title: Integrating housing into the whole system of care for older people
Creators: name: Menzies, Laura
Publisher: name: University of Liverpool Repository
Year: 2016

description: The ageing population in the UK is placing huge pressure on Health and Social Care, exacerbated by current economic pressures to cut costs. The British Government is politically driving integrated care, to encourage the different services that constitute the whole system of care to work together in order to reduce fragmentation and overlap in the system. However, methods for effective partnership working towards integrated care are not well researched. This thesis details an action research project to virtually integrate Housing into the whole system of care in Conwy in particular, concluding that the methods used provide an appropriate approach for partnership working towards integrated care, thus addressing this gap. Housing plays an important role in the whole system of care for older people as a person's home environment has a high impact on their wellbeing. Poor quality housing can negatively impact on health, and care can be provided in the home due to the government's emphasis on 'ageing in place'. However, whilst the importance of considering Housing's role in the whole system of care is identified in government policy, efforts towards achieving integrated care do not commonly include Housing departments or providers. The thesis concludes that only types of housing which inherently include care (e.g. extra care, care homes) are integrated into the system, despite the fact that residents can access care in any type of housing. Soft systems methodology (SSM) is used to identify the whole system of care in Conwy, Wales. A Steering Group was established to develop an Older Persons' Housing Strategy (OPHS) for Conwy, one of the aims of which was to integrate Housing into the whole system of care. The local authority act as the 'strategic enabler' in achieving this. Each Steering Group member was interviewed to establish their role within the system, and their worldviews on it. This enabled the Steering Group to develop a shared vision for the OPHS, which is a key feature of successful partnerships to achieve integrated care. Support is identified as an appropriate integrating function and examined to establish appropriate operations structures. Through a survey of support services in Wales, it is identified that support, provided by wardens in sheltered housing, is currently going through a transition period, due to changes to funding guidelines for support. Many local authorities in England are now using offsite support, but the impacts of this are not well researched. This research provides an evidence base for practitioners looking to change the structure of their warden service. This is based on a SWOT analysis of onsite and offsite support, conducted from the data gathered during the survey. Local authorities can capitalise on the changes being made to warden services, taking the opportunity to upskill wardens and using support to integrate Housing into the care system by signposting other services. Finally, focus groups were conducted with older people to ensure the OPHS met their needs. This also served to triangulate the findings of the SSM and the survey, demonstrating the effectiveness of combining these methods.