing Allowance (LHA) rate. The Work and Pensions Committee and the Communities and Local Government Committee launched a joint inquiry into these proposals in December 20161. This paper provides a review of the existing evidence regarding the impact of sheltered housing, and then draws on this to make some initial estimates as to the cost savings it can achieve in a range of fields.

The UTOPIA Project: Using Telecare for Older People in Adult Social Care. The Findings of a 2016-17 National Survey of Local Authority Telecare Provision for Older People in England
Woolham J, Steils N, Fisk M, et al Social Care Workforce Research Unit, King's College London, London. 2018

This report describes how electronic assistive technology and telecare are used by local authorities in England to support older people. It is based on an online survey of local authority telecare managers to identify local authority’s aims when offering telecare to older people, the methods they use to assess whether their objectives are achieved, and how telecare is operationalised and delivered. It also aimed to explore why the findings of the earlier the Whole System Demonstrator project – which found no evidence that telecare improved outcomes – have been overlooked by local authorities and policy makers, and whether there is other evidence that could account for WSD findings. The survey results found a third of local authorities used research evidence to inform telecare services and half were also aware of the Whole System Demonstrator. It also found that telecare is used in most local authorities to save money. Although there was some evidence of monitoring, there was no evidence of local authorities adopting agreed standards. The final section of the report provides suggestions for improving telecare service practice. They include the areas of using telecare as a substitute for social care; expanding the focus on telecare beyond risk management, safety and cost reduction; the impact of telecare on family members, carrying out effective assessments, and training

Valuing Retirement Housing: Exploring the Economic Effects of Specialist Housing for Older People
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2016

This report:

Explores the potential economic effects of specialist retirement housing
Estimates the financial value of these economic effects drawing on relevant social survey, administrative and population data;
Aggregates the total estimated financial value of a single unit of new specialist retirement housing across the lifetime of its first resident

This report looks at how specialist retirement housing can influence:

Health and care costs
Local authority adult social care expenditure
First time buyers ability to get on to the property ladder, and their subsequent retirement wealth and housing costs.

The report estimates that the development of a single new specialist retirement housing unit may result in savings to the state.

Warm Homes for Health: Exploring the Costs and Outcomes of Improving Population Health through Better Housing
Tudor Edwards R, Nathan Bray N, Burns P, et al Centre for Health Econmics and Medicine Evaluation, Bangor. 2016

This briefing by the University of Bangor reports on a research project undertaken with Gentoo in Sunderland to understand the impact that warmth-related housing improvements have on the health, well-being and quality of life of families living in social housing.

In addition, it sought to find out the costs and outcomes associated with new warmth-related housing improvements, compared to existing, unmodified social housing.

Of note, it found that after installation of housing improvements:

across the cohort the number of GP visits in six months reduced by 10%
hospital visits reduced by 67%
accident and emergency department attendance reduced by 45%
inpatient stays reduced by 4%
More than £50,000 worth of NHS cost savings were observed due to reduced health service use

The researchers estimate, ‘if the 4.8million ‘unhealthy’ UK homes were to receive similar housing improvements the NHS could potentially save £1billion a year in health service use costs.’


NIHR School for
Social Care Research