Integrating health and housing

Does housing affect health? We know in the UK that there is a significant shortfall in housing. The Housing Federation puts this figure as an annual shortfall of 340k homes a year just to meet requirements.

In addition to this, many people live in unhealthy or unsuitable homes, or live in precarious situations. These factors can have a significant and detrimental impact on health outcomes. And there are some people who are particularly vulnerable – babies and children, people with disabilities, and older people. This is not just about housing, but also public health.

How do we integrate health and housing? This was the question to kick off a webinar discussion in July facilitated by Ethan Williams, researcher at the King’s Fund. Panelists included:

• Rachel Toms – Programme Manager, Healthy Places, Public Health England
• Rachael Byrne – Executive Director, New Models of Care, Home Group
• Vic Rayner – Executive Director, National Care Forum

This report has been updated following the publication of Creating healthy places: perspectives from NHS England’s Healthy New Towns programme from the King’s Fund.

How housing can affect health

There are many ways that housing can effect health.

• Unhealthy homes – homes that are cold or damp, or have poor heating can impact of health in a myriad of ways – from reduced educational attainment for children to impacting on respiratory conditions and so on.
• Unsuitable homes – that are not meeting the needs of occupants. There may be issues of overcrowding, or homes not adapted to meet needs. For example, imagine someone living with arthritis, unable to bathe as it requires climbing into a bath which they’re unable to do.
• Unstable homes – where people are at risk of eviction or are otherwise in a precarious position.

And of course within this there are people who are homeless. The average life expectancy for a homeless woman is 43.

There are populations who are particularly vulnerable. For example, some older people own their own home but are cash poor. This could mean someone who can’t afford heating, and can’t access services to prevent a further decline in health. Loneliness is also important to consider.

Housing Associations have a role to play here, in building new homes and supported housing. However, one of the challenges is to meet needs both in terms of the numbers of new homes, and getting the housing right for people who need additional support.

What do people mean about integrating housing and health

There was general agreement by the panelists that integrating health and housing, including care, needs to reflect local needs both now and into the future.

And there are some significant challenges here, including:

• Getting the commissioning right in a way that supports integrating housing, health, and care. NHS Trust often don’t know what the housing offer is and how to access it;
• Addressing significant shortfalls in staffing;
• Ensuring services connect up. Significant work needs to be undertaken on data transfer and data interchange and while work is beginning on this, there remain large gaps, and;
• A need to get a clear message across that housing does have a really strong offer to health.

Underpinning this is a real need to demonstrate that housing, and giving people the support they need, can be better for individuals, and lead to significant cost savings. But building the evidence base takes time.

A point that came up a number of times was the importance of leadership and trust. NHS Trusts and Local Authorities need to be confident of the benefits of investments. Also, there needs to be a shared vision. In the West Midlands, Accord provides housing appropriate for people with dementia. There is about having a shared ambition that enables people to thrive and live independently for as long as possible.

Where things are working well

While work is ongoing in aligning data across health and care, housing providers have often been left out of these discussions. But there are case studies of where things are working well, though further evidence is needed.

For example, in the Northwest, Belong now have seven villages, and more in development, on co-located sits that provide care home provision, extra care provision, domiciliary care, co-located GP surgeries and Allied Health Professionals such as physiotherapists. In this way, housing can help unlock capital and provide healthy and supported environments.

Within communities, about one in five homes are of a ‘non-decent’ standards. There could be problems with heating, a leaking roof, poor plumbing, blown light bulbs which the owner is unable to replace. In many parts of the country, organisations have come together to support people to remain in their homes through housing and health referral services such as providing a handyperson to fix issues around the home. Such services exist in Derby, Cornwall and the Scilly Isles, providing a coordinated service that can provide real benefits.

And programmes such as the Transforming Care Programme from NHS England link up health and housing. There are 48 Transforming Care Partnerships working with people with a learning disability, autism or both and their families and carers to agree and deliver local plans for the programme. The partnerships are made up of clinical commissioning groups, NHS England’s specialised commissioners and local authorities.

There is also the NHS Healthy New Towns Programme with 10 demonstrator sites with a focus on meeting new and future health needs. And the King’s Fund have recently published a series of insights into the programme – Creating healthy places: perspectives from NHS England’s Healthy New Towns programme.

The role of technology

From a care perspective, tech is one area that has largely remained untouched for many years. There is real potential for technologies in supporting for instance electronic care plans and medication management. This will require significant investment.

At the Gateshead Innovation Village, there are testing out different models of modular home. In one of these homes, researchers are living in to test out specific technologies, and build an evidence base of what works and what doesn’t.

And work is being undertaken to improve data sharing, and learning from the data to improve health. WCS Care Warwickshire have been on a drive to increase fluid intake and have been able to track this against falls and incidences of UTIs. Learning from such data, and how to ensure people are adequately hydrated is still and at early stage. While data is building, it’s clear that in the context of housing, we have a lot less data.

Reducing health inequalities through housing

Healthy years lived are an important indicator of health inequalities. In the most deprived areas, people on average have 19 years fewer of healthy years compared to those living in the least deprived areas. And this gap in healthy years is even starker when it comes to homelessness.

To address health inequalities, the panellists discussed the need to look at population heath data and look at future demographics to inform spatial planning policy and determine site allocations.

Final thoughts

Housing has a significant effect on health and health outcomes and the impact can’t be understated. To get this right, Trusts and Local Authorities will need to increasingly look to how they can align their interests with those of housing providers. This requires leadership, investment, and a robust evidence base. Work is underway and there is still much more to do.