Our Cinderella Service

November 26th, 2015 by Rachael Byrne, Executive Director, Care and Support in Care and Support blog


Overlooked and undervalued, supported housing is sometimes referred to as the Cinderella service, toiling away without recognition.

But there’s renewed hope for Cinders, all that toil could very well support the transformation of health and care as detailed in the NHS Five Year Forward View.

The Forward View - a report from the head of the NHS - makes clear that a high-quality health service is only sustainable if demand is reduced at the same time efficiency and funding rises.

The government has committed an extra £8bn in cash, but that still leaves £22bn to be found in savings and reductions in demand.

With the number of elderly people in the UK set to rise by 50% in the next 15 years, how can the NHS possibly square the circle of substantially cutting demand from an ever-growing and increasingly vulnerable population?

One thing is clear – it cannot do it alone.

The solution has to involve the care and support sector and a much greater focus on prevention.

As things stand, current NHS systems often don’t deliver the best outcomes for people. Perverse incentives reward treating more people rather than treating people better or helping them stay healthy in the first place.

In recognition of that, a number of vanguards have been set up - pilot schemes across the country that trial new approaches and offer hope of finding a new pathway for conditions that have traditionally been under served by the health service.

We know, for example, that many people go to their GP for help with problems like anxiety and depression. The symptoms can be medicated but that does nothing to address the underlying issues.

Incorporating a care and support element into the treatment, however, can tackle the root causes – rent arrears, anti-social behaviour, tenancy problems - rather than simply medicate their manifestations.

Home Group is currently piloting a Surgery Service scheme, based in GP surgeries where we can help alleviate the ever-growing pressure on doctors by providing more appropriate care for people whose needs extend beyond the scope of a 15 minute time slot.

We have also introduced a Carers’ Service in Birmingham that recognises the importance of the carer/patient relationship and which provides support and empowerment to carers, knowing that their wellbeing is integral to the health of the person they’re looking after.

The Carers’ Service reduces prescribing costs and hospital admissions, saving over £3,000 per person by achieving a single key outcome.

Over the past five months we have worked with 150 carers in the scheme. Assuming a similar rate of referrals, the scheme could produce savings of £1.1m over the course of a year – significantly more than the cost of providing the service.

And this is a key point when it comes to care. As well as considerably better outcomes - helping keep people stay well in the community, enhancing social inclusion, easing transition from hospital and improving self-management of long term conditions – integrated care makes sense financially too.

The Homes and Communities Agency estimates that investment in supported housing results in a net cost benefit of around £640m per year.

And yet this financial reality is not always reflected in public policy.

While supported housing is exempt from Universal Credit requirements, it will be subject to the government’s recently announced 1% rent cut.

That cut poses a particular risk to care services that already operate on wafer thin margins. It risks leaving vulnerable people with very few options.

That’s why, as a sector, we are calling for a similar exemption from the rent cut for such services. Without it, many would become unviable and the NHS would face even more acute pressure from people with nowhere else to turn.

If the government is serious about reducing demand and costs in the health service it needs to look again at the so-called Cinderella service in the corner. It may well find the glass slipper fits. And while it won’t be enough to guarantee we all live happily ever after, it would help turn true integration between care, health and housing from fairy tale into reality.