LTP Priority: Wider Social Impact: Health and the Environment
Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service, Community and Civic
Type of Interventions: Housing Referral Service
Major driver of health inequalities in your area of work
The right home environment is essential to health and wellbeing throughout life and is a wider determinant of health. There are risks to an individual’s physical and mental health associated with living in:
An unhealthy home:
A cold, damp, or otherwise hazardous home is associated with respiratory illness; cardiovascular problems, mental health problems; injuries, particularly in children and older people; poor diet in children; poor infant weight gain; domestic fires; and excess winter deaths. Example: rotting floorboards and poorly lit properties can increase the risk of a trip or fall.
An unsuitable home:
A home that does not meet the household’s needs – due to risks such as overcrowding or inaccessibility for a disabled or older person – is associated with tuberculosis; respiratory illness; mental health problems; negative impacts on children’s development, education and behaviour; physical injury and meningitis in children; tobacco harm; social problems e.g. interpersonal conflicts or isolation. Example: children sleeping in the living room or sharing a bedroom with a parent can harm family relationships and impact on mental health.
An unstable home:
A home that does not provide a sense of safety and security including precarious living circumstances, risk of eviction or homelessness is associated with alcohol and drug misuse; emotional, behavioural and mental health problems in children; suicide; tobacco harm; and tuberculosis. Example: a widower with limited mobility, on a short-term tenancy, who faces eviction and having to move away from his small social network.
In contrast, the right home environment protects and improves health and wellbeing and prevents physical and mental ill-health. People living in homes that are healthy, suitable and stable also supports implementation of the NHS Long Term Plan, local authority plans for social care and the wider economy. Good housing:
- Enables people to manage their own health and care needs, including long term conditions
- Allows people to live independently, safely and well in their own home for as long as they choose
- Enables patients to complete treatment and recover from substance misuse, tuberculosis or other ill-health
- Delays and reduces the need for primary care and social care
- Prevents hospital admissions
- Enables timely discharge from hospital, and prevent re-admissions
- Enables rapid recovery from periods of ill health or planned admissions
- Helps people move on successfully from homelessness or other traumatic life event
- Enables people to access and sustain education, training and employment
- Helps people participate in and contribute to society.
- Inclusion health group
- Protected characteristic
Housing Referral Service.
A housing referral service tackles unhealthy, unsuitable and unstable homes, particularly for people facing the greatest disadvantage, by providing support including advice, improvements and repairs or financial assistance to overcome problems such as disrepair, energy inefficiency, hazards at home, overcrowding or insecure tenancies. Because people living in deprived and excluded communities are at greater risk of poor health outcomes from housing, and because people in vulnerable groups often spend more time at home than other groups, housing referral services can play a big role in reducing health inequalities.
A single-point-of-contact housing and health referral service such as Middlesbrough’s Staying Put Agency (see below) helps reduce the downstream costs of housing-related ill-health to individuals, society and the NHS. Where valuable but more limited services already exist, they can be expanded in terms of the range of support provided or the geographical reach and the number of people they help.
A housing referral service relies on upstream investment and partnership working, often between healthcare, local government, housing bodies and the VCSE sector.
Poor housing in England accounts for £1.4 billion of NHS spending each year, making up 8% of the total cost to society of £18.6 billion (BRE’s ‘The full cost of poor housing’, 2016).
The total number of QALYs saved by improving England’s housing stock is 175,000. Overcoming excess cold and preventing falls have particularly good QALY returns in relation to the cost of healthcare treatment.
Recent research has shown that improving the homes of people aged 60 and over is associated with up to 39% fewer admissions, compared with those living in homes that were not. Reduced admissions were associated with electrical systems, windows and doors, wall insulation and garden paths. There were small non-significant reductions in hospital admissions associated with upgrading heating, adequate loft insulation, new kitchens and new bathrooms.
NICE Guidance 6 identifies evidence based interventions to address fuel poverty.
PHE’s ‘Spatial Planning for Health: an evidence resource for planning and designing healthier places’ shows that health harm and health inequalities are reduced though:
- Warm, energy-efficient homes
- Retrofitting the homes of people with low incomes
- Good lighting and hazard reduction to reduce falls and other risks
- A diverse housing offer, including affordable homes
- Housing for vulnerable groups and for people with particular chronic conditions
In terms of new housing, NHS England’s ‘Putting Health into Place: Introducing NHS England’s Healthy New Towns programme’’ indicates that the health of new communities is maximised by 10 key actions, including:
- Fostering health in homes and other buildings
- Providing services that help people maintain their own health and manage any health conditions everyone spots)
Three Integration Briefings – (a series)
- Disabled Facilities Grant Funding via BCFs – An Opportunity to Improve Outcomes
- Home Adaptations, Integration and the Care Act
- Innovation in home adaptations – a fresh chance
Guidance for Commissioners
NICE NG6 – Excess Winter Deaths and Illness and the health risks.
Guidance may be available, based on the experience of services including Middlesbrough’s Staying Put Agency. The Staying Put Agency is an advice and repair service enabling older, vulnerable and disabled people to stay in their own home. Established in 1991, they are Middlesbrough’s home improvement agency, working with social care and other organisations to provide a service to help older people, people of all ages with disabilities and those who are otherwise vulnerable to remain and live more independently in their own homes. The agency provides: practical advice and assistance, Disabled Facilities Grants to install adaptations, a handyperson service, a telecare and hospital discharge service, low level repairs, home improvement loans, a private works service and ‘Winter Warmth’ projects. This links housing, prevention, health and care strategies.