CIH submission to the Casey Commission on Adult Social Care

Timely and successful discharge from hospital to communities, and continued care in the community, depends fundamentally on safe, decent and accessible housing that can help people to recover health and independence, alongside appropriate care. That includes short term step/ step down rehabilitation within supported housing, or moves into long term supported housing to continue living as independently as possible. 

Schemes that integrate housing professionals  in wider hospital discharge services enable housing solutions to be considered from the outset at admission, meaning that effective housing-based solutions can be identified - see for example the partnership across Sussex Partnership NHS Foundation Trust, social care, housing and community groups, which help people with mental health needs leave hospital into supported housing. Other examples can be found in CIH’s sector showcase in partnership with Skills for Care,

The role of housing in effective hospital discharge and in CIH Cymru’s publication, From hospital to home: planning the discharge journey.

Poor quality housing has been estimated to cost the NHS £1.4 billion but the wider societal costs, including social care, are much higher, estimated at £18.5 billion a year (BRE, The cost of poor housing in England, 2021).

In comparison, access to the right supported housing provides savings to other public services.  A Local Government Association (LGA) report estimates that a supported accommodation scheme in Bradford helping people who are homeless or at risk of homelessness with intermediate care and support saves the NHS approximately £47,000 per person. Research into the benefit of supported housing for people experiencing homelessness by NHF demonstrates savings for social care, health and criminal justice. Nine out of 10 people experiencing homelessness have at least one health condition or disability, whilst half have more than one. It estimates that six per cent of people in supported housing would otherwise be in more costly residential or psychiatric care.

Older people are a growing proportion of our population, with those over 85 being the fastest growing age group – up to 3.3 million by 2047 compared to just 1.7 million in 2022 (British Geriatric Society, 2025). Over half of single person households are older people, and Age UK estimate that around two million are living with unmet needs for help with personal care and everyday tasks of living. Older people account for about 40 percent of hospital admissions (British Geriatric Society). This will mean continued and increased impact for care and health services.

Specialist housing for older people has been demonstrated to provide benefits for individuals and for public services, for example; a longitudinal study into the impact of housing with care by the ExtraCare Charitable Trust revealed that their model led to reductions on costs to the NHS and social care, and significant improvements in residents’ self-reported wellbeing.

However, the opportunities to move into specialist housing (or indeed smaller accessible mainstream homes) in some areas are lacking. Analysis by the NHF estimates that 38,000 more specialist homes for older people are needed a year to address demand from an ageing population.

The Older Person’s Housing Taskforce looked in detail at the needs of older people for greater housing options, and made a number of recommendations that CIH supports (Our Future Homes: housing that promotes wellbeing and community for an ageing population, 2024) These are also reflected in the 15 point plan developed by the Housing and Ageing Alliance (of which CIH is a longstanding member) and what we need for a comprehensive approach to housing for an ageing population. In particular, we recommend that government establishes a national strategic framework that incentivises local systems to identify and develop more of this housing (across housing, health and social care partners).

However, most older people will continue to live in existing, mainstream housing. Access to services that help people to make repairs and necessary adaptations to their homes is equally important to ensure safe and decent housing across all tenures. We also need to ensure we develop more accessible homes that are adaptable across our lives, in future (as below).

Supported housing is facing huge viability challenges and many providers are closing schemes, further reducing availability in many areas. A survey of providers by the NHF revealed that more than half responding to questions about scheme closures – 56 per cent – were concerned that without emergency support funding, some of their schemes would close or be decommissioned.  22 per cent were considering exiting the supported sector, with an estimated potential loss of 50,000 schemes, mainly affecting schemes for working aged people. There was also a corresponding concern about developing new or regenerating existing schemes without more guaranteed revenue funding in the long term.

CIH has addressed what is required in its submission to the autumn budget, including:

• Creating an emergency fund to stop the closure of much needed supported housing schemes 
• Investing in a long term revenue fund for housing support
• Investing in new supported housing development 
• Developing funding streams for effective and speedier transfer of care from hospital into housing-based solutions
• Addressing the use of temporary accommodation where extra support is required.

Whilst this may be outside the remit of the commission, CIH believes these measures are critical to prevent or reduce increasing dependence on high cost, intensive care services, and therefore to the transformation of social care.

We are an ageing population, and many are experiencing increasing ill health and conditions that limit their ability to conduct tasks of daily living without help. Healthy life expectancy over 50 is decreasing with marked inequalities; for example, Age UK's research highlights an 11 year age gap in healthy life expectancy in the most deprived areas compared to the least deprived. There is also a growing proportion of disabled children and working aged people in the population – increasing from six to nine and 15 to 21 percent of the population respectively over the last 10 years (ONS data 2021). 

However, we have an existing housing stock that largely lacks the most basic levels of adaptability, and in 2019/20, one million households did not have the adaptations they needed in their homes. Currently we continue to build homes that will also be expensive and difficult to adapt in the future, with marked regional variation in the accessibility of homes being planned. This has long term consequences for demand on social care, but also on the loss of productivity and contribution to society that could otherwise be made by disabled people, currently being limited by their living circumstances.

The most acute housing shortage is for people requiring wheelchair adapted homes; Habinteg Housing Association estimate that about 400,000 people requiring such housing are stuck in unsuitable homes. Research by LSE for Habinteg has demonstrated the long-term financial benefits of wheelchair accessible housing - £67,000 over a 10-year period for a household with a disabled child and £94,000 over the same period for a working aged disabled adult. This is due both to savings for public services, including health and care, and to revenue generation through people active in the workplace.

CIH is a member of the Housing Made for Everyone (HoME) coalition, which aims to highlight the issues faced, and the advantages that would come from ensuring people have access to homes that are accessible and easily adapted to different needs across the lifecycle. We were pleased that the previous government made a commitment in July 2022, to mandate the higher accessibility standard (Building Regulations Part M 4 (2)) for all new homes with limited reasonable exceptions. However, since that commitment has been made no further action to implement it has been taken.  Mandating it would reduce the limited additional costs (being factored into plans and designs from the outset), remove any competitive disadvantage that currently makes developers reluctant to incorporate the standard.  Developers also challenge the requirement for social rented homes on viability grounds within mixed tenure schemes so levelling up the playing field and setting clear expectations for all homes would substantially help deliver in that tenure as well. Introducing the higher accessible and adaptable standard for all new homes without delayis a critical step forward in enabling people to access homes that are safe, decent and support them and carers in daily living.

In addition to supported housing and developing new homes to higher accessibility standards, the condition and lack of accessibility of existing homes can be a delaying factor in timely and successful discharge from hospital, and in the need for increasing care services to support individuals. Unsafe, non-decent homes are estimated to cost the NHS more than £1 billion, and social care a further £1.1 billion, plus £3.5 billion for family and friends providing unpaid care.

Since 2015, Disabled Facilities Grants (DFGs) have been included in the Better Care Fund, with a priority of delivering more effective hospital discharge. In 2016-17 DFGs received a large increase in funding (79 per cent) reflecting the rising demand for adaptations, the role of adaptations in supporting people to be successfully discharged from hospital, and the economic and social benefits from reducing or preventing further increases in demand for health and care services (Foundations, DFG evidence). Delays to making timely adaptations increases the risks for older and disabled people and reduces their effectiveness. Given the increase in older people’s households, including those living alone, and people living with long term limiting conditions, demand for DFGs will continue to increase.

Many middle-income households are unable to access DFGs, but still require support to identify trusted contractors to repair and adapt homes, with advice, information and support as identified in the Care Act 2014 (examples include the proposals for Good Homes Hubs).

A resource such as the Good Homes Hub could usefully include or link with the duty to provide information and advice on care services included in Section 4 of the Care Act 2014, particularly as it could address the issue of preventing or reducing increased dependence on care services, by enabling people to complete tasks of daily living more safely on their own or with less help. It is important to acknowledge that often households require support beyond the provision of advice and information, and advocacy is often the missing element for these households, providing assurance about the management and quality of services they receive. This is a strength of home improvement agencies and the basis for the Good Homes Hub, as demonstrated in their evaluation.

Social care transformation is both necessary and a complex matter. However, the quality of the home is fundamental both to the health and wellbeing of individuals in receipt of care and support, and to care givers, whether family and friends or formal or paid care professionals.  We hope that the material provided gives the evidence to support the commission to explore how embedding housing could contribute to a more sustainable care service in the future. We would be pleased to have further conversations on this at any point.

For more information on our submission please contact Sarah Davis, policy manager: sarah.davis@cih.org.