Helen Birtwhistle's speech from the Health & Housing Conference

Read Helen Birtwhistle's (Director of the Welsh NHS Confederation) speech from the Health & Housing Conference on 18 July:

Good morning. My name is Helen Birtwhistle and I am the Director of the Welsh NHS Confederation.

For those of you who don’t know what the Confederation is and does - it’s an independent organisation that represents the 7 health boards and 3 trusts that make up the NHS in Wales. Essentially we are their one, co-ordinated voice.

And in that role I am delighted to be here, participating at an event that I very much hope will result in moving the focus of partnerships forward between health and housing. From sharing knowledge, celebrating best practice and inspiring one another to be visionary in new future initiatives.

Working in partnership is important. One key reason for doing so is to be able to achieve more. The whole being greater than the sum of the parts.

However there are many more reasons,
• To tackle complex problems
• To create changes and improvement
• To gain advantages from pooled learning
• And to benefit from collective financial resources

These are all relevant to NHS Wales, particularly at such a challenging economic time. However it is not essentially about finance but about the improvement and sustainability of quality patient care – delivering substantial benefit to people’swellbeing.

There is a clear inter-relation between health and housing. Scientific evidence on the many links between housing and health has grown substantially.

It suggests that living in poor housing can lead to an increased risk of cardiovascular and respiratory disease as well as anxiety and depression. Problems such as damp, mould, excess cold and structural defects also increase the risk of an accident as well as hazards to health.

In addition to the human cost, there is the financial implication. The Building Research Establishment has calculated that poor housing costs the NHS at least £600 million per year in the UK.
While there are some prominent partnerships that are attracting interest, changing the health service to address its current issues such as health and social services, there are those that are of equal merit such as health and housing that could be overlooked.

However the health/housing link is not new and has been recognised before. Aneurin Bevan, Father of the NHS, was Minister for both health and housing in Clement Atlee’s post-war Labour Government. It was a time of opportunity…. of creating new foundations and future prosperity.

An immediate priority then was improving overcrowded housing in inner city areas. New housing was seen as the solution to preventing the spread of disease caused by rundown, inadequate housing.
One of the quickest and cheapest solutions was the prefab, mass produced in the factories that had previously made aircraft and weapons during the war.

Perhaps in some ways there is a loose comparison to what is happening now– I doubt that there isn’t anybody in this room that is unaware of the struggle that the NHS is facing. It is trying to cope with overwhelming demand. We have an ageing population with complex chronic conditions. The service is under severe strain.

It is clearly a time for change.

However our solution isn’t about making quick, make do, under pressure decisions. NHS Wales has set in motion a radical and innovative service reconfiguration programme that will enable good quality care to be sustained.

As with a great deal of change, we can all be resistant and it can create uncertainty and fear. In Wales we are fiercely defensive of our NHS. Many of the smaller hospitals were built as a result of miners donating a hard earned sixpence from their wage packet so that proper healthcare could be provided for their community. They are therefore embedded in our historic roots.

And it goes someway to understanding one of the most difficult challenges we have in changing the NHS. We have to overcome perceptions that good healthcare can only be provided in a hospital. For many people, health care is synonymous with a hospital – however in essence, just a series of buildings.

New thinking has created an alternative blueprint that moves away from this out-dated and unsustainable model and seeks to provide care closer to people’s homes.

Hospitals will remain, of course, they have a vital role to play, but our dependence on them will lessen. Patients will spend the least amount of time they need there with other options for appropriate care closer to or in their own homes. We believe that this will improve their individual outcome.

It will mean they have the emotional support that it so important from being in their familiar community. Not only from the design of their own homes but of the wider environment.

Independent living is a goal for many people and research indicates that it can significantly improve health and contribute to a better quality of life. The NHS would support this. So it is clear that there is a natural synergy between health and housing in improving wellbeing – on both an emotional and physical level.

Preventative healthcare has a high priority in NHS Wales. By having a safe and modified home environment it would prevent accidents that can lead to unnecessary long-term hospital admissions.

Clearly more of this is needed particularly in response to the concerns raised by the National Assembly’s Communities, Equality and Local Government Committee. Its report drawing our attention to the inconsistencies in the system for adapting elderly people’s homes was on BBC Wales yesterday.

In the event of hospital admission, as a result of an accident or illness, by having proper supportive care it would allow earlier discharge into a more recuperative environment, closer to family and friends
Both scenarios have an enormous impact on the running of a hospital and availability of beds. It will mean that more beds will be made available for those that need them the most.

The points I have raised have particular relevance to the older population.

People are living longer than ever before, and the proportion of older people in our society is growing. This is rightly a cause for celebration.

However, population ageing, with the fastest rise in the ‘oldest old’, means that the overall number of people in our society with health or care needs has risen. This has altered the very nature of our health and care services, with older people now the biggest users.

One of the areas showing the biggest strain is unscheduled care. Over the past six months, the demand for emergency care services has risen steeply, due mainly to the number of acutely ill elderly patients being admitted to A&E departments.

All parts of the UK are experiencing these pressures but Wales has the highest proportion of people over 85 and this number is increasing at the fastest rate.

Older people with complex conditions often need to stay in hospital longer but pressures are made much more difficult when beds are occupied by patients who remain there after they are ready for discharge.
These changes hold new responsibilities for the NHS and social care in helping older people stay healthy, active and independent for as long as possible.

One of the examples of projects providing new options for older people already underway is the new Home for Life housing scheme in Pembrokeshire that is the result of a partnership between Family Housing Association, Pembrokeshire County Council and Hywel Dda Health Board.

The scheme comprises of apartments for older people plus a new Primary Care Resource Centre and day care provision.

The scheme is in response to the lack of existing housing for older people in the area and will be built using a mixture of social housing grant and private funding.

This shows that it is possible to build strong partnership working between NHS organisations, local councils, the private sector and older people. And this is what today is all about – new ideas and new enthusiasm. We are clearly not lacking in either. We are very lucky in Wales to have a real public service collaborative ethos that offers us the genuine chance to construct services differently around the citizen and patient.

As ever there comes a point where finance has to be talked about. The impetus for change is being able to provide quality care for patients with the money we have. It is not about having more money but changing the focus of healthcare to accommodate our growing and changing needs. Therefore we need to be innovative in our thinking.

Today is about making sure that we drive that innovation forward, that we build on those projects that have already achieved success. That we are bold, that we take the initiative, that we are committed. Only then will it be possible to reach our goal. That is to provide the best possible healthcare to everyone in Wales.