My Lords, in tabling these amendments, the noble Lord, Lord Best, brings to the attention of the Committee the important role that housing plays in both care and support, and as a determinant of well-being. I have listened with care to the powerful contributions in support of them. Having done so, I begin with an observation that I hope is incontrovertible, which is that simply having a roof over your head will have a profound impact on your well-being. Having access to suitable housing for those with care and support needs plays a vital role in promoting not only their well-being, but their independence. The noble Lord, Lord Best, brought this point home very well. Properly taking into account the suitability of someone’s living accommodation could, for example, help to prevent a frail older person from falling and thus suffering the pain and trauma of broken bones and an unnecessary stay in hospital, the need for a greater level of care and support following discharge, and the costs of this to the public purse. It is vital that the system actively works to promote independence rather than waiting for people to reach a crisis point.
To reflect the importance of housing as a determinant of well-being, we have explicitly included the “suitability of living accommodation” in Clause 1(2), which sets out a list of things to which well-being relates and that the local authority is required to promote in performing its care and support functions. Furthermore,
“accommodation in a care home or in premises of some other type”,
is set out in the high-level list of examples of how to meet needs in Clause 8. Together, this means that the Bill ensures that housing is an integral part of care and support, where it is not general housing as excluded by Clause 23.
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In doing this, we are clear that local authorities are required to do several things. They must identify housing options that could prevent, delay or reduce needs for care and support under Clause 2(2)(a). They must
shape the market for suitable and specialised housing under Clause 5. They must consider the suitability of living accommodation in a needs assessment under Clauses 9 or 10, by virtue of it being included in the list of matters in Clause 1(2) that must be considered as part of the assessment process. They must also give information and advice on suitable and specialised housing options, as well as housing adaptations under Clause 4, and integrate this with other housing information that they or another authority provide in their area.
In addition to the information and advice that local authorities are required to give under this Bill, they have duties under other legislation to give information and advice about housing in their local area. We would expect local authorities to align these information services in line with their duties towards integration in this Bill.
Before I move on to that matter, I will address the very interesting idea put forward by the noble Lord, Lord Campbell-Savours, that local authorities should share in any revenue from the homes of those moved into care. I shall certainly think about that. Some local authorities fund organisations to smooth the difficult process of moving house for older people whose homes have become unsuitable. In going further, while the noble Lord’s suggestion appears to have some merit, the preliminary advice that I have had suggests that there may be legal difficulties in local authorities gaining financially from such a service. However, I shall investigate that point further.
Joining up housing with care and support offers the potential to make measurable improvements in patient experiences and outcomes. Clause 3 requires local authorities to promote integration between care and support, health and health-related provision. This reflects the integration duty placed on clinical commissioning groups under Section 14Z1of the National Health Service Act 2006, as amended. “Health-related provision” includes any service that may have an effect on the health of individuals that is not provided as part of the health service or local authority social services. This clearly and intentionally includes housing, thus creating a clear duty on both local authorities and the NHS to promote integration between care and support, health and housing.
To be able to meet needs in a joined-up and integrated way, multiple agencies must co-operate to ensure that care and support is properly co-ordinated. Clause 6 requires local authorities to ensure the internal co-operation of relevant officers, including housing officers, in delivering services relevant to care and support. As recommended by the Law Commission, the Bill places a reciprocal duty to co-operate on the relevant partners listed, all of which are public bodies with relevant care and support and carer’s functions at a local level. It also imposes a clear duty on local authorities to co-operate, as appropriate, with anyone involved in functions or activities relevant to adult’s care and support or carer’s support. This could include all relevant housing providers with which local authorities work.
The noble Baroness, Lady Emerton, asked what happens if there is resistance from local authorities to provide appropriate housing support. Clause 7 creates a duty to co-operate in response to specific cases.
Through this, a local authority in its care and support functions could request the co-operation of the local housing authority in the case of housing an adult with needs for care and support. The housing authority would be required to co-operate with this request unless doing so would be incompatible with its duties or have an adverse effect on its functions.
The noble Baroness, Lady Howarth, pointed out that the degree of co-operation with local housing services varies by area. Of course, we recognise that there is local variation, but when areas respond co-operatively, fully involving housing as part of the solution, there can be manifest benefits to health and social care; for example, in the north-west of England, an initiative at Whiston Hospital arranges for adaptations to be made to an older person’s home, ensuring a safe and timely discharge after a fall or injury. With that in mind, my department is undertaking work with NHS England and stakeholders to form a compact that will identify and break down barriers to the integration of health, care and support, and housing. This is also linking housing to outcomes in the health, social care and public health systems.
The noble Lord, Lord Best, rightly emphasised how vital it is for housing providers to co-operate with commissioners and relevant partners in their local area. I agree, but we need to consider how best to achieve this in a meaningful and practical way. It is not our intention to impose new regulations on private, voluntary and third sector providers. Rather, we would expect local authorities to ensure that those who provide services on their behalf are required to co-operate through contractual arrangements.
The Government have shown their commitment to supporting joined-up and co-ordinated working by making £3.8 billion available for joint spending between the NHS and local authorities in 2015-16, which I mention particularly in response to points made by the noble Baroness, Lady Wheeler. She is right that there is anxiety about funds leaking out into wider local authority budgets. We believe that the arrangement we have proposed, whereby local services will have to demonstrate that the money they are going to receive will directly benefit the patient or service user in terms of their health or social care needs, will ensure that there is no leakage in that sense. By including within that joined-up fund the disabled facilities grant, which helps to fund adaptations that can support people to live independently in their own homes for longer, there will be a real incentive to drive integration between care and support, housing and health.
I hope I have reassured the Committee not only that the Government recognise the importance of housing but that the Bill makes it clear that access to suitable housing—including, where necessary, the provision of accommodation—is an integral part of care and support; and that, further, it creates a legal basis for integration and co-operation between care and support and housing more generally. I hope that the noble Lord, Lord Best, is comforted by all that and that he is content for the moment to withdraw his amendment.