A new commitment to improve the delivery of home adaptations
The newly published National Disability Strategy makes a commitment to “accelerate the delivery of home adaptations in England and Wales by improving local delivery of the Disabled Facilities Grant” (DFG) to enable older and disabled people to live safely and independently in their own homes.[1]
Although light on detail, this is welcome news. Around 1 million households in England alone currently lack all the adaptations that they need,[2] while over 400,000 wheelchair users are living in homes that are neither accessible nor adapted.[3]
Around two thirds of DFG applications are for people aged 60 and over.[4] With more than 90% of older people living in mainstream housing, the implications of our ageing population upon demand for adaptations is significant. As more people live for longer, often with multiple long-term health needs, it is important to build upon existing examples of innovative adaptations practices, to ensure that demand can be met in a fair and effective way.[5]
Considering the impact of the COVID-19 pandemic
The COVID-19 pandemic has had a significant impact upon the delivery of adaptations. Many services have needed to adopt alternative working practices due to lockdown restrictions and when working with clients who were shielding. In some cases, this has led to delays in providing adaptations and increased waiting lists, which may in turn have increased the likelihood of health needs deteriorating, or new needs developing. [6]
As the government develop their plans to bring about improvements to the DFG process, they will need to consider the impact that COVID-19 has had upon demand for adaptations services, and the implications for the capacity and wellbeing of the adaptations workforce, including occupational therapists.
Reframing services using Adaptations Without Delay
The Royal College of Occupational Therapists’ (RCOT) report Adaptations Without Delay is a vital tool in helping services to reframe their processes to benefit their clients and workforce alike. The report provides a practical framework to increase the efficiency of the adaptations process by making best use of the available workforce and giving increased agency to the individual requiring adaptations.[7] A survey of Adaptations Without Delay users, conducted by RCOT and Housing LIN in 2020, identified that 95% of respondents found the report useful, 59% had made changes to their services because of the report and 98% would recommend it to others.
A key theme of the report is the need for all stakeholders to communicate and collaborate effectively, recognising the unique role and skillset of all members of the workforce, and ensuring that their skills are deployed in the most appropriate way. Qualitative feedback from the Adaptations Without Delay survey identified that the development of good interprofessional relationships enabled positive change in adaptations processes, whilst unwillingness to engage by particular professional groups was a significant barrier.
Collaboration across the health and housing sectors
The new commitment to improve the adaptations process comes at a time when the wider health system in England is also strengthening its approach to cross-sector working. Integrated Care Systems (ICSs) will be operational across England from April 2022, with ICS Partnerships as part of the statutory arrangements. An ICS Partnership is described as a “broad alliance of organisations and representatives concerned with improving the care, health and wellbeing of the population, jointly convened by local authorities and the NHS.” [8]
Although not mandatory, involvement of housing organisations is recommended within ICS Partnerships. This must be actively encouraged, as the conditions in which people live are inextricably linked to their health, wellbeing and independence, as demonstrated in Improving Health and Care through the home: A National Memorandum of Understanding. [9] The housing sector, working alongside health and social care colleagues, will have an important role to play in ensuring that people’s health and care needs are identified and met in an effective, equitable and timely way as we recover from the COVID-19 pandemic.[10]
If home improvement and adaptations services wish to influence the direction of travel within ICS Partnerships, now is the time to examine their own processes, to ensure that they are working in an efficient and sustainable way. As practitioners across health, housing and social care, with expertise in considering the impact of a person’s environment upon their wellbeing, occupational therapists are well-suited to take up key strategic roles in the move towards greater collaborative working.
This RCOT blog is one of a series being produced by members of the Housing and Ageing Alliance, a collective of local and national organisations working together to bring about improvements to the housing and living conditions of older people.