3Good Practice Identified

Contents

1Introduction

2Background

3Good Practice Identified

3.1Mental Health

3.2Health and wellbeing

3.3Independence

4Priorities for further action

4.1Welsh Government

4.2Local Strategic Partnerships

4.3Operational development

4.3.1Mental Health

4.3.2Health and Well-Being

4.3.3Independence

5Conclusions

1Introduction

On 26th March 2012, Cynon Taf Community Housing Group co-hosted a Health and Housing Event with Cwm Taf Health Board and Merthyr Housing Association. This event was designed to raise awareness of and provide support for the vital relationship between health and housing.
The event was opened by Antonia Forte, Chief Executive of Cynon Taf Community Housing Group who welcomed delegates from various professional housing and health backgrounds (Listed in Appendix 1). Antonia explained:

“A considerable amount of money is accessed through housingrelated support that directly impacts on health outcomes. Working in closer collaboration with health colleagues, we can make this money go further.”

Angela Jones, Consultant in Public Health, presented an overview of the health challenges facing those working across Rhondda Cynon Taf and Merthyr Tydfil. The day continued with themed workshops looking at existing practice and opportunities to improve joint working in the areas of:

• mental health
• health and wellbeing, and
• preventing hospital admission and facilitating early hospital discharge

Delegates were delighted to welcome Huw Lewis AM, Minister for Housing, Regeneration and Heritage, who stressed the difference we can all make by working in synergy, connecting and strengthening the bridge between good housing and good health in Wales. This was particularly important in the current, very challenging, financial environment.Heinviteddelegates to identify practical interventions that could help bridge the organisational divide locally and lead to better outcomes for people living in the valley communities, and confirmed that he would be more than pleased to consider any recommendations coming forward.

This report will be shared with the Minister.

2Background

In late 2006, Pontypridd and District Housing Association (PDHA) seconded an officer to the then Rhondda Cynon Taf Local Health Board to investigate improving the links between health and housing in the locality. The report that followed identified many areas to maximise the advantage of joint working. Although there has been considerable restructuring of the public and independent sectors in relation to the housing roles, it was useful to revisit the main recommendations to ensure the learning from this was not lost. This was reviewed in planning this event.

More recently, the stakeholders’ survey conducted by Cynon Taf Housing Association in November 2011 demonstrated the importance of good housing to health outcomes and the desire of Health Board members and officers to work more collaboratively. Drawing in Merthyr Housing Association, it was decided to bring practitioners from Cwm Taf Health Board, the two Local Authorities, and the most active housing associations working in the geographical footprint of the Health Board to explore practically what is going on currently and what could be done better.

3Good Practice Identified

It was clear from the feedback at the event that there is a lot of good work being undertaken in partnership. This section highlights some of the good practice in each of the areas.

3.1Mental Health

For tenants who are experiencing difficulties related to mental health and emotional well-being, there are a number of services that can provide advice and improve access to accommodation and support.These include:

• The whole range of local services provided by the Supporting People Programmes in Rhondda Cynon Taf and Merthyr Tydfil, (such as Gofal’s housing advice services and Tenancy Advocacy services);
• The Mental Health and Housing Protocol in Rhondda Cynon Taf which develops stronger links and improves access to Mental Health services;
• “Move On” programmes where support is provided to tenants and then reduced gradually as they become more independent. The support is then provided to new tenants in different accommodation rather than moving the tenants on to new accommodation;.
• Specialist support for tenants with dementia, which is considered to be extremely effective.
• Work within the private landlords forums

3.2Health and wellbeing

A range of current interventions that support people to make positive choices to improve their health and wellbeing were considered to be effective:

• Community well-being coaches were recognised as having a positive impact with tenants, with several case studies cited;
• Mentoring schemes for tenants (up to two years support) were identified as good practice;.
• Money Management support available for tenants in relation to budgeting skills. In addition, access in some areas to energy saving officers able to provide advice and support tenants with cost saving measures andhome insulation projects to help reduce fuel poverty. .
• Access to nutritious food at low cost e.g. community food co-ops, food banks.
• A range of services and events provided for tenants e.g. sexual health scheme for younger tenants, therapies in the community, cooking skills, community development teams to provide support and skills to improve general health and wellbeing.
• Range of intergenerational projects, re-ablement team.

3.3Independence

The workshop focussed on good practice to prevent admission to hospital and facilitate discharge, but recognised that the work identified in the section above helped support independent living in the community by helping people to keep well and active and supporting them when they need particular assistance at times of difficulty or illness.

In addition, many of these services will also be particularly important to facilitate discharge and prevent inappropriate admission to hospital or residential homes:

• Programmes providing adaptations and property improvements such as Care and Repair;
• AgeConcernHospital discharge support andbefriending services;
• GofalHospital to Home mental health service;

• Extra Care and Sheltered accommodation schemes;
• Telecare services;
• Joint Health and HousingHospital Discharge Protocol;
• Re-ablement Services.

4Priorities for further action

This section identifies recommendations for improvement at three levels – those that are for Ministers and officials at the Welsh Government to consider; those that call for strategic consideration by local strategic partnerships, and those that can be implemented locally without significant additional resources or a change of policy direction.

4.1Welsh Government

There are three suggestions that the event’s delegates have made for consideration by the Welsh Government.

• That Welsh Government formalises an expectation that each Local Service Board recognises the importance of housing to the health and well-being of local communities, and sets tangible outcomes for service providers to work towards.

• That Welsh Government seeks to use any local determination powers that it may have to provide housing benefit support for ‘trial’ or “step down” tenancies to maximise hospital discharge schemes for all appropriate client groups. Particular regard should be given to provide flexibility beyond six weeks for continued housing benefit support during transition periods.

• That Welsh Government set up a centrally funded, three year grant programme for community well-being coaches, with a robust process to agree criteria and evaluate outcomes.

4.2Local Strategic Partnerships

It was recognised that local statutory and voluntary strategic partnerships provide a focus for more development work with partners, including the independent, voluntary and private sectors. However, it is felt that the recent changes in statutory partnerships introduce potential risks to further development, as well as opportunities to strengthen progress made. For example, the introduction of Single Integrated Plans in place of specific strategies for Community, health and well being, Community Safety and Children and Young People. In addition, the new joint Collaboration Board between Rhondda Cynon Taf and Merthyr Tydfil Local Authorities and partners.

Against this background, and building on successful work already undertaken, the following recommendations for action at a strategic level are made:

• A strategic approach to the development of local housing, accommodation and support services is required. This needs to be informed by comprehensive data from a range of sources, including health services and the local authorities, and accurate, up to date mapping of existing services. Knowledge of existing good practice across both local authorities needs to be shared together with evidence of recognised good practice from further afield.To this end, a Housing Needs Assessment should be undertaken across the Cwm Taf footprint to identify local priorities and opportunities for collaborative advantage.

• Ongoing partnership work (through task and finish action focused groups or workshops) to address the priorities for action, as appropriate.

• Ensure housing and its impact, for example on health and wellbeing, safety and prosperity, is consideredin the development of the Single Integrated Plans of both Local Authorities.

• Promote more work on the Cwm Taf footprint to promote consistency for residents, especially in relation to hospital discharge.

• Build the findings of this event into the development of strategies and action plans to address the housing and support needs of local residents, in particular the Supporting People Operational Plans and the Homeless and Vulnerable Groups Health Action Plan.

• Consider opportunities for partners to make better use of service user engagement mechanisms employed by housing providers

• Make this workshop an annual event, as an effective and efficient mechanism for joint working in the Cwm Taf footprint:
• To feedback actions and improvements from this workshop
• Identify new priorities, best practice and an action plan for further improvement
• Raise awareness and build relationships and understanding between staff across all sectors
• Include staff from wider range of departments and organisations to broaden the remit e.g. Social Services and Ambulance service

4.3Operational development

The workshop sessions identified opportunities for a range of innovative work that could be progressed, in partnership, to further improve the interface between services and the experience and options for residents.

4.3.1Mental Health

Activity to reduce stigma is important if tenants with needs related to their mental health are to be effectively engaged and supported to maintain tenancies and improve their health and wellbeing. A number of schemes and projects were identified thatcan help reduce stigma and create a better service interface for tenants. These include:

• Develop and implement a new Mental Health and Housing hospital discharge protocol across Cwm Taf
• Training for all types of staff delivering services to tenants, including Mental Health First Aid and training available from local mental health services, the voluntary sector and service user groups;

.

• Explore opportunities to develop local joint projects with housing providers as part of the national Time For Change programme to tackle stigma and discrimination;

• One to one work with tenants (such as that undertaken by the well-being coaches) that improves confidence and self-esteem and reducing isolation;
• The development of tenant involvement in social enterprises provides both opportunities to engage tenant with mental health support needs and pathways to volunteering and employment;

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• Awareness raising within the private landlords forums;

• Awareness raising and training for local councillors and other community leaders to support increased understanding of the needs of local residents related to mental health and substance misuse.

• Utilise Part 1 of the Mental Health Measure to ensure GPs and primary care teams are better informed about support available from the housing sector, and where to refer patients for support.

• Encourage and support tenants to participate in tenant involvement opportunities.

• Specialist support for tenants with dementia is extremely effective. There is an opportunity for expansion with health and social care sectors to enable tenants to remain in their own home for as long as possible.

4.3.2Health and Well-Being

There is great opportunity to join up a range of work being undertaken in communities to support people to take control of their lives. Providing services that are targeted in areas of greatest health inequalities alongside support to access these services will help strengthen self esteem, reduce social isolation, and foster personal responsibility for health and well-being. Actions to promote joint working and target health inequalities include:

• Promote the interface and joint working between Housing Associations and the new Community First Clusters to maximise the impact of actions to address health inequalities;
• Develop a Smoke Free Homes toolkit and implement with all Housing Associations and Community First Clusters in Cwm Taf, including training and evaluation. Targeting in the areas of greatest deprivation and highest smoking prevalence will reduce exposure to second hand smoke, encourage smokers to quit improving their own health and addressing poverty by reducing the proportion of very limited incomes spent of tobacco products;
• Explore options to introduce wellbeing coaches with all Housing Associations in Cwm Taf, including the Local Service Board European Social Fund bids. Wellbeing coaches can work with individuals to support access to services and support to improve their health and quality of life e.g. community weight management, volunteering, exercise on prescription, benefit maximisation, debt support;

• Development of links with GP and primary care services to signpost to local services;
• Explore opportunities for consistent data collection and standardised indicators across all agencies to inform sharing across different agencies.

4.3.3Independence

The event highlighted that many partners were not aware of all the services available to support people and how to access them. and that communication was a key component of the way forward. Other opportunities to prevent admissions should also be maximised:

• Organise a training and awareness event for front line staff from all partner agencies to increase knowledge of services available and processes to access services to ensure a seamless interface for residents at discharge from hospitals across Cwm Taf;

• Implement and evaluate recently approved Health and Housing Hospital Discharge Protocol;
• Broaden the scope of the planned review of the discharge accommodation project in Rhondda Cynon Taf. . The review should include the identification of the barriers to success. In addition it could consider how housing providers and a range of accommodation opportunities across the Cwm Taf footprint can both support the hospital discharge process and also help to prevent inappropriate admissions to hospital or residential care;

• Link more closely with owner occupiers and Housing Associations for falls prevention initiatives as well as access to other initiatives such as home insulation and money management schemes

5Conclusions

The event was very well attended and the engagement in the workshops was very encouraging. Clear priorities for joint working have been identified and will be taken forward over the next year.

Nicola Davies, Assistant Director of Partnerships at Cwm Taf said;

“A number of positive and practical ideas were voiced which will be taken forward together over the coming months.”

The workshop will be repeated next year to feedback on the progress made against the action planand identify further priorities for joint working in the future. The mechanism of annual workshops and task groups to progress work is an efficient way of working together in partnership.

Unanimously, delegates felt that the day had opened many doors and created space for change.

Karen Dusgate, Chief Executive of Merthyr Housing Association commented:

“It was clear that much has been achieved and that even more can be achieved if we are able to collaborate more closely.”

Appendix 1 – Delegates who attended the Health and Housing Event