Health & Housing: The NHS is in need of a good home
Housing associations have an important impact on our health and wellbeing by offering decent homes and services, but as a report from the King’s Fund has argued – they can also help to keep our NHS hale and hearty too. By Mark Cantrell
THE NHS is in a critical condition – dare we add but stable? – as it struggles to cope with rising demand for its services, an ageing population, and the consequences of modern lifestyles, so the last thing it needs is the burden of poor quality housing.
But it has to carry the can there too; it doesn’t need to be this way. The case for decent housing and its positive effects on our health and wellbeing has been made before, but in the frenzy to solve the general housing crisis, it can all-too-often become somewhat lost in the noise.
“We have known for many years that good quality housing is critical to health,” said David Buck, senior fellow in public health and inequalities at the King’s Fund. “Research evidence tells us this, our common sense tells us this, the NHS and wider health and care sector knows this, and the housing sector knows this. But, despite this knowledge, and many good intentions, the housing and health sectors are too often like ships that pass in the night.”
Buck is one of the authors of ‘The Economics of Housing & Health’, published in September by the King’s Fund, with support of the New NHS Alliance. It was one of three reports commissioned by the National Housing Federation (NHF) to examine the economic case for a closer working relationship between the housing and health sectors, and how the former can go about improving the way it presents its case.
In so doing, the enterprise has also reiterated the essential message: that good housing benefits our health and wellbeing, which in turn is good for the NHS, the economy, and society as a whole. But it’s not a problem the NHS – of itself – can solve, after all it’s not a housing provider; it’s just left to pick up the pieces.
Housing isn’t just detrimental to our health in the most immediate manner – damp, cold, mouldy, that kind of thing – but also in a more opaque sense. The same property that is perfectly adequate to an able-bodied occupant in good health is a trap for those whose mobility is impaired, either by disability, illness, or the frailty of age; this can exert a toll on their sense of mental wellbeing above and beyond any physical and physiological ramifications.
Too few UK homes are built to be accessible and easily adaptable through the course of life’s stages. And this, too, feeds through into the added burdens faced by the health and care sector. As the report points out:
- Poor housing costs the NHS in England between £1.4bn and £2bn each year due to excess cold, damp and safety issues
- Failure to fit adaptations or take other preventative measures is estimated to cost the NHS £414 million annually
- Falls cost the NHS around £2bn annually
- The total cost of dementia to the UK is £26.3bn, of which £4.3bn is borne by the NHS and £10.3bn goes on social care costs. Two thirds of these costs are incurred by people with dementia and their families, either in unpaid care or in paying for private social care
- Delayed hospital discharges cost the NHS in England £820 million a year, though the report suggests the true cost is probably higher as treatment may be diverted to more expensive private sector providers to free up capacity
- The rate of hospital admission and A&E visits for homeless people is four times higher than the general public. Overall use of health services by homeless people is between four and eight times that of the general population, which is said to create an excess cost of £85 million a year
“Suitable housing that is safe and warm is one of the foundations of personal wellbeing, whether in childhood or old age,” says the report. “It enables people to access basic services and build relationships with neighbours and other members of their community, and can facilitate interventions designed to promote and improve health. For people with complex or severe needs – including the rising number of older people – good housing can help them maintain good health and independence for longer.”
The good news for the NHF – and by extension, its member associations – is that the report essentially endorses its case not only for building more quality affordable homes, but for a closer working relationship with the health and care sectors.
As the report notes, housing associations provide homes that are good environments for wellbeing, are safe and are at a decent standard; they also provide a host of services that helps alleviate the burden faced by the healthcare system. That includes anything from supported housing to support and adaptation services that enable people to live in their home independently for longer.
“[H]ousing associations provide a wide range of other services that improve health and have economic value, to the NHS and to society more broadly,” the report added.
The case is clear, not that there was ever really much doubt: a good quality home that meets our needs isn’t just a benefit to us as individuals and families – it’s also of tremendous importance to the health and wellbeing of our NHS.
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The missing link
It’s not just the NHS that’s feeling the strain of Britain’s morbid housing situation; the nation’s army of unpaid carers also endure ill-effects of unsuitable homes too, as a report from Carers UK made clear earlier this year.
Caring Homes, as the report is called, paints a gloomy picture of people struggling to get by in unsuitable and inaccessible – often plain unhealthy – housing. Indeed, it suggests they have been all-but forgotten when it comes to devising national housing policy.
This failure to address the needs – or the realities – of carers and those they tend to has in itself become a health issue, it argues.
“There are currently 6.5 million people across the UK caring unpaid for an older, ill or disabled relative or friend,” said Heléna Herklots, the charity’s chief executive. “This number is predicted to grow as we live longer, often with long-term health conditions or disability and because social care services have not kept pace with growing demands for care. This is forcing more families to step in to look after their loved ones, often without the support they need.
“The failure of the UK’s housing stock to adapt to the changing demands of an ageing population is making it more difficult for carers and those they care for to manage at home. Unless this is addressed, carers will be unable to cope at home, placing increased pressure on an already fragile social care system.”
The report aims to highlight the important links between housing and health outcomes. There is a growing demand for specialist homes that cater for specific care and support needs, yet these homes make up just 5% of the national stock. Moreover, while the UK faces a shortage of suitable homes for its ageing and disabled population, the quality of existing stock is not fit for purpose. Some 95% is currently deemed inaccessible, for instance.
Damp, unfit and cold housing exacerbates or increases the risk of a range of health problems, especially for those who already have health conditions that require care. Meanwhile, carers’ health is itself put at risk while waiting for adaptations to be made, and indeed the process of navigating and pressuring the system can itself be stressful, which also takes its toll.
As it is, unmodified homes leave families less able to manage and caring becomes even harder, placing greater strain on them. What’s more, carers can sustain injuries and strain from moving and handling the person they are tending.
In a survey of 5,000 carers, the charity found that:
- 18% are waiting for adaptations to be made to their home
- 10% said their home was in poor condition, damp, or in disrepair. This rose to 15% among those renting privately
- 15% said there wasn’t enough space for someone to provide overnight care, rising to 19% for those living in social housing
- 13% said that as a result of caring there isn’t enough space to live comfortably, rising to 18% of carers living in social housing
The charity has made a number of recommendations to tackle the issue. Overall, a national cross-governmental housing and care strategy needs to be developed, it said. Carers should also be excluded from the bedroom tax, while local authorities should be supported to create a nationwide database of suitable properties.
Planning obligations should also be put to better use to ensure more accessible and adaptable homes are built.
“Time is not on our side,” Herklots added. “As more of us begin to take on caring roles, we need the right housing to be able to do so safely and well. The Government has already identified the importance of improving support for carers through the development of its Carer’s Strategy, and this must extend to housing. Until a national cross-Government housing and care strategy is developed, with the needs of an ageing population at its heart, carers will continue to struggle in homes that are inaccessible and unsuitable for caring.”
This article first appeared in the October/November 2016 print edition of Housing magazine