Speaker 1 – So good morning, everyone. My name is Neil Whithall. I’m a specialist housing Occupational Therapist working in Gloucestershire. I am hosted by Gloucester Health and Care NHS Foundation Trust, but I’m actually funded by the ICB and the County Council. So, thank you for coming. I’d like to tell you a story, if that’s OK. So, it’s a story about a man called Fred and his community Occupational Therapist called Neil. That’s me, by the way. I’m afraid our rather challenging story begins with a car accident injuring Fred. It’s a tragic car accident in fact involving a cervical spinal cord injury causing incomplete tetraplegia. Fred has sustained complete paralysis of his lower limbs and a partial loss of function and feeling in his upper limbs. Fred can use his hands but has limited bilateral wrist, finger and thumb function. Now after the accident, Fred has excellent rehabilitation services from the acute hospital over many months and then more specialist rehab services and psychological support at Stoke Mandeville spinal injuries unit. Fred’s goal was to get home, and he wanted this more than anything. More than anything else, he wanted to get back to be with his family. He was in hospital for quite a long time. Fred has a substantial disability, but with all of this specialist care, support and intervention, and with the further support of the community health and social care services in Gloucestershire from both myself and some of my wonderful colleagues in the integrated care team and the community, Fred does indeed go home. Fred goes home a full-time wheelchair user, but he gets back to his house to be with his family, which is great news. Fred is able to move short distances in his manual wheelchair. His wife is able to manage his moving and handling using specialist equipment, techniques and training that she’s received. The Community nursing team are able to manage his bladder and bowels, bowel care and begins to teach his wife how to do these new challenging tasks herself. Fred has all the moving and handling equipment, pressure care equipment that he needs and a package of care to enable him to live in the community. He’s done it against some odds, he’s actually got home. And yet, despite all of this intervention, support, care and time in which to come to terms with his new life after the accident, Fred is depressed. Fred is depressed because Fred gets home and finds he’s disabled. And my sad and lasting reflection of this case is that Fred is disabled by his home. It is his home that prevents him getting to the bathroom, his wheelchair cannot get through the doorway. It is his home that prevents him getting to the kitchen because, again, his wheelchair won’t go through the hallway to get there. It is his home that prevents him getting to the children’s bedrooms to be a dad to them. It is his home that means he now lives only in the lounge. That he washes, eats, sleeps, reads, opens his bowels and does everything in his life. In fact, in this microenvironment, and I’m sure you can all appreciate the awful lack of privacy that he has to endure at times. Fred is depressed because Fred’s home is disabling him. Now the occupational therapists around the, might shout DFG. Fred needs a DFG. The Disabled Facilities Grant or DFG is a grant that we can use to adapt somebody’s homes to meet their needs. This is great news. Fred is financially and clinically eligible, and with my assistant he can apply. This grant is really important, it provides a lifeline to so many people and is such a rare example of a mandatory grant that’s available and we should celebrate that. But sadly, it turns out after several visits from a surveyor who specialises in disabled adaptations, that in fact Freds home is not adaptable. The position of the staircase in the centre of the home prevents any realistic hope of changing the layout in the budget that we have available. Now at this point I start working quite carefully with Fred and his family to discuss the further options. After several visits, Fred and his whole family come to terms with the fact that they need to move. This is quite a scary prospect, after everything they’ve already been through as a family. With Fred’s agreement, I write a detailed housing report setting out the kind of home that will meet his needs, albeit probably with major adaptations still. And the family lift their spirits and start to look positively towards a new future in a new home that they’ve not been expecting but recognised now is going to be necessary. Even more sadly, after a year and a half of searching, there are no suitable houses available that can be adapted. Well, sorry, that can be adapted with the right number of bedrooms for their family. It would appear they are stuck. I’d seen this before in my career, but there was something about Freds case that I just could not shake off. The injustice of it, the inequality of it. The freedoms that most of us take for granted just being denied. Now, a few months later, a new role was advertised in Gloucestershire for a specialist housing OT occupational therapist. I applied and got the job. It was to develop the disabled facilities grant process the DFG process and as our head of profession said at the time to look at all things housing. As I prepared for the interview, I thought deeply about Fred and his family and his predicament, and actually about all the patients I’ve met over many years of working as an OT in housing. And it seemed to me that the solutions actually were fairly straightforward. Why can’t we have faster DFG’s? What is taking so long? Why can’t we find more homes that are accessible or adaptable more easily? Why can’t we build more homes that are more accessible, more inclusive, in the first place? How difficult can that be? I thought to myself. I just need to talk to the right people in the right organisations and once they hear how straightforward these solutions are, we can put them into practise together. Now, I’ve been told that I’m not allowed to use any screens or PowerPoint today, which rather robs me of my security blanket if I’m being completely honest. But they didn’t say anything about cardboard screens. So, I’ve decided to call this new technology card point. Caroline, do you want me to? 

Hold them up. You hold them up and then I won’t be at risk of showing the backs by accident. 

Thank you. There we are the first one. 

Speaker 2 – So 400,000 wheelchair users in England live in homes that are neither adapted or accessible. 54% of housing association tenants in England have a long term illness or disability. 9% of the homes in England have the most basic access features and in terms of general need, family homes for wheelchair users, the costs is £100,000 in Gloucestershire versus an additional. So let me start that again because I got it confusing. So it’s going to cost £100,000 in Gloucestershire to adapt a general family home versus an additional £30,000 to create a better designed accessible new build home. If you do that at that point of building. That’s right. We got there, didn’t we. 

Speaker 1 – So back to our story I set to work on all this easy stuff. Easy in the same way that living in your home, in fact should be easy. I felt that if I spoke to the County Council, if I spoke to colleagues in planning, in commissioning, in housing and I explained the problems and I explain the solutions needed in overcoming these, it would all be easy. But in reality, I was being a bit naive. There are layers of challenge. There are layers of bureaucracy to overcome. There are layers of different people to speak to. In fact, there are layers of different policies to address. If we Fast forward two years. There have been some successes so the DFG system in Gloucestershire now benefits from 11 trusted assessors. These are unregistered, suitably trained and competent support staff who can assess for major adaptations in simpler cases. That’s new. We haven’t done that before. Gloucestershire has a new process for those with conditions such as MMD, so they can avoid the means test when we’re assessing for the adaptation so that we don’t have to delay it if they’re still in work. And we’ve worked together with all of our six district councils to create a faster approvals process for DFG across the county. I’m also working on an accessible housing register for social housing in the county, so that disabled people can have a truly informed choice when they bid for empty homes and hopefully we can find those adapted properties more easily. And what of that Holy Grail campaigning for more new build accessible housing? well-being honest, this is probably a career long goal for a whole team of people, a whole team of wonderful people I work with in commissioning and something that we hope to achieve together. There are some glimmers of light. We now have two out of our six district councils, which have put specific measurable targets for accessible housing into their local plans and I see that as a great success that I hope we will see rolled out across the county. So, has it been easy as I thought it would be? No, in a word. Those layers of challenge are indeed challenging. But as I sit in yet another two-hour meeting about the national planning policy framework or a discussion about the need for a better understanding of the technical aspects of part of the building regulations. Or I have to sit through a yet another thorny planning meeting with the developer about why those standards have not been met. Sometimes I feel as though I might be losing my shape. But in those moments, I think of Fred. I think of Fred and his family. I think about the determination, the perseverance, the tenacity, the hope, in fact, that Fred has to find every day, and I feel reshaped by this great courage of others, to not give up. I think about not being constrained with a silo approach to my work. Not staying just within my organisation, not being constrained by my job description either, kind of hoping my boss isn’t listening to this. I think about not losing sight of that goal of having more accessible new build housing in the 1st place. The difference that that could really make to people. So, what happened to Fred? Well, after two years, I’m delighted to tell you that he did move to a home that was big enough for his family. We used a DFG to extend the property at the back and reshape the inside and create access. He wasn’t able to get to his children’s bedrooms, unfortunately that wasn’t something we were able to achieve, but we spent £100,000 doing that. Changing that home. So, Fred is now able to access a room for sleeping, aroom for living in with his family, an accessible bathroom for having a shower and a room for preparing food. Fred can get in and out of his home by himself and he’s able to move around his garden and feel the sun on his face. Maybe Fred can inspire some of you to connect with others and to change the world a little bit for the better. Thank you.