Written evidence submitted by Gloucestershire Health and Social Care NHS Foundation Trust [DPH 012]
The views expressed below are not necessarily those of the Trust.
The author has over 22 years experience of working as an Occupational Therapist in the field of major adaptations and housing; including housing design, accessibility standards and use and re design of the disabled facilities grant process.
Submission content:
1.1 The optional technical building regulations – make M4 (2) mandatory and set a mandatory target for M4 (3)
The committee should consider the extent to which the optional accessibility standards set out in Approved Document Part M4 (2) and (3) are actually creating a regulatory environment that demonstrably promotes the building of more accessible homes at a local level.
Approved document Part M4 (1) is mandatory but does not meaningfully assist in creating accessible dwellings because the standards described within it do not address the basic needs of those with common mobility related disabilities. These include, for example, being able to fit a stairlift or have a WC on the entrance storey capable of accepting a level access shower – both often needed as people age.
Parts M4 (2) and M4 (3) however do set out to create truly accessible dwellings but as long as they remain optional regulations they can be ignored and new homes are often built that do not meet the needs of our ageing population.
Local authorities, who are keen to promote new house building, are concerned when developers argue that a development may not be financially viable if those standards are insisted upon. The value of the land, the rising costs of development and the larger nature of the plot required for a wheelchair accessible dwelling that meets the standard M4 (3) may combine to negatively impact profit for developers. This creates tension and disagreement in the planning stages. Thus the optional standards, that would be so critical in enabling barrier free homes for disabled residents, can get ignored.
The 29th July 2022 government press release advising of the intent to mandate M4 (2) is welcome. A date for implementation is urgently needed as no date was given for the M4 (2) directive and anecdotally some local authorities have delayed adopting targets themselves assuming a directive from Government is coming soon. There is also a pressing need for a percentage target to be mandated for M4 (3).
1.2 Disabled Facilities Grant expenditure rises with inaccessible development
Developer led financial viability assessments do not consider the costs to society, public services and the individual of continuing to build homes that are neither accessible or easily adaptable.
An extension to meet the needs of a wheelchair user costs around £80-100K in this local area. However the costs of building a 2-bed terraced dwelling to M4 (3) in the first place amount to about £16K more to the developer.
Subsequent adaptations such as ground floor extensions, that are often needed for wheelchair users, fall to the stretched local authorities disabled facilities grant (DFG) process to fund and organise.
The committee should consider asking Government to mandate minimum percentage targets nationally for M4 (2) and M4 (3) dwellings. There is growing evidence that people with disabilities are more likely to remain in work and less costly to the NHS and Adult Social care when living in an accessible home. Barrier free environments benefit not only the individual, their own family and immediate close community but also our wider society as a whole. The hyperlinked reference below clearly sets out the savings that can be made and the difference this can make to people’s lives.
Living not existing: The economic and social value of wheelchair user homes (habinteg.org.uk)
1.3 Accessible Housing Registers
54% of social housing tenants in England have a long-term disability but only 9% of the country’s existing dwellings have the most basic 4 features of accessibility.
Housing Associations and Home Adaptations report summary (foundations.uk.com)
2018-19_EHS_Adaptations_and_Accessability_Fact_Sheet.pdf (publishing.service.gov.uk)
Where adapted or accessible homes do already exist they are a very precious resource that must be let to families or individuals in need. Outside London, the housing registers which applicants view to make choices about appropriate available lettings for them often provide very limited or no information at all on the accessible nature of the homes they advertise. This risks such a precious resource not being let appropriately (with subsequent large costs to the local authority). People with disabilities have different needs and therefore require different home environments. The committee should consider asking Government to require accessible housing registers nationally to list specific accessibility features that an applicant would recognise as likely to meet their needs and family circumstances. This would help ensure that disabled people have an informed choice (such as the system in London).
1.4 Existing Housing
The majority of disabled people will not move into new build housing. Instead they will require adaptations to existing housing stock. The numbers of people in need are quite staggering and indicate the importance of the Disabled Facilities Grant process to supporting people in their homes with essential activities such as getting in and out of their house, or getting to the toilet.
In 2019-20, 8% of all households in England (1.9 million) had at least one person with a long-standing physical or mental health condition and said that they required adaptations to their home. This proportion has not changed since 2014-15. 81% of households that required adaptations felt their home was unsuitable to meet their needs.
Home Adaptations Report FINAL .pdf (publishing.service.gov.uk)
The importance therefore of a successful, timely, person centred and accessible adaptations process cannot be underestimated. Please see section 5 on the DFG below.
2.1 Limitations of the NPPF
There is only one reference to the optional technical design standards(Part M) within the NPPF. This is a small foot note reference in Chapter 12 which is titled Achieving well designed spaces on page 39. The ambition here is to create safe, inclusive and accessible neighbourhoods but advising that planning decisions should use these standards, where needed, is not strongly worded enough to achieve success in a complex, multi layered planning environment. It goes on to suggest that the nationally described space standards maybe enough when the in fact the specified space under NDSS is totally inadequate to meet the needs of a wheelchair user to be able to move around their home. The NPPF falls short of the direction required from central government to deliver accessible homes and falls short in its detail to meet the spirit of the Equalities Act 2010.
2.2 Indirect discrimination
Indirect discrimination, as described in the Equalities Act 2010, occurs when a provision places someone with a protected characteristic at a particular disadvantage when compared with someone without that characteristic. Housing that is inaccessible clearly disadvantages those with disabilities by creating barriers in the home environment that are not experienced by those without that characteristic. In this way, providing houses that are not accessible may be judged to contravene the Act. This may also be true of advertising housing inadequately and not enabling disabled people to make informed choices about the actual local availability of the homes they need. Which organisation would be responsible for such discrimination, in these complex situations, is less clear.
The local authority and the planning inspectorate also hold a public sector equality duty to ensure equality of opportunity.
The author can only advise from his local experience in the South West but the impact has been negligible. Indeed, the announcement to mandate M4 (2) as a minimum standard for all housing may have had a negative impact, whilst we await its implementation. It raised the issue locally of accessible housing, creating debate, but some District Councils have avoided creating targets for the optional standard M4 (2) within local plans because the decision to mandate is expected soon. No date has been given and the delay, meaning homes being built now which are not accessible or adaptable, will be having a negative impact on disabled peoples lives and there is a wider cost to society of delayed hospital discharges and costlier adaptations. Delay will prove costly in lost opportunities for disabled people to thrive and we are building inaccessible homes today that local authorities have to adapt later at much greater cost.
4.1 The role of Government:
a) should be to proactively drive the hardening and timely implementation of the current standards by mandating :
b) Require the use of accessible housing registers across the Country to ensure disabled people can exercise informed choice and enable the precious resource of adapted homes to be identified and re let to those in need.
c) To urgently undertake a specific review of the DFG delivery process and legislation. In doing so obtain evidence of the levels and type of staffing available in all agencies (now and prospectively) to be able to deliver more adaptations through the DFG.
d) Require the monitoring of adaptation services by the Care Quality Commission to drive the spread and speed of delivery of faster adaptations.
e) Create a cross disciplinary task force consisting also of people with disabilities to keep under review the changes required at a local level; to sponsor and promote change and report on progress along with developing good practice on the ground.
4.2 The role of Local authorities:
a) Adopt a process of careful research of local needs for accessible housing to inform, set and then implement corresponding targets for M4 (2) and M4 (3) in excess of the minimum mandate by Government (recommended above) where it is needed.
b) Bring in the knowledge and real time involvement of Specialist Housing Occupational Therapists in their Town & Country Planning departments to work with developers, planners, architects, designers, surveyors, ICBs and County Councils throughout the entire planning process including advice at the pre-application planning stage. They can support people with disabilities as they move in and complete post occupancy surveys to ensure the needs of people with disabilities are being met. There is a lack of understanding of the optional technical design standards and an urgent need for this expertise to sit within local authority planning and building control functions. Confusion between the standards is often observed which negatively impacts the lives of those subsequently living in these homes.
c) Deploy sufficient staff to progress DFG’s at all stages including occupational therapists, technical officers, home improvement agencies and case workers.
d) Publicise the DFG and other services more widely to enable more people to exercise their right of choice to remain safely in their own homes as they age or develop health issues.
e) Encourage the use of appropriately trained “trusted assessors” for DFG’s across the country in order to streamline decision-making for simpler cases.
Home Adaptations Without Delay Planning Guide - RCOT
4.3 The role of developers:
a) To develop housing solutions that cost effectively meet the needs of all and to participate in understanding and meeting the needs of our ageing population.
b) To work collaboratively with local authorities in creating accessible homes and accessible neighbourhoods that are inclusive and promote well-being.
c) To be prepared to undertake holistic viability assessments that consider the potential negative financial and social impact of inaccessible housing across the whole range of stakeholders.
d) To embrace the need for planning positively for providing prospective homeowners with the choices they deserve for the benefit both of the purchaser, the developer and their mutual wider local community in which they all live – and thereby our society as a whole.
5.1 The DFG transforms lives
The DFG is a valuable and rare example of a mandatory grant which transforms thousands of lives. It enhances the wellbeing of individuals, promotes their independence, reduces falls, improves safety and gives a lifeline of basic provision for those in need. Indeed, adapting a home can enable people to thrive again after long term illness or life changing injuries. The author has seen first hand the wonderful benefits of improved confidence and mental health that has enabled people to go on to achieve productive roles in society. Disabled people are four times more likely to be in work in an accessible home:
5.2 The DFG system is overstretched
The biggest single issue facing those in need are long delays. These delays are set out County by County in the research article featured last year on Channel 4 news:
The Housing, grants, construction and regeneration act (1996) places a duty on the housing authority to consult with the welfare authority in each case (in two tier authority areas) and four organisations(Occupational therapists/Trusted assessors, grants officers, technical officers and contractors) are required for each grant in some areas. Sufficient staffing is needed in each organisation to be able to deliver adaptations swiftly and many have difficulty recruiting and retaining staff. The increase in the capital grant over recent years is welcomed but the staffing resource required to deliver these adaptations has not been increased. Long delays are common and the process is bureaucratic. Previous national DFG reviews have not brought about meaningful change and there is no agency monitoring performance across the country of timely delivery; the DFG’s role in prevention relies on adaptations being available quickly and the staffing levels are often not in place to enable this to happen at a local level.
5.3 The DFG needs urgent review
The £30,000.00 mandatory grant limit has not kept pace with building costs and the most expensive adaptations, ground floor extensions, are routinely costing three times this amount, in this County. People with disabilities are left with stark choices where the local authority does not offer a discretionary sum over this amount. They maybe forced to borrow the additional money or go without the adaptation altogether with the resultant impact on their wellbeing and independence.
There was an intention by government to review the 30k limit, the national funding allocation formulae and the applicants means test, to consider aligning it with the means test used for care, but all these have been dropped.
The Housing, grants, construction and regeneration act (1996) has been designed solely for the purposes of meeting the needs of those with a physical disability and there is no provision for those with other impairments. This is not equitable or fair and the grant has no provision for adaptations for those with mental health conditions, learning disabilities, emotions expressed through behaviour, neurodivergence and those with sensory needs. The purpose of making the dwelling safe is used for meeting some of the needs that arise, but having to prove that without the adaptations the dwelling is unsafe, is not a reasonable basis on which to make these determinations.
5.4 Linking the DFG into wider housing strategy.
It is clear that the cost of attempting to adapt inaccessible housing is more expensive than designing for people’s needs from the ground up. See previous references above for figures but significant savings can be achieved and more importantly people with disabilities don’t have to wait, sometimes years, for the adaptations they need.
M4 (2) contains a requirement to place an installed level access shower drain beneath a bath dramatically reducing the cost of providing a level access shower, as peoples needs change. The adaptations approved in our County are about 60% level access showers so it possible to see the reductions in expenditure and difficulty that could be achieved by mandating this as a standard.
The cost of ground floor extensions is rising for those with high or complex needs; spinal injuries patients, catastrophic injuries and acquired brain injury patients for example. Local authorities need therefore to make a strategic connection between the number of adaptions being requested through the DFG and the requirement for building more M4 (3) and M4 (2) accessible and adaptable housing. The need is greatest in the social housing sector but provision is very limited for owner occupiers and information is very limited for those seeking accessible housing due to poor marketing of these properties.
Accessible housing registers allow identification of previously adapted stock, sometimes at great expense, and go some way to ensuring they are then let to those in need reducing the need for further costly adaptations.
5.5 The DFG’s role in prevention
A well designed, person centred adaptation, funded through the DFG, can reduce falls, reduce the likelihood of admission to hospital, facilitate discharge from hospital, delay admission to residential forms of care and improve people’s mental health and wellbeing. There is a growing body of evidence to support these claims:
The role of home adaptations in improving later life.pdf (ageing-better.org.uk)
This prevention relies on people knowing about DFG services, being able to access them easily and finding them to be effective in understanding and responding to their individual needs. Living in homes that are barrier free is a right we should all expect to enjoy and the access created to basic facilities are often those we all take for granted.
There are so many lost opportunities and we can do better, in respect of resources poorly applied but more importantly, to significantly improve people’s lives.
September 2023