Kieran Findlay

Welcome to the Scottish Housing News Podcast with me, Kieran Findlay and Jimmy Black. In this episode, we’re discussing new research into the systems, funding and support behind adaptations.

Jimmy Black

Commissioned by the Scottish Federation of Housing Associations, ALACHO and CIH Scotland, the research has been conducted by Professor Vikki McCall and her team at the University of Stirling. Professor McCall and Susie Fitton, policy manager at SFHA, join us today to talk about what’s working, what isn’t and what urgently needs to change.

Kieran Findlay

Susie, welcome back to the podcast. It wasn’t long ago that we were talking about the Housing Bill and some of its amendments, but we’re here to talk about this new research that’s just out. So shine a light on the process of commissioning a piece of research like this. What prompted it, and why is now such a critical moment to re-examine how Scotland delivers housing adaptations?

Susie Fitton

So adaptations at the right time, delivered and funded in the right way can be life-changing for an individual and for their family members or carers because adaptations with things like hand and grab rails, ramps, stair lifts, through-floor lifts, larger adaptations to create a bathroom adaptations or wet rooms and a whole range of things, including technology, which I’m sure we’ll touch on, support independent living, they support full use of the home and ageing well at home and in the community.

They postpone the need for additional care and costly residential care, they prevent falls and injuries, hospital admissions, enable early discharge and support carers. And they’re fundamental to making the best use of our housing stock, and that’s absolutely critical to meeting the housing needs of an ageing population and future-proofing the housing stock as we age. It’s a fundamental part of prevention, but we have an adaptation system that is often slow and inconsistent, hard to navigate. Delivery is shaped more by tenure and geography and funding mechanisms than by need, and too often and for too many people, support only arrives at the point of crisis if it arrives at all.

Housing associations and local authorities are at the forefront of providing appropriate and timely adaptations, but they frequently report that the policy legislative and funding systems are complex and confusing and tenure-led rather than person-led and that budgets for adaptations, particularly for us in terms of SFHA members, Stage three funding for housing association adaptations have been inadequate for the last, certainly for the last 10 to 15 years, despite a significant increase in demand.

Jimmy Black

Susie, can I just ask you? We’ve known all this for years. I’ve been involved in the housing world, I’ve been involved in councils and adaptations has always been a subject. There’s never been enough money we’ve never had. What do people have to do to get the Scottish Government to actually move on this?

Susie Fitton

So we think now’s a really opportune time. We’ve got a new cabinet secretary for housing who is in post and going to be very keen, I’m sure, to make an impact and to try and resolve, as you say, something that has been talked about and reported on for 25 years at least. And so, we know that the Scottish Government committed in ‘Housing to 2040’ to undertaking a review of adaptations.

Now, there’s been lots of previous reviews, but we really feel that there’s a really opportune moment given that there’s such a necessity to think about protecting budgets, but also spending in a way that supports prevention, that we really felt that now was a really important moment to clarify minds and to talk about demand and increasing demand and how we meet that, but also to talk about wider reforms to the system in a way that would be listened to. So we were really keen to partner with CIH and ALACHO, given the importance to the wider sector of adaptations, but also the fact that housing associations and local authorities are at the forefront of providing adaptations.

We also wanted an independent but highly respected partner, which is why we’ve commissioned this research from the University of Stirling as part of the project around tackling the stigma of place-based ageing, which I’m sure Vikki will talk more about.

Kieran Findlay

Vikki, that’s where you come in. So your research describes the adaptations system as complex and fragmented. What does that mean in practice for people trying to access support at the moment?

Vikki McCall

As Susie mentioned, this is part of the ISPA project, which is about intersectional stigma of place-based ageing, and that’s also supported by the Economic and Social Research Council. And this is a five-year programme of work of which we’re highlighting adaptations as a part of that wider picture in that if we’re setting up a housing stock that is future-proofed for our ageing demographic and we normalise and integrate accessible and inclusive and flexible design, what we do is normalise accessibility and make environments that are just good for everyone, whether they’re growing older or whether there’s a disabled person or it’s just good for all groups and all ages.

So the wider picture is that that tackles stigma in relation to ageing, disability and place, and that’s the society we all really want to work with. And how does that work with lived experience? We are working with our community peer researchers and they’re keeping diaries for us over a two-year period as part of this project. And it’s them that highlight why this really matters.

Because when we are talking about a fragmented landscape, a difficult process, what the reality is, the outcomes of that, is that people are not able to bathe, people aren’t able to sleep, people are trapped in their homes, they cannot access services in their community. And the vast majority of people in Scotland are ageing in homes that already exist. And adaptations is really the only process we have that can go in and intervene and support to build those inclusive and flexible environments.

And Susie mentioned that the need is increasing, and the report highlights this. We project that into 2040, and it’s just going one way. We have an ageing population, and that is fantastic. It’s great to celebrate it. But actually, Scotland, in comparison across the UK, has the lowest healthy life expectancy. And in fact, our healthy life expectancy is declining. So it’s averaging 60-62 in Scotland. So we’re living longer. But our healthy life expectancy is declining.

So therefore, what’s going to bridge that gap where more of our health needs are becoming a bit more complex? Well, our health and our social care systems are not going to be able to support that in a fundamental way. It’s going to have to be supportive, flexible, healthy environments where people can age in place for as long as possible. And our report highlights that while at the same time bringing the voices of the lived experience alive to show people why that matters and highlighting all the figures that show that adaptations costs are going to increase.

There’s going to be increased needs and demand and also that funding has somewhat stalled and we’ve never we’ve done a review of the last 20, since 2020, of all of the policy documents that have given recommendations around adaptations and they come back with the same recommendations again and again and again.

We know the solutions, we know how to make this work. What we need is leadership, investment and prioritisation of this adaptations process if we want to get to the place we want to be in Scotland and future-proof for the ageing demographic.

Jimmy Black

Vikki, adaptations don’t seem to be a particular priority for people who designing and building new houses. If you look at all the houses being built under the Affordable Housing Supply Programme, only a small percentage of those will be wheelchair accessible or will actually just be easy for people to get around. I mean, we build semi-detached houses with stairs. I wonder why we don’t design accessibility and inclusivity in from the beginning rather than adding adaptations later. I mean, think the clue lies in the word adaptations. Rather, you know, why don’t we just build things properly in the first place?

Vikki McCall

That’s a good question, something I’ve asked quite a lot. And I think there’s a few reasons for it. You’re quite right. Accessibility has been treated as an add-on and not something that has been prioritised. And it is such a shame because of all of the ways we can make tangible changes to environments, that’s the best chance we have to future proof is because real things, accessible doorways are great for people with wheelchairs, absolutely, but it’s also great with a parent with a pram. And I don’t think that the wider benefit of inclusive design has really kind of come through culturally.

And even I think one of the main issues is no one thinks they are growing older, right? Older in our research is always 10 or 15 years older than you. No matter what age you are, we’ve interviewed 93-year-olds where the older people are down the hall, you know, so we don’t personalise ageing. It’s something that we do that we other it. It’s a problem also for the future. We’ll worry about that later. And I suppose that’s why we’re in the trouble we’re in, where we have such a lot of non-decent homes or inaccessible homes that aren’t ready for the changing demographic and our changing health needs. So there’s a cultural piece in here.

And we’ve found on our stigma project that a lot of that is to do with stigma as well. You know, people are defensive because of the stigma attached to ageing, attached to disability, and that’s very hard to overcome. So a lot of this is not just about the process being reviewed and changed and invested in and led in, but it’s also about the information and advice for people to also change their own minds for homeowners, private renters, social tenants, about actually getting ready for growing older. We need to start thinking about that a lot sooner. And it’s a very difficult thing because there’s no one-stop shop, there’s no central hub to go for information advice. It’s sporadic, it’s fragmented, difficult to access.

Kieran Findlay

Moving on to the inequality of access to these aids and adaptations, Susie, you mentioned earlier that a person’s tenure or even their postcode could affect their ability to get the adaptations that they need. Can you tell us more about that?

Susie Fitton

We’ve already mentioned it actually, the fragmented landscape. We know that integration authorities, so health and social care partnerships are responsible for adaptations, but the system of delivery and funding is very fragmented in terms of the mix of legislation and policy and the practical delivery and the funding is also fragmented. It’s tenure-led rather than being person-led.

So for housing associations, funding is typically drawn from the Stage 3 budget or from social landlords’ own resources. So quite a lot, and you’ll be aware of this, I’m sure. Jimmy, you mentioned that you’ve been aware of the challenges with adaptations for a really, really long time. And this is part of it. In quite a lot of cases, housing associations end up supplementing Scottish Government funding and front funding essential works. And that can lead to delays for tenants, individual tenants and households sometimes, particularly for major adaptations if the funding’s not available and we’ll talk about funding in more detail I’m sure.

For local authority tenants, adaptations are funded from rents via the housing revenue account. There’s no ring-fenced Scottish Government funding for local authority tenants. It can be quite difficult, particularly for owner-occupiers and private renters to get not only funding, but also information about adaptations and support to project manage an adaptation. Funding comes from, for owner-occupiers, it comes from the council’s general fund and applications are made through the local authority scheme of assistance, which was created by the 2006 Housing Act. And it creates different access routes and timelines depending on who owns the home. And it complicates coordination. It often undermines the principle obviously of a needs-based delivery. And there’s no consistent framework. And we’ll talk about this to determine who receives what and how decisions are made. And so we do get this postcode variation and we get delays and we get confusion for both practitioners and service users. The variety in practice, not only across tenure, but within certainly within organisations, within our own membership is really quite significant.

Some housing associations support self-assessment for their tenants. Others will fund an adaptation if there’s a housing needs assessment by an OT. Lots of local authorities are only assessing for critical needs. So there’s such a range of things that can fragment the system and complicate it.

Kieran Findlay

Susie, on this alone, what is the solution? Do you assess people individually rather than based on what type of house they live in?

Well, as we’ll talk about, I think we need to move away from a tenure-based system, really. mean, I would, I think, like to see a cross-tenure funding pot for adaptations. I think if you understand, and Vikki’s talked about this very eloquently, if you understand that we’re all ageing and that most of us live in a home that already exists. So whilst accessibility standards and design standards are crucial, and Jimmy, you talked about this, you said, surely we should be making sure that homes are accessible from the design stage. And that’s absolutely true. But the majority of homes that people live in, so pre-1919 tenement houses, post-war terraced houses, they’re already in existence. And so we need to think about a cross-tenure funding solution for this.

Don’t get me wrong, I have a strong belief in the effectiveness of the RSL adaptations programme. It’s not funded enough. The funding doesn’t meet the level of requests that RSLs are making in this area. Housing associations and local authorities are very effective at adapting homes, so we need to increase the budget for them, but we also need to think about private owners as well. So it’s about trying to remove the complexity and the funding complexity and having a sensible solution to essentially an essential part of prevention.

Jimmy Black

Susie, it’s true that sometimes adaptations cost an absolute fortune if you take an extension to a house to allow someone with severe physical disabilities to continue living in their home. You could be talking 20, 30, 40, 50,000 pounds to make that happen.

Kieran Findlay

Vikki, did you just want to comment on that last point before we move on to the next question?

Vikki McCall

I did, if that’s all right. And it was just to say it’s not all about extensions. Those are a lot rarer in terms of the adaptations that are occurring. And our report highlights that the average cost of an adaptation for the local authority landlords is £2,325 in 2019 and that will rise and then £2,467 in 2023, and for RSLs that’s £2,114 in 2019 and £2,671 in 2023. So I just want to bring that back to realistic expectations on costs because actually what the report highlights is small, I mean what’s £2,000 when you’re talking about somebody being able to actually bathe in their own home. It is small costs with very big impacts in terms of outcomes, and actually is a very good investment in terms of housing, where the housing intervention will then save costs in health and social care later down the line. So I just want to bring that back just slightly.

You also, Kieran, asked about the solutions and as well as the funding that Susie set out so well, there are other things that can be done and one of them is making clearer processes that have also an overall national expectation because whenever you’re talking to service users at the ground level and also talking to professionals delivering in this area, it’s always difficult and it’s always a fight. It’s very bureaucratic, sporadic, postcode lottery, and it’s not clear where they can go. So I think clearer processes seems like a good win as well in terms of this.

The second thing is going back to the concept of adaptations and tightening the statutory duty around this because it’s currently extremely woolly.

It doesn’t come across as a statutory duty, they almost add on guidance and people get very confused over that. So that could be a really easy win to tighten up what’s expected from local authorities as well. And also going back to what it includes in terms of adaptations conceptually, because what we need to support as we grow older has widened a lot since this had been created.

And people think about adaptations as quite traditional, that handrail, that ramp, but it’s a lot wider than that. The Scottish Housing Regulator also includes in its definition assistive technology, for example. So we need to really widen out the importance of that. And we’ve got a lot of research. So even small gadgets and things that make a small cost, but a big impact. So I would like a review that looks at this in its entirety as a process of what we include, the service user perspectives, the professional perspectives who are working so hard in this area. There’s actually a lot of innovation going on there, great work going on out there, but it feels like they’re not getting the support to do that. It’s been made harder than it needs to be. And the reality is we’ve got service users that, for example, working with us on ISPA project that been waiting for an adaptation since 2017 and still don’t have it.

Jimmy Black

Now you mentioned the standard and you said it’s wooly. Are you talking about housing for varying needs here? And you know, what about the new Scottish Accessibility Standard, which is coming? Will that be any better?

Vikki McCall

So these are all slightly different. We were talking about the legislative framework as set out in the Public Bodies Joint Working Scotland Act 2014 and also the Social Work Scotland Act 1968. All of the statutory guidance that sets up our expectations for adaptations is kind of spread out there. It’s not the clearest in terms of the legislative and policy framework that supports it.

Jimmy Black

OK, we have hundreds of thousands of people in tenements. I think it’s hundreds of thousands. It’s a lot anyway. And we can’t just demolish those tenements. What can we do to make tenements more accessible? I once suggested that we put lifts on the back of Glasgow tenements and the Dundee tenements, but the people I was at, were just open-mouthed at the possible cost of that. What can we do with tenements?

Susie Fitton

There are some challenges with adapting tenements. There has been progress, so there was a real effort to try and simplify the system for obtaining consent to adapt a common part, so essentially if you needed to ramp the communal entrance to a tenement, you used to previously have to get majority, unanimous consent for that. And that, as you can imagine, in a tenement situation with lots of different neighbours and some absent neighbours, that was really difficult. But the Scottish Government took that on board. It did take a long time, but they did eventually change the legislation so that you only need majority consent for an adaptation to a common part.

And there has been quite a lot of work to try and improve the understanding of people who live in tenements to the importance of supporting an adaptation and consenting to a situation where their neighbour may be looking for a stair lift to a curved stair in a tenement or a door entry system or something that allows the common area and the common access to a tenement to be accessible. So there has been a focus on this and there has been some improvement. Are there design solutions, such as you say, Jimmy, putting something like a through-floor lift in a tenement or a lift at the back? There’s work still to be done on how we make large-scale access solutions in tenements. It’s an ongoing conversation basically. And it really does kind of highlight the need for the range of reforms to a number of systems that we need to ensure that we have enough accessible and adapted housing.

So when, for example, an access solution to an individual home in a tenement block is not going to be a long-term solution, how we can support people to move to more accessible new build housing. As you’ve talked about, we’ve got this commitment to make an accessible housing standard in Scotland. That’s a commitment in Housing to 2040. And we know that we’ve had this review of housing for varying needs, the design standard for social housing, but that review has stalled. We’ve had the consultation, but we haven’t had the output from that consultation.

So at the moment, what we want really is a cross tenure design standard that creates the most accessible homes that we can within a framework that’s possible and with a grant funding system in terms of social housing that supports the development of accessible homes. So we need a number of systems to be working properly and this applies to people in tenements as much as in other parts of the system. So we need new world homes to be accessible. We need support for organisations to provide specialist homes. We need, obviously, as this report makes very, very clear, we need a system that supports the provision of adaptations and we need to support the provision of technology and technology-enabled care and those things are really fundamental to responding to an ageing population, whatever the type of housing that people live in.

Kieran Findlay

I think you’ve just answered my next question there, we’re trying to build this utopian system here. We’ve got the multi-tenure funding mechanism. We’ve changed the stigma towards aids and other adaptations. What would be required to move away from this reactive system to a wholly proactive method? Susie, Vikki, sorry.

Vikki McCall

You framed it as utopia, but there are other models that do that. We can look just across the border to England and they have Foundations which supports home improvement agencies across tenures. There’s one pot, there’s the DFG, the Disabled Facilities Grant, and Foundations is a national body that supports people and agencies that deliver across the board and different local authorities. So it certainly can be done and I would have said other countries are somewhat further ahead than us. We seem to always trip up when the tenure, when the funding elements come up and it is just seen as too tricky to change.

But when other people have done it, it does seem that that is doable in terms of that, especially having, I would love my utopia would be a national body that across Scotland brings all this together where people can go for a one-stop shop both when I’m feeling really ambitious for professionals to go and see best practice, see how it works and that can and a body that would help people understand the legislature, the statutory guidance, the framework, the expectations, what it includes, pro setting and support processes and leadership around that. But also something that supports that information and advice piece just for service users as well.

Somewhere where it’s really known, go to this place for advice when you are looking for an adaptation and to be more proactive in sending out information. And our research suggests we should be thinking about this 55 plus onwards about right sizing, about getting our homes ready for us when our health needs may change or whatever life throws at us, and a place where we can go to that everybody knows about where that information and advice is available and if you need help is very clear on how to then go ahead and get that help, how the process works, how the system works and what’s included.

Jimmy Black

There is another way and I think it’s something you’ve highlighted yourself, Professor McCall, in your research, which is self-directed support. Now, as far as I can tell, self-directed support hasn’t had the take-up that everybody thought it would have, but nonetheless, it’s another way of providing money for adaptations.

Vikki McCall

I think it is that culture piece again that they don’t know that they can use it. And one of our recommendations is greater use of self-directed support, particularly direct payments. And that would need, I think, to work clearer guidance, practitioner training and access to trusted contractors as well as people because there’s a big part of people managing that process and one of the barriers that comes up again and again around adaptations is in a time of crisis, often after a health crisis, people have to become suddenly project managers, working with contractors, and that’s a really difficult system to navigate. So that really applies to that process as well.

Kieran Findlay

So Vikki, there’s a set of eight clear priorities for change. If you could pick one to implement immediately, one that would make the biggest difference. Which one would it be and why?

Vikki McCall

Well, the go-to is going to have to be sustained and sufficient funding for adaptations and the staffing, the assessment and the coordination required to deliver that effectively. By 2020, Scotland is spending about £25 million a year on housing adaptations across the sectors. And by 2040, there’s caveats to this researcher-wise, but we’re looking at about £80 million by 2040.

And most of that spend is going to fall on local authorities and housing associations unless more support is provided also to homeowners. So that would be we have to get that funding right. There is really no way around that. But what would also strengthen it and I would say easier wins in some ways is to really go forward with a clear legal and policy framework that strengthens that statutory guidance that had enforceable standards as well and something that could be reported to as well that ensured tenure-neutral access and support across areas.

But the first step of that, and sorry I am being greedy this is now my third thing and you asked me for one, is that commitment and follow through to review the adaptations policy and take this wider approach to adaptations that we’re advocating here in the report.

Kieran Findlay

Susie, the report calls for greater political leadership but what does this is look like in practice? You’ve mentioned that there’s a new housing sector and that’s great. But then there’s also a cabinet secretary for health and social care. Anyone who was at the housing, our very own Housing and Social Care Accessibility Summit last year, would have heard us bang the drum over and over again about the need for these two different areas to work closely together. So, who needs to take responsibility then, and how do we hold them accountable?

Susie Fitton

So for us, we need clear political leadership on the issue. As you say, these and as we’ve talked about at length, really, these issues have been banded around for 25 years. But this report gives a clear outline of what is required in terms of recommendations and opportunities. It’s a call for action. So the first thing is that we want the Scottish Government to receive the report and to respond to it.

We want to see a cross-party commitment to ensuring sustained and sufficient funding. So we will be looking for a commitment to a cross-tenure funding pot for adaptations and possibly a single delivery body for it. Because at the moment, as we’ve talked about at length, the system is so fragmented that it’s impeding delivery.

We’ve talked about the review and there’s been this commitment to a review in that, and we want to ensure that this report influences that review. So again, we want a commitment from the Scottish Government to take account of the recommendations of this report in that review. But there’s been reviews time and time again, so it can’t just be left at the review stage. We need a strong commitment from the Scottish Government that there will be sustained and sufficient funding for adaptations across tenure. And we need political leadership on that and that needs to come from the highest levels of government.

Obviously, the cabinet secretary, we’d like to see a response to this report and we’d like the Scottish Government to follow through on the commitments that it’s made to adaptations over the years and the commitments that it’s made to updating national guidance and introducing consistent reporting mechanisms as well as funding. So we really need to see a commitment to prevention and adaptations at the highest level of government.

Jimmy Black

OK, but you’re making a big assumption here, which is that the Scottish Government responds to well-argued, good arguments from well-respected and well-informed organisations. Now, that doesn’t actually cut the mustard politically. There’s an election coming up. How are you going to get the kind of support behind the things that you’re calling for from the people who may be affected by this? I mean, can they be drummed into action as a way of forcing the Scottish Government to actually look at this and take it seriously?

Susie Fitton

So I was really quite surprised actually, at the amount of pick up and take up of a report that we put out as part of our Road to 2026 series. So we’re outlining key policy positions that we would like to see in parliamentary party manifestos ahead of the election. And we put out a report called Homes Fit for the Future, which really outlined what needs to happen in terms of responding to an ageing population. And our calls for action included a national strategy for housing older and disabled people, completion of the review of housing for varying needs, which we’ve talked about, creation of a new cross tenure design standard for new homes, the commitment to the RSL adaptations programme and a budget that actually meets demand and ensuring the system for delivering and funding adaptations across tenure is fit for purpose and recognising the wide range of benefits of housing support. And we actually got an enormous amount of pickup for that.

So my view is that the tide of public opinion is really changing on this and it’s turning. And I think that we will see and I think that this is a really opportune moment to really push for these type of things to be included in manifestos so that we actually see some cross-party pressure and the Scottish Parliament actually advocating for concrete things that we can do to ensure that we do respond to an ageing population. I really do think that there feels like a, this feels like a really important moment for this research to land.

Vikki, I don’t know how you feel, we’ve both been talking about this. Certainly, I’ve been talking about this since I started out working on housing issues. I started out supporting disabled people to build, buy and rent more accessible homes. I supported an advice service to support, often private owners actually, to adapt their homes and was really, really struck then by the range of barriers that people had to accessing adaptations and adapting their home properly. But it feels to me like we’re not, we don’t seem to have to explain the necessity for adaptations anymore. It’s really about people saying, ‘well we know this is important and actually what do we need to do?’ So I feel like we’re actually at really important moment for this research to land.

Vikki McCall

Absolutely, I think we’re in the cusp of real action here. The evidence over the last decades and we’ve been doing this for decades now is unbelievably consistent about the need and the barriers that are out there. The challenge isn’t really no longer knowing what to do, it’s doing it. We have this going over that step and the need is just growing. The report is very clear about that. It’s just going one way, it’s going up and the cost of inaction will mount as well. You’re just deferring costs into the future and future problems if it isn’t addressed at this moment.

And we are building a quite surprising amount of momentum that includes a lot of motivated and enthusiastic professionals and members of the public as part of, for example, our inclusive living alliance as part of the Accessible Housing Network. And I’ve been part of other groups where there’s so much momentum at the moment that people say, ‘right, now is the time’. People are already living in situations that you would not, that do not support human rights, that are not supporting their dignity, their confidence, their everyday day-to-day activities that everybody else takes for granted. So that’s only going to get worse.

And the impact also on wider sectors is coming to light in different ways. We don’t have this figure for Scotland, but we do know from the new BRE report in 2024 that poor housing costs NHS in England £1.4 billion a year. So we know this is cross-sector in terms of a challenge, and we’re definitely building momentum in terms of people saying, ‘right, that’s it. Now is the time we could do something really special in Scotland around this’.

Kieran Findlay

Well, that’s all for this episode of the Scottish Housing News Podcast. A huge thank you to our guests, Professor Vikki McCall and Susie Fitton for joining us and sharing their insights. Keep banging the drum, please. And we’ll keep highlighting the great work that you’re both doing. If you’d to read the full research report, you can find the executive summary and key findings on the Scottish Housing News website. We’ll include a link in the show notes to this episode and we’ll also include Susie, the Homes Fit for the Future report as well, since you’ve given that a mention.

Don’t forget to subscribe and share the podcast, and thanks always to Jimmy Black and thank you for listening.