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‘Imagine leaving your home abruptly and never returning to it again. Or being told that you are moving house tomorrow and you have no control over where you are moving to and how much it will cost.’
These are the opening words of the previously published NHS England’s Quick Guide: Discharge to Assess and benefits for older, vulnerable people. With the words ‘home’ and ‘house’ right there at the start the value of including housing services in health systems is made clear.
We therefore welcome the new NHS England Quick Guide on Health and Housing which identifies how housing and health can work together to ‘prevent and reduce hospital admissions, length of stay, delayed discharges, readmission rates and ultimately improve outcomes for people’.
Housing quality and suitability are major determinants of health and well-being. There is a quantified evidence base which models the costs to the NHS of a range of specific housing features. There is a causal link between housing and many of the most prevalent long term conditions whilst risk of falls, a major cause of injury and hospital admission amongst older people, is significantly affected by housing conditions and the wider built environment.
Decent, warm, suitable housing can reduce the costs of health care. It can decrease GP visits by older people with chronic conditions, enable timely hospital discharge, and extend independent living at home. Addressing housing shortcomings is a key element in effective hospital discharge and prevention and true service integration means integrating health and care and housing.
The national Memorandum of Understanding to Support Joint Action on Improving Health through the Home is supported by many agencies including NHS England. Starting with the shared statement that ‘The right home environment is essential to health and wellbeing, throughout life’ it recognises housing’s contribution to: addressing the wider determinants of health; health equity; improvements to patient experience and outcomes; ‘making every contact count’; and safeguarding. Developing a local Memorandum is a useful first step in setting out a shared commitment and action plan.
What are key elements of housing provision that can improve health and enable faster hospital discharge?
Offering timely information, advice and support to patients that looks at their home situation as early as possible after admission can help to address potential housing issues that may prevent safe, timely discharge. Our report report summary on housing advice and information services in hospitals demonstrates too the savings that can be made across a range of housing services reducing the risk of future health problems.
With around 18% of patients in social housing (council and housing association) local connections between these providers and health are important – in connection to allocations priorities and housing related support services, for example. And as the vast majority of older patients live in ordinary, mainstream homes, practical adaptation and repair provision, such as those delivered via home improvement agencies and fast track handyperson services, are crucial components. Streamlined medium and larger home adaptations, including innovative use of the increased national funding for Disabled Facilities are another key element. Care & Repair England’s briefings, supported by Public Health England, on home adaptations offer advice and case studies in this field.
We commend the new NHS England Quick Guide on Health and Housing and urge all CCGs to engage with housing service providers locally to improve discharge and prevent unnecessary hospital admission. Not only will this improve patient care but also save money in the long run.