4. Statement by the Minister for Climate Change: The Housing-with-Care Fund

– in the Senedd at 3:00 pm on 17 May 2022.

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Photo of David Rees David Rees Labour 3:00, 17 May 2022


Item 4 this afternoon is a statement by the Minister for Climate Change on the housing-with-care fund. I call on the Minister to make the statement. Julie James.

Photo of Julie James Julie James Labour 3:05, 17 May 2022

Diolch, Dirprwy Lywydd. Sorry, there was a small thing about sharing pens there, so apologies.

Decent, affordable housing is fundamental to the health and well-being of everyone in Wales. Healthy homes provide individuals and families with a stable and secure base that meets the household's needs. They give us a place where we can feel safe and comfortable, and where we are connected to the community, to work and to services. 

Investing in healthy homes is an investment that works hard for us. A quarter of our carbon emissions come from the housing sector. Building new homes to low-carbon and zero-carbon standards makes a significant contribution to tackling climate change. Building new homes creates jobs and apprenticeships, and stimulates economic growth.

And as a preventative service, healthy homes reduce pressures on health and social care services by helping people to maintain their independence. Healthy homes reduce chronic diseases, improve mental health, reduce falls and accidents, and provide a safe environment for early hospital discharge.

Since 2018, we have invested £145 million in the integrated care fund capital programme, providing specialist housing for older people, people with dementia, people with a learning disability, children with complex needs, and unpaid carers. We also invested in intermediate care accommodation in the community, and essential social care infrastructure.

This morning, I visited Tŷ Glas y Dorlan in Cwmbran. With a £1.7 million Welsh Government grant from the ICF, Torfaen County Borough Council, Aneurin Bevan University Health Board and Bron Afon housing association have worked in partnership to deliver a remarkable development that can have a profound impact on health and well-being in Torfaen. The development includes six extra-care flats for older people on the third floor, and 13 short-term reablement and rehabilitation flats with their own front doors. These reablement flats offer a home-like setting for people stepping down from hospital, and an environment where people who may be considering residential care can be supported to learn new skills so that they can continue to live independently in their own home. Tŷ Glas y Dorlan is a hub for care and therapeutic services for the whole community. Developments like Tŷ Glas y Dorlan are the reason why we are significantly increasing our investment in specialist housing and accommodation in this Senedd term, in support of our programme for government commitment to provide innovative housing to meet care needs.

Today, I am announcing the housing-with-care fund, a four-year fund that builds on the ICF capital programme. In this year's budget we allocated £182 million over the next three years to regional partnership boards to provide housing with care. We aim to increase the total stock of extra-care housing in Wales by up to a third over the next four years, as a direct response to the ageing population. It enables us to accelerate our long-standing policy of helping people with a learning disability, autism spectrum disorder, and other neurological conditions, to live independently, where possible, in their own home.

We will also invest in intermediate care accommodation, such as that provided at Tŷ Glas y Dorlan, as well as accommodation for people who are not yet ready for full independence, and who can sometimes find it difficult to maintain a home, such as a tenancy in the private or social rented sectors. This makes them vulnerable to harm and to experiencing homelessness. This includes care leavers, young adults with learning disabilities, and people with emotional health or mental well-being needs. Investment in transitional accommodation for these groups can contribute to preventing homelessness and all the harm that that can cause.

We will also invest to support our programme for government commitment to fund regional residential services for children with complex needs, ensuring their needs are met as close to home as possible and in Wales wherever practicable. Too often, vulnerable young people with higher needs and challenging behaviours are placed in out-of-county or out-of-country, even, placements. These are staggeringly expensive, with over £200,000 a year per child not being uncommon, and detrimental to their well-being, cutting them off from family and friends, and severing links with local health and care services. Regional partnership boards must address the need for local accommodation as a matter of urgency.

The housing-with-care fund is part of a package of cross-government funding for regional partnership boards, which includes the health and social care regional integration fund and the integration and rebalancing capital fund. In total, this package is worth £255 million in 2022-23.

With this funding comes key leadership challenges for regional partnership boards. The first is to maximise the value of these combined funding streams, using revenue and capital to drive fundamental change. And the second is to build stronger partnerships with local authority housing teams and housing associations, so that social housing providers are an integral part of how health and care services are delivered. And the third is to make smart investment decisions that support our cross-cutting priorities and set us on the road to a healthier, more resilient and low-carbon Wales. Diolch.

Photo of Janet Finch-Saunders Janet Finch-Saunders Conservative 3:09, 17 May 2022

Thank you, Minister, for your statement. In 2017, local authorities warned at that time that they expected an increase in demand for housing with care over the next five years. In fact, your own Welsh Labour Government published a report on the evaluation of extra-care housing in Wales which noted, and I quote:

'The vast majority of local authorities'

—and that was 18 out of 22—

'expect an increase in demand for general needs housing for older people and the majority (16) expect demand for extra care housing to increase over the next five years.'

A similar profile of responses was forthcoming from housing associations, and the majority of local authorities, housing associations and extra-care scheme managers agreed that demand for extra care was outstripping supply. So, I suppose one has to ask, as we are the official opposition: why has the Welsh Government waited five years since the publication of the report to make the statement on this funding today?

I acknowledge that social housing grant funding previously made available by the Welsh Government has been important in driving some growth. In fact, as of 2017, three quarters of all schemes have been developed since the Welsh Government published guidelines and made ring-fenced funding available to support the development of extra-care schemes in 2006. So, do you think that it was a mistake to end housing with care's dedicated funding, and has this negatively impacted the number of such homes we have in Wales today? At present, according to an independent report prepared for the Welsh Government, there will be a shortfall of approximately 5,000 units in Wales by 2035.

Housing-with-care schemes are typically located in cities and towns, rather than rural areas, and this is despite 25.4 per cent of residents in rural counties in 2019 being the age of 65 or over, which is an increase from 16.6 per cent in the year 2000. The national survey for Wales has reported that three quarters of people aged over 65 report feeling lonely sometimes. A report published by the Associated Retirement Community Operators states that housing-with-care residents experienced lower levels of loneliness, with only 1 per cent of residents feeling isolated often. So, isn't that a model we should all be looking to work towards?

So, bearing in mind that loneliness and isolation can be at its worst in rural communities and that rural counties are seeing more ageing populations, what steps can you take, Minister, to see funding prioritised to support some development of schemes in our more rural areas? Such schemes in rural Wales could free up homes for the younger generation. It would also give a boost to the Welsh NHS.

A report has found that residents living in housing-with-care schemes see a reduction in frailty and falls within two years of living at their home, with improved exercise and fitness, and additionally, for those living in integrated retirement communities, costs for GP, nurse and hospital visits reduced by some 38 per cent. In Llanrwst, ClwydAlyn have Hafan Gwydir, an extra-care scheme with fantastic facilities, and that one actually has an adjoining health centre and an on-site GP surgery. So, do you agree with me, Minister, that planning authorities should now be encouraged to allocate land in our local development plans for housing-with-care developments, on fields next to or near GP practices, if they're unable to actually afford to be able to put that new service in place where it's more all singing, all dancing, and people can access medical needs as well?

And you'll be aware that tenants do have varying needs. For example, some require care support. In light of the ongoing care crisis with lack of staff, especially amongst the domiciliary home care providers, it is easier for them to have clients in one location instead of spreading out miles apart from each other. So, would you acknowledge that by providing funding to develop housing-with-care schemes, we could also alleviate some of the significant pressures on our overstaffed—no, not 'overstaffed' at all—our overstretched domiciliary care workers? And let's work together; it's having a more integrated housing-with-care system here in Wales. Thank you, Deputy Presiding Officer, and Minister. Thank you.

Photo of Julie James Julie James Labour 3:14, 17 May 2022

Thank you, Janet. I think I discerned somewhere in there an enthusiasm for housing with care, which I certainly am really pleased to see. So, just to set your mind at rest: we obviously haven't waited five years. In response to the report that you mentioned, the ICF capital programme was started in 2018-19, and it was established to provide housing and accommodation to support models of care that enable vulnerable people to live independently or regain independence via intermediate care settings.

As I said in my statement, the £182 million builds on the initial ICF capital programme. That programme had £145 million-worth of capital, which was allocated out to 198 projects right across Wales to the total value of £363 million when you factored in other funding streams. They included 50 housing projects, including extra-care and supported living, 66 intermediate care projects like children's residential and step-up, step-down accommodation, 82 services and infrastructure projects like community hubs, feasibility studies and equipment. The beneficiaries did indeed, as she asked me to ensure, include older people, people with dementia, adults with learning disabilities or autism, children with complex needs and unpaid carers. Janet's also aware, because she mentioned it with ClwydAlyn, that I've actually opened one of these in her own constituency, so we definitely do have them in rural areas as well, and that's exactly the point.

A couple of other things you said, though, Janet, I must say I have to take a little bit of exception to. So, absolutely, this is a programme for all of Wales. We have an ageing population across large parts of Wales, and part of this is in response to that. In the project I went to see this morning, which made my heart sing, to be honest, everybody there was amazing. The people living there were really happy to be there—the people going through the reablement services. One young woman in particular really did bring tears to my eyes in her enthusiasm for the difference that it made to her life. She had had problems that had really meant her life was pretty much over, as she saw it, and staff at the reablement centre had got her from that point to the point where, at the end of this month, she's actually moving back into a normal house in the community with the support that she needed to be able to take her life forward, having had it emphasised to her what she can do rather than have it emphasised to her what she can't do, which is a really important part of it.

The project also allows a hub method of getting services out into people's homes in the community. I don't think that we need to corral people into a central place where they don't necessarily want to be, although for some people they will want to do that. What we want to do is enable a model that helps people have the living that they want. So, if they want to stay in their own home, or they want to go into residential, or they want to do something in the intermediate care space, we need to be able to enable that. And so, the occupational therapists I met this morning, who are an incredible bunch of people, and very enthusiastic for all of the gadgets and gizmos that they had there to help people live independently, are able bring people into the suite there, to show them how to use things and what's available, and then facilitate, through, of course, our increased disabled facilities grant, which, as you know, is no longer means tested for low and medium-sized projects, putting that equipment back out into people's houses so they can stay in their own home and not come in centrally.

So, I think, Janet, we were sort of agreeing with each other, but I think there's a bit more to this model than meets the eye, which I think you would agree with once you've had a chance to look at it in more detail, and perhaps visit Tŷ Glas y Dorlan, which was fantastic.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 3:18, 17 May 2022

Thank you to the Minister for the statement. According to the Welsh Government guidance on the fund, the main purpose of the housing-with-care fund is to increase the stock of housing to meet the needs of people with care and support needs, to support independent living in the community for people with care and support needs, and to provide intermediate care settings in the community, so that people who need care, support and rehabilitation can return to living independently or maintain their existing independence. This is to be welcomed as it plays an important part in ensuring that the people of Wales have a right to housing, and housing appropriate and suitable to their needs. This is a crucial principle, as we move forward, to answer the housing crisis.

As your guidance notes, we are facing a number of growing challenges with regard to healthcare, social care and housing in Wales. We have an ageing population. The 2018-based population projections estimate that the total population age 65 and over will increase by over a quarter over the next 20 years, with the number of those age 75 and over rising by almost 50 per cent to a little under 0.5 million people by 2041. Alongside age-related poor health and disability, other growing challenges include greater numbers of people with existing conditions living longer into older age, with cumulative health impacts, such as people with a learning disability or dementia. For these populations to live independently with dignity and care, the housing-with-care fund must be effective in responding to the challenges ahead.

We also need to ensure that the accommodation and care needs of particularly vulnerable groups, who are not able to live fully independently, are met as close to home as possible. As it stands, many children and young people are placed each year in out-of-county or out-of country placements, as you mentioned yourself, Minister, which is costly, reduces local control over the person's health and care management, impacts on family contact and relationships and the well-being and outcomes of the individual. So, as a more overarching question, I'd like to ask the Minister what lessons she has learned from the previous integrated care fund with regard to how it helped respond to the aforementioned challenges and what bearing these lessons have had on the new fund. Can the Minister also explain how much input health providers, social care providers and occupational therapy are having in developing housing plans, from spatial plans, such as our LDPs, to individual sites, to ensure that people's needs are answered?

Another stated key driver of this fund is the need for intermediate health and care services in the community and adequate facilities to provide step-up or step-down reablement and rehabilitation at a local level through the provision of appropriate bedded facilities, as well as community facilities that reflect home environments, supported by appropriate care and rehabilitation services. With regard to the need for these facilities, how successful was the last fund in terms of delivering these requirements? And with regard to this four-year capital programme, with a confirmed £181.5 million over the first three years, what targets do you have for the delivery and the construction of facilities by 2025-26? In terms of projects funded by the ICF, an evaluation found that key barriers to funded projects included the COVID-19 pandemic, the impact of annual funding arrangements and the implications that this has had upon staff recruitment and retention. On the point regarding staff recruitment and retention, I'm keen to hear from the Minister how the new fund will respond to this challenge. Diolch.

Photo of Julie James Julie James Labour 3:22, 17 May 2022

Diolch, Mabon. You make a series of really good points there. We absolutely have learnt lessons from the ICF; we always look to evaluate our programmes as they run through and hope to adapt them as we go. Amongst the lessons learned, we've been looking at how the structure of the funds can be improved. In particular, we want regional partnership boards to focus on strategic functions, ensuring that they have the expertise to identify the capital investment opportunities appropriate to their population, and we are supporting them directly with the resources to do just that. At the same time, we want to see much greater involvement of social housing providers, local authorities and housing associations in delivery, hence the change in the emphasis of the fund. It was the integrated capital fund, this time it's housing with care, so putting housing front and centre to make sure that those providers are much more integrated into the planning than they were for the first iteration of the fund. They were there, but not quite as integrated as we would like them to have been.

We're also looking to encourage a mix of social housing grant and HCF, or the housing-with-care fund, to increase the number of schemes that can be funded, and that will ensure that regional partnership boards have pipelines of schemes that are more resilient to slippage, with things like the pandemic. We're currently experiencing, as everyone in this Chamber knows, real issues with supply chains and increased costs of supplies. So, we're making sure that the pipeline is there. We have a series of different funds that can be brought to bear. Also, I want—and everybody in this Chamber will have heard me say this—these sustainable communities that we talk about. We don't want retirement villages, we want people spread into their communities so that we have a mix of tenures. So, allowing our social housing grant to be used alongside it means that we can get social homes into the mix as well. I'm really keen to do that.

We're also using the same assessment criteria as our main social housing programme while making allowances for the additional requirements of specialised housing. The evaluation model will look the same, so we'll be able to compare them in a way that we weren't able to do with the first fund, and that's one of the lessons learnt, as well. There is a real call for strong leadership from the regional partnership boards to use the resources at their disposal to forge stronger partnership relationships with housing partners and to ensure the investment of support across Government portfolios for a healthy and more resilient low-carbon Wales. So, to that end, we're also insisting on low-carbon passive house-type standards for these buildings, so they have low energy requirements and they don't contribute more carbon than they need to to the climate problem, both in the construction phase and in the living phase. So, we're ticking a lot of different priorities here with the same thing. 

And then, just lastly, I actually opened a children's home, as it happened, in Torfaen, under the old programme, and it was one of the most—well, I don't know how to describe it, really—emotional things I've ever done as a Minister, because it brought two young people back from out of country, back into their community. Their parents were there to greet them, they had supported housing in the middle of their community, and the joy on their faces was just worth every single penny. But, even better, it was actually saving money as well, so what's not to like about this model? So, I really hope to see this rolled out across Wales ASAP.

Photo of Mike Hedges Mike Hedges Labour 3:25, 17 May 2022

I very much welcome the Minister's statement on housing with care. Members probably remember my continual and regular call that decent, affordable housing is fundamental to the health and well-being of everyone in Wales. It's been really nice to have that echoed by the Minister today.

The Attlee Government in 1945 realised the relationship between health and housing. That seems to have got lost since then, and I hope this is us moving in that direction to actually work along those two and the link between the two. I welcome the development of reablement and extra-care flats, especially reablement flats. Too often, people get discharged from hospital into a home and then that's it, the end, and they stay there until they die, which is probably going to be premature, because they lose the will to live. So, reablement is really important. We don't do enough about reablement, and I wish the health Minister was here, because I could be saying that to her as well—that we don't do enough about reablement.

I have two questions: does the Minister agree that we need to build council housing at the scale of the 1950s, 1960s and 1970s to deal with housing need? And how many units of housing will the £182 million achieve?

Photo of Julie James Julie James Labour 3:26, 17 May 2022

Thanks, Mike. Yes, I do absolutely agree with that; you've always been a champion for this kind of housing, I absolutely acknowledge that, and it's been really good to work alongside you on these agendas. We are absolutely going to scale and pace. One of the big, big frustrations for me, because of the global supply chain problem and the climate crisis, is in trying to get the availability of the supply chain, so that we can actually build those houses. It has been a real frustration. So, we're working really hard across Wales with all kinds of partners in both the public and private sector to try and get those supply chains running as fast as possible. And with that in mind, we're also allowing the integration and rebalancing capital fund programme to come alongside this one, to put different funding streams in place, so that we can get that pipeline I just talked about when I was responding to Mabon, so that we have complementary funds, and they're all supported by the regional integrated funding to provide new models of care to go alongside this. So, I could not agree with you more; the idea that somebody coming out of hospital just gets put into residential care and has their basic, physical needs looked after, but that's it—that is not a model that we want to have. And going to Tŷ Glas y Dorlan this morning, I spoke to a number of people whose lives have been absolutely transformed by the concentration on what they could do rather than the concentration on what they couldn't do, and the hope and optimism that had given them was just a joy. So, we need to get more of that out there into our communities, and we need to build—you're absolutely right—those houses at scale and pace.

Photo of Carolyn Thomas Carolyn Thomas Labour 3:28, 17 May 2022

Minister, very often with these announcements, you can't put them into reality until you actually visit a facility, I think, and I visited Marleyfield House in Buckley last year. The capacity has doubled and been designed with reablement in mind, so patients can leave hospital, build up strength before moving on to their own home. It's fantastic. Each room has balconies overlooking Hope mountain, there are dementia-friendly walks, and the mature trees have also been incorporated into the landscape. It's got 54 solar panels, a part-natural green roof, and surface water drains into a pond, creating an area of biodiversity as well, which is absolutely fantastic to see. Minister, would you visit this facility with me so you can actually see the difference Welsh Government funding, working with the council funding—it's a council care home, by the way, as well—and Betsi Cadwaladr, who have actually funded the revenue funding of running it in the future, is having, so you can see that package working collaboratively and what it can achieve, and how it actually relieves pressure on the NHS, which we were debating last week? Thank you.

Photo of Julie James Julie James Labour 3:29, 17 May 2022

Yes, I'd be delighted, Carolyn, to come and visit. I'm planning a trip up to north Wales very soon, so perhaps we can incorporate it then. That would be lovely. That's a project that absolutely evidences what we've just been talking about. That is bringing a number of revenue streams together, all available from the Welsh Government in different guises, to make these projects work. Preventative care budgets, housing budgets, capital fund budgets all coming together to make a really good model of care, both for the residents in intermediate care and for the community, on a hub model, really works well. And also, what I really love about the projects you're talking about there are the use of brownfield sites, the preservation of the good parts of those sites, and the ability to bring those sites back into use. So, we don't have to be expanding out into greenfield, we can be using sites that are available for adaptation or replacement, and we can get that care right into the heart of the communities where it's most needed.

Photo of Jenny Rathbone Jenny Rathbone Labour

Thank you very much. I very much welcome your mention of regional residential services for children with complex needs, because this is a really good example of invest-to-save, because, at the moment, as you say, we spend over £200,000 per place, and if they're far away from home, then who is actually monitoring the quality of that provision? So, I wondered if you could give us a bit more detail on how many places we are outsourcing away from Wales, and therefore are very difficult for families or the corporate parent to monitor, and what progress you expect to see regional boards make on this one.

Secondly, I'd just like to pick up on what was mentioned by Mabon ap Gwynfor, which is around dementia. It's a broad-spectrum description of a condition, which can range from just brief memory loss to complete inability to manage your own life. But the telemedical possibilities enable people to live as safely as possible in their own homes, without having people absolutely on top of them the whole time. So, I just wondered if you could say a little bit more about whether the market is about to provide for these sorts of needs, whether it's in people's existing homes or in specialist accommodation, or whether this is something you think the Welsh Government's going to need to lead on.

Photo of Julie James Julie James Labour 3:31, 17 May 2022

So, going backwards with your questions then, Jenny, on that last one, we're looking at a mixed economy, really. So, we haven't got very many of these yet in Wales, but we're accelerating the pace of building them. I want to encourage the regional partnership boards to go as fast as possible with that, alongside other care models. And one of the reasons I'm not putting hard-and-fast targets for how many of these to build and so on is because each regional board will have a different view about what's required because of the current mix of services in their area. So, what we want is not duplication but an integration of those sets of services around what, in this particular instance I went to visit this morning, has become the hub for those services, in a really great way, because people can be brought in to a space designed for the use of various equipment, to help them rehabilitate or re-enable, make the best use of their abilities. And then that equipment can be translated, once they've understood what's possible, using a disabled facilities grant, into their own home, in order to be able to keep them in that home, which is what most people want, as long as possible. And then there's also the chance of intermediate care or, indeed, even if you move into residential or nursing care, which some people do choose to do. And I met a lady this morning who was choosing to do that, but in a much more positive way, because she had a much better understanding of what she would be able to do for herself, and so did the home, and so she was likely to have a much more productive life, and her daughter was absolutely delighted with what had been done. So, it's a mixed picture; I wouldn't be able to say it would be the same everywhere in Wales, but we do expect that integrated service.

In terms of the numbers, I don't know the answer to that—that's Julie Morgan's portfolio—but we can get the answer for you. What I do know is that it absolutely is an invest-to-save, and that everywhere where we've worked together across the portfolios to do this, the families have been delighted, in human terms, but the local authority and the health board have been delighted in financial terms, because it is a very serious saving to the budgets of both of those organisations. And that's why, looking at the Gwent regional partnership board, and how integrated they've been in planning for this, it's a model we'd like the other boards to have a look at and spread out as fast as possible, with a view to getting as many people who are both out of county and out of country back into their own communities as fast as possible.