Housing Provision for an Ageing Society - Baroness Andrews

I would like to thank Sunder Katwala for the kind invitation to speak to you today about housing in an ageing society, and about the work we are doing to address the challenges – and opportunities - our ageing society present. It gives me particular pleasure to continue the conversation you have already had with Yvette and Ruth – about the economic context of housing, and about the validity of the culture and imperatives of home ownership. I know tantalizingly, questions were raised about the demographic implications – which we can now explore in more detail. Housing is soaring up the political agenda. And, of course, Gordon Brown has identified housing as a personal priority for his premiership.

I also want to thank Sue Adams of Care and Repair England and Jane Minter of Housing 21 who are sponsoring this event. Sue and Jane are both also members of our advisory group - the Housing and Older People's Development Group – bringing not only their expertise, but also their direct responsibility to older people, so we can be confident that they are in touch with older people are telling us.

This is work in progress – I know this audience more than most understands the virtues of gradualism; I also know that Beatrice and Sydney would have been scathing if it had ever been suggested that age was a disqualification for love, respect or radical thought. So, challenges yes – but this is surely the time and the place for serious thought too. And I see this occasion as an opportunity to begin this conversation, to have a dialogue with this audience which will also help us shape our thinking and policy. If we indicate direction of travel, rather than specific details it is not because we have overlooked or been defeated by them; we are still thinking and working on them.

The work so far enables us to explore for the first time what has been known in social and health policy for at least a century; that better housing is at least important as medical progress in terms of public health – and emotional, physical and mental well being. Yet it has been treated in policy and practice as if it were separate. This is an opportunity to close that gap, to cross reference the work that is done in housing, health and social care, and to reduce inequalities and create better systems for the future.

I want therefore to explore some key themes and to take you through the logic of what we are trying to design in terms of a housing policy for an ageing society which takes as its starting point not only a vision for inclusive communities and neighbourhoods, but also a more hopeful and realistic vision of ageing itself. It's not something that happens to other people, although our vocabulary and policy suggest this in too many ways.

We are planning for our future. Not them - us. So I want to describe first the landscape of ageing as a whole, and how housing fits into the firmament of policies to support individual well being; I shall then describe some of the specific changes in the landscape of housing itself, before moving on to talk about how we will attempt to meet those challenges in the strategy which is emerging.

And, underlying it all, is our consciousness that this is quite virgin territory. As the International Longevity Centre has put it:

"We don't know enough about what people want, but we know what they don't want … The limited research that has been done into people's preferences and decisions about housing indicate that planners require more sophisticated information about how factors such as lifestyle, income, biography and culture influence people's decisions. This information is needed to make it possible to predict demand for housing related solutions to the challenges of ageing."

We have started filling in some of those knowledge gaps. We have commissioned York University to undertake some analyses for us to help inform the Strategy – projecting household patterns and looking at tenure and equity; and some fascinating qualitative work looking at people's housing choices and aspirations.

BUT we do know what we think will work: it's not heroic – but it would be new, and necessary.

• New housing and neighbourhoods which are explicitly masterplanned for and with an ageing population. This will mean moving beyond lifetime homes to lifetime neighbourhoods which are properly designed so space can be shared and enjoyed, equally, across the ages.
• to make the most of all our existing housing stock, making it fully adaptable as circumstances change, enhancing quality and resilience in the face of climate change, recognising the essential role it plays in promoting and sustaining good physical and mental health.
• to give a far higher and more systematic priority to maintaining independence in the home in the community by ensuring that services as well as homes, are more flexible and functional as individual circumstances change – and building in support for carers as well as care
• to ensure that specialist housing reflects the fact that people will choose to live and be cared for in different ways in the future. Supporting and enabling independence perhaps through different forms of individual support or collective provision, and guaranteeing services for those as dependence increases, particularly for those who will suffer from confusion and dementia.
• to ensure that older people have confidence to make the right choice for them by ensuring they have the information they need about what's possible – whether that is in the way they use their assets and resources, organise or access opportunities and services, and prepare for changing circumstances – circumstances which are often likely to be more traumatic than at any other stage of the life cycle; the death of partners, friends, and even children; or the loss of faculty and competence.

I shall say more about progress in our work at the end – but let me say something about the diagnoses and the realities that are driving the work.

STATISTICS AND STEREOTYPES

Lets look briefly at the statistics.

In broad terms, the Government Actuary's projections show that over the next 30 years the population aged 65 years and over will rise from 9.7 millions to 16.5 millions - that's a 70% increase. The percentage increase is even more dramatic for older age groups, with those aged 75 years and over set to rise by 83 percent, and those aged 85 years and over rising by 149 percent.

Or, to make it personal; one in five children born today will live to be over 100. My partner's mother is 104; she lives with her sister who is 98. We think that is exceptional. But soon it will not be. Children in their 70s and 80s; our grandchildren in their 40s and 50s will not only see caring responsibilities stretching ahead; they are going to have to wait a long time for their share of the equity…..

That's what we know. But predictive science in this area is still uncertain. While we can be fairly sure that as we live longer we will experience more years of infirmity and disability, we do not know, for example, what the new medical technologies may bring, or conversely how today's lifestyles themselves – obesity for example – will complicate the picture. The human genome gives us greater clues about patterns of chronic disease; that will enable us to determine patterns of health care but it brings its own challenges too. The implications are not just for those who are affected, but for those who care for them, formally and informally.

Inevitably, the balance of life and work also changes. In 1950, the average male retired at 67 and could expect to spend 10.8 years in retirement. But our children have the prospect of a third of their lives in retirement - something which could not have been built into Beveridge's assumptions.

What we also know, however, is that the standard stereotype of old age as a drift into dependency cannot go unchallenged. Neither can the prejudice and discrimination which this has justified continue. The dimensions of discrimination are linked to the paradoxical perceptions of what we choose to believe old age is like.

In a study commissioned by Age Concern and published in 2005, Professor Dominic Abrams of the University of Kent, found that from age 55 onwards, age prejudice was reported nearly twice as often as any other form of discrimination. The same study also found - not surprisingly - that our definitions of old age are quite fluid. As we get older, the age markers we have in our minds for the start of old age tend to recede. "If you are a 24 year old man, you believe that old age begins about 55,(or indeed, 64) which is surprising because if you are a 62 year old woman, you think youth doesn't end until 57." That fluidity is one reason why we have resisted in our thinking putting policy within boxes defined by age; people age in different ways at different times.

But the same study also explored the stereotypes of old age. One in three of those surveyed said that they viewed the over 70s as incompetent and incapable. Try telling that to the Reverend Edgar Dowse, who received his doctorate from Brunel University at the age of 93; to my mentor, Michael Young, who fathered a child at 82, and, even while dying, was challenging the health service to be more innovations. That kind of creativity doesn't die with age.

Professor Abrams also found that older people were seen as friendlier than younger ones, as "doddery but dear" - again challenged recently by elderly lady, described as "the original neighbour from hell" who, had to be warned, on receiving her ASBO - that "old age is not a licence to disregard the law".

These images confound our perceptions, but means that we also must come to terms with the fact that life doesn't grow simpler as one grows older. Early findings from the work we have commissioned from York University show that life is complex; people split up these days at 50 and 60; the extended family has achieved heroic proportions; grandparents are looking after step children's children – and so on.

CHALLENGING INEQUALITIES

But what also and more urgently needs to be challenged are notions of silence, isolation and invisibility – something which the Zimmers have achieved recently. Because there are certainly still two countries in old age. One of the most worrying things about old people is that they are undemanding, hugely modest in their expections, grateful often for minimal service especially for affection and attention, but need and want to have fun, company and stimulation.

At the same time, many older people live in the worst housing conditions: a third of older people live in non-decent housing, with the worst conditions in the private sector. Whilst the most recent figures we have show a modest improvement in conditions for older people, there's still a long way to go. Older people are twice as likely to be in fuel poverty, and at highest risk of dying in a dwelling fire.

All this is backed up by the statistics which show that whilst older people live in some of the worst housing conditions, they also tend to be the most satisfied with their accommodation.

There is no paradox here. Remember, this is the generation that experienced the post-war slum clearance, the generation which can remember outside toilets and severe overcrowding, and no security of tenure. This is the first generation to benefit from housing standards and the welfare state.

But, this is the first generation, as well, to live in a very altered landscape of housing wealth and higher expectations.

We were the lucky generation; the first into mass higher education; earnings related pensions; the start of childcare and equal pay and conditions; and owner occupation. And coming down the track are of course the Baby Boomers – loud and squalling about standards, experienced and confident market players who are more likely to know their worth – and especially their economic worth - to society.

They are workers, volunteers, entrepreneurs, consumers, holidaymakers, leaders and carers. Nearly 8 million over 50s work, two thirds of volunteering is done by over 50s. The over 50s account for 40 percent of consumer spending, 60 percent of total savings and 80 percent of UK wealth. And they know about and use the internet.

In terms of housing - housing wealth accounts for more than 42 percent of household wealth, up from 22 percent in 1971. The wealthiest 30 percent of children will have access to 58 percent of housing wealth by 2013. This is predicted to rise to 66 percent by 2023. But we want a policy that is more than simply saying to younger people, "you should have chosen your parents better"!

And older people are key to the housing market. 30 percent of households are already headed by someone over retirement age. Already older people are driving the housing market in a number of areas, and they are likely to do so increasingly. 78 percent of older householders own their own home, and the over 65s hold £460bn un-mortgaged equity in their homes. Those aged 65 years and over make up 46 percent of projected household increases between 2001 and 2026. The vast majority of older people choose to live in the community well into later life; just under three quarters of people aged 90 and over were living in private households in 2001. Only a minority of older people choose to live in sheltered accommodation.

Between these two countries in old age are deep and complex challenges. On the one hand there is the consolidation of advantage, and on the other there is the consolidation of poverty. The Bank of Mum and Dad will be in a position to fund housing for another generation of advantage. But for those who have missed out on life's chances, for whatever reason, those chances become fewer; meagre resources become even more difficult to replenish.

On the one hand, therefore, what I am saying today fits in to what Ruth and Yvette have already spoken about – the necessity for breaking through those inequalities by opening up more housing choices; by building more and differently; by expanding low cost home ownership and social housing; and by planning the sorts of communities which are inclusive, expansive, and welcome for all ages.

And on the other hand, to look at the costs and benefits of a more intelligent and thorough policy for promoting well being and preventative care, through a coherent policy of housing linked to health and care in different ways.

Of course none of us wants to think about the long term; of course people choose to stay in their homes, no matter that they are at greatest risk from ancient wiring, threadbare carpets or steep stairs. But all too often, the choice is between two sorts of risk; staying at home – where you are at least known – or at the last resort – find a residential care place. But the problem is that the choice is so often simply not there.

Numerous studies have linked poor housing to poor mental and physical health. The most severe manifestations of this are well documented and include 'winter deaths' and deaths from falls. Furthermore, the inter-relationship between the individual housing situation and care home admissions is clear. A typical route into care homes is after hospitalisation when a return home is no longer practical. Falls because of hazards in the home are a common route into care.

Housing design and adaptations promote independence and can improve health and care outcomes. For example a major study by Plautz (1996) found 60% reduction in falls following provision of minor home safety modifications.

The preventative model of social care is an essential part of the picture – and some examples graphically tell a difficult story regarding the challenges.  Social Services in some areas are already at 'critical', and the Joseph Rowntree Foundation estimates that long-term care costs will rise by 300% by 2051. 40 percent of those aged 80 and over report a long term illness or disability and there are currently 1.5 million people with a medical condition or disability requiring specially adapted accommodation. Older people's falls cost the NHS around three quarters of a billion pounds each year. But a grab rail costs £50 and a hip operation - £6000.

All of this means that we need to look to the important role that improved housing and housing services can play in preventing the need for - and reduce the demand for - acute health and care services.

To do that we also have to confront some uncomfortable realities – that planning ahead for age, looking at assets and resources in terms of health and wealth – needs individual courage as well as a clearer more understanding contract between the individual and the community about what can be expected; what choices at which stages; how should individual and community resources be spread? And how to promote partnerships which will include the private, the voluntary, the public sector – alongside the individual.

Both Wanless and JRF are clear that it cannot be left to government alone to fund many social care services and so they are clear that the relationship between the State and the individual has to change. But even here – in the work of the key independent thinkers – the inter-relation between housing and care is not fully developed. We are quick to link health, care costs and also the role of benefits such as Attendence Allowance. JRF puts forward equity release as a social-care funding option. However, mainstream and specialist housing, housing support services, housing benefits and adaptations are often seen separately even though we know their impact on health and care. Housing assets are a huge part of the picture for many individuals and needs to be considered in the debate about what in effect might constitute a new social contract.

The government has engaged in this debate and made a range of new individual provisions which are keeping more people safe and well in their own homes. Over £19 billion has been invested in Decent Homes in the social sector since 1997. We have reduced non-decent homes by over 3 million since 1996 across all tenures; and Warm Front alone has helped well over 1 million private sector households.

But the most interesting model is, of course, Individual Budgets, which, in its own way, could serve as the first expression of this new kind of social contract. They are built around the individual, personalising service delivery, setting out a range of choices, and, in part, determined by what you already have. They increasingly allow flexibility of use of state resources, to combine more effectively with individual resources such as housing.

And perhaps the most interesting model of how older people are being consulted and involved is coming from the work being done around new approaches to engagement being piloted through LikeAge Plus, and of course, the excellent work of front line workers in bodies representing older people – Help the Aged, Age Concern, Care and Repair England, Housing21, to mention but a few. These put older people at the heart of decision making, not simply through consultation, but in determining the services they want and how they are delivered.

All this is being driven through the work done across Government through Opportunity Age, but it is also now being piloted in a raft of models such as Link-Age Plus and POPPs.

Our work, therefore, is building on much of what is being done already, but is bringing together a greater appreciation of what is now needed by bringing together not just housing and planning and community building and design from within our own department; but also be thinking in terms of life times and life courses - and involving all the key Whitehall departments and other partners in doing this – especially listening to the voices of older people themselves.

THE STRATEGY

Working principles of the strategy – what older people say they want…

• Independence and control at home, supported by coherent services
• Progressive support in dependency – choice and quality enabling dignity
• In lifetime communities that are inclusive and mutually self-supporting
• Higher priority for prevention and low-level intervention

The challenge for the housing world is therefore to future proof what we do by…

• planning and building new homes which are truly sustainable and inclusive for all ages, in neighbourhoods which are properly designed for inclusion
• ensuring the suitability of the existing housing stock – where the majority of people will continue to live
• building the right sort and range of specialist housing, and
• providing the right information and services for people to make positive housing choices

PLANNING is key to much of what we want to do – and this is a new departure for govt.

The first great challenge is to plan and provide differently for the future. We need to plan for the changing needs and aspirations of older people in the same way as other parts of the market – something that we have not done well in recent times.

We have already addressed this in Planning Policy Statement 3 (PPS3) last December, which requires local authorities to consider the requirements of older people as part of creating sustainable, mixed communities. This means that Local Development Frameworks will need to plan for a mix of housing on the basis of the different types of households that will require housing, including older people.

Regions and local authorities need good evidence to plan well. This is why we will have recently published Strategic Housing Market Assessment Practice Guidance, which helps authorities to assess the local housing requirements of older people, future projections and points to relevant analytical tools.

Coming out of planning must be a far higher salience for design - in housing and neighbourhoods. We want to see inclusive design in the mainstream, with lifetime homes, in lifetime neighbourhoods.

Inclusivity is the key – Keeping people well and happy in the community will be successful only if we design our homes and our neighbourhoods for the changes of a lifetime. Not just wider doors; flexible walls and space we can reconfigure for different uses over time; accessible gardens; homes that we actively want to live in; homes with enough storage space and a spare room for a relative or carer, or for our retirement hobbies, or space to look after the grandchildren. We have some of the worst, and the best, designs - I have seen some of the most innovative designs in the use of space for disabled children and older people - kitchens and bathrooms that are safe to use.

But a large proportion of the population, families, disabled people and older people have to settle for housing that simply doesn't work for them. Why do housing adaptations look like they belong in a hospital ward rather than our homes? Perhaps walk-in showers, grab rails and disabled bathrooms are the NHS spectacles of the 21st Century. Just like glasses we will see these products move from the territory of health and care to mainstream design and fashion within ten years.

And we need to be more imaginative about the types of housing provision to overcome isolation. Loneliness is a sad – and often hidden - fact of growing older for many people. And increasing age often means that our lives are increasingly focused around our homes - older people spend 70-90% of time at home. For some, the solution will be to choose co-housing, to live with existing friends or to forge new friendships. This is a relatively little know choice with potential, which is already being done in other countries.

Contact with the wider community is also fostered by providing facilities for the wider community within developments for older people. In Southwark, for example, Darwin Court is a development providing homes for the 50+ alongside facilities for the whole community. The building comprises 76 flats on the first floor and above, all built to 'Lifetime Homes' standards.

Darwin Court has aimed to provide a combination of living space, workspace and shared facilities - including communal centre, social care and health and fitness. The health and leisure facilities for residents and the local community include a swimming pool, healthcare suite and an IT suite.

We are setting a new direction of travel therefore by ensuring that demographic change and good design is mainstreamed at every level throughout the planning process – which will mean that especially in the growth areas - such as Thames Gateway, Milton Keynes or new communities such as Northstowe – we build to the highest imagination – eco friendly and age –friendly – and encourage innovation and new models of inclusive mainstream and specialist housing. And one of the encouraging things is that we have the support of English Partnerships and the Housing Corporation for innovation.

• Lifetime Homes

Crucial to this are Lifetime Homes Standards, which we are now exploring and testing in different ways. Within the strategy we will set out the evidence and our policy position on Lifetime Homes Standards. Much work has been done on issues of space and costs and this is work in progress. Many people and areas e.g. HC are already implementing Lifetime Homes Standards and I applaud them. For me this is also an issue of equalities and driving up the quality of housing.

• Lifetime Neighbourhoods

But we want to go further.

Lifetime neighbourhoods is a new concept we have developed with people like ILC. But what do we mean by this?

Discussing with the ILC what might be possible, we have considered for example, how residential or collective homes of the future – built at the heart of the community – could themselves offer services to the community, adding value to those communities; how more physical integration of care provision could open up more contact between generations and services. Space is hotly contested – but it need not be. Think of the Italian piazza for example – it's much more than good street lighting.

But we could start with that – good street lighting; sensibly located public toilets; building in the green spaces; harmonious not contested spaces; challenging isolation…. Informal as well as formal space so that town centres work for everyone at all times; But also access to health and social care; health centres and outreach; community care delivered in different ways; space for self help and support groups.

All this can be done within new assumptions about planning and housing delivered together for the future. And it can be done far more effectively within the framework of new Local Area Agreements – focused on 35 key objectives, determined locally; and clearer contracts with the third sector.

Making the best use of existing resources

But the majority of people will continue to live in their existing homes.

The second great challenge is therefore to make the best use of our existing resources to keep people well and independent in the community for as long as possible.

As part of this we must also provide simple housing solutions, 'that bit if help', prevent expensive and detrimental health and care problems later on.

In order to improve preventative services we have commissioned the King's Fund to undertake a pioneering piece of work for us – on a predictive risk model which will look at how preventative interventions might be targeted on those most at risk a year before they go into hospital or a care home. This is a radical approach as it will pick up excluded older people who have no contact with services other than registration with a GP.

This will help us plan in the future for reducing risk at home whether that is through adaptations or personal services. As a government, we are already doing much to enable independence, choice and control at home, supported by coherent preventative services, including information, advice and advocacy, Home Improvement Agencies, and Supporting People and the Disabled Facilities Grant.

Many of these services are focused on engaging people who are in particularly acute needs – not least the needs of diverse communities including those in rural areas, and in black and minority ethnic communities, and those from the most excluded groups such as homeless people.

For example the Supporting People Programme provides vital housing related support to around 785 000 older people each year. This figure is not very well known, but this is more than twice the number of people receiving home care services. That support might be help and advice to access benefits and services such as a GP; provision of security or alarm services; or advice on home improvements. That will remain a key part of our programme.

But health and housing cross over in a particularly acute way in the DFG grant. My Department has recently consulted on improvements to the Disabled Facilities Grant – looking at short and long term improvements in funding mechanisms, delivery and scope. It is a service which is under tremendous pressure – indeed it exemplifies everything I have been talking about today. The DFG helps about 35,000 older and disabled people each year to live independently in their homes, by adapting the home to meet their needs. There are many difficult challenges yet to be met to provide a service which will meet a continuously increasing demand for DFG.

The changes proposed in our consultation – both short and long term – will enable DFG service providers to deliver more front line support to vulnerable people as part of a wider, progressive social care package which will support independent living. We should be publishing a summary of responses to the publication in the next few weeks.

Part of the task of helping people to stay at home involves making the most of our existing housing stock – most of which is in private hands. So what must be done? Well, a key part of my argument today has been that government cannot solve these problems without older people driving change themselves. Government often believes that it can simply pull a lever and make change happen. Experience tells us differently. Let me put it another way. £460 billion of un-mortgaged equity is owned by older people. Older people are driving much of the housing market growth. But government can also provide the leadership and environment for individuals and the market to respond to this new challenge.

For example, we need to ensure that the information is there to make the right choice, for example, for equity release, if that is what people want to do. Clearly, private industry – the market – has a key role in developing safe, clear and reliable options and this could be an increasingly important option for people – when properly advised. Again, this is something we are looking at in more detail in the strategy.

But what about people who are more vulnerable, for whom the market will not respond effectively? We will continue to invest in major programmes such as Warmfront and Decent Homes, which have already done much to drive change in the private sector. We will make Home Improvement Agencies a key priority for government and improve adaptations and repairs services. We will also improve targeting of support to ensure that our resources are focused on those most in need, not those who shout loudest.

And, finally, we will want to build on the innovations that are flowing from the development of extra care models of housing. The DH has invested £350 million in extra care housing since 2004 – high quality care around the clock – but your own front door too. Security, with companionship, and a place in the community.

CONCLUSION

So, in concluding, I want to leave you with one final thought. I have outlined some stark facts about the grand challenges we face and the need for housing to be part of the solution and not the problem. I have also said that government is only one part of the picture and that we need older people, the general public, to engage in this debate. But I'd like to emphasise that this is about all of us here – This debate, put simply, is actually about what we want for our future selves.

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