See the great work being done in this area, highlighted in The Guardian recently which features a local couple who have been helped with special thanks to Shevaughan Tolputt of Cornwall Council, a key partner in Cornwall and the Isles of Scilly Health and Care Partnership.
Please read the article and in particular the case study supplied by Cornwall, illustrated in the shaded out box within the article.
It made me depressed’: how poor housing costs the NHS £1.4bn a year
With a fifth of English homes officially not decent to live in, health and housing professionals are joining forces to improve residents’ wellbeing
When Billie Dee moved to London after university, a run of unpaid internships meant she could only afford a windowless room in a flat share in Stratford or stay with her boyfriend in Guildford. The room in Stratford made her “horrendously depressed”, she says. “There was no ventilation or natural light. I felt incredibly claustrophobic and my mental health rapidly deteriorated.”
Her boyfriend’s basement room was even worse: “His room was rotting and damp. I actually got whooping cough, which lasted nearly three months. I was so depressed and anxious, and my self-worth was seriously low because my surroundings were so bad.” The situation dragged on for a year until Dee got a new job and could afford somewhere better to live.
The impact of poor housing on residents’ mental and physical health is well evidenced. In 2017, research by Shelter (pdf) found that one in five adults had experienced mental health issues in the past five years due to housing problems, and GPs say housing issues are often a key factor in patients’ mental health conditions. According to the University of Birmingham’s housing and communities research group, one fifth of housing stock in England does not meet the decent home standard.
Poor housing costs the NHS £1.4bn a year (pdf), according to the Building Research Establishment. In terms of physical health, cold, damp homes can increase the risk of cardiovascular, respiratory and rheumatoid conditions. They exacerbate symptoms of arthritis and reduce dexterity among elderly people, increasing the risk of falls. Poor housing represents a similar risk to the NHS as physical inactivity, smoking or alcohol. It’s a link the health secretary, Jeremy Hunt, made in 2017, when he suggested the NHS could in future pay to remove the damp from council homes.
That is not yet a reality, but health professionals are increasingly working with local authorities to improve health through interventions in the home. Around the country, there are schemes to facilitate home MOTs, install heating systems, and refer patients for adaptations such as grab rails or widening doorways.
Tackling fuel poverty to improve residents’ overall health is a core aim for Cornwall council, which plans to invest £8m over the next year to install central heating in 1,000 homes, particularly those in more rural areas. It has also set up an emergency fund for short-term relief, a dedicated phone line for referrals from other agencies, and produced two toolkits (one for local authorities, the other for healthcare professionals) in partnership with Citizens Advice to encourage other areas to follow suit. Anthony Ball, advanced public health practitioner at Cornwall council, says good relationships with healthcare professionals is key; ambulance crews and dementia nurses have been a particularly good source of referrals. “Before, they didn’t necessarily know what to do if someone had a freezing-cold house,” he says. “Now they do.”
The broader impact of something as simple as putting oil in someone’s tank or adding money to their energy account is often immediate, he says. “Being freezing cold impacts on their ability to cook, and shower and wash …
Cornwall council worked with Coastline housing association and local firm Kensa to install geothermal central heating in Cunningham’s bungalow and the homes of seven neighbours in October 2017. He says it’s made a real difference – the house no longer has mould in the bedroom or kitchen and it was the first winter he didn’t get a cold or the flu. He’s also saving around £300 a year on energy costs.
In Leicestershire, housing specialists placed in hospitals worked with an 86-year-old woman who had been admitted eight times in the previous 12 months, largely because of the unsuitability of her accommodation. “She was essentially living in a lean-to [at her daughter’s],” Jane Toman, chief executive of Blaby district council, says. “She was cold, it was damp, and she was going home, getting ill again and coming back to hospital … we worked with her and found her sheltered housing. Six months later and she hasn’t been [readmitted].”
The hospital enabler role sits alongside Blaby’s acclaimed Lightbulb project, which was initially funded by a £1m injection by the government’s transformation challenge award in 2014. It works by tackling residents’ housing issues early through an MOT that identifies adjustments needed in the home. More than 2,300 people have benefited from these interventions in the past six months. A reduction of one fall for every 17 residents saves an estimated £21,000 a year. The focus, Toman says, is on making the process as holistic as possible.
“It’s difficult doing it at a time of austerity, and it challenges the way we’ve always worked,” she admits. “[But] the service should be better [because] there’s fewer people involved. We’ve tracked cases that would have taken five contacts and cost £400. With Lightbulb, it took two contacts and cost £200 … If you get every agency committed to making things better, it can happen.”
It’s this holistic approach that Brian Robson, acting head of policy and research at the Joseph Rowntree Foundation and co-author of a recent three-year study on housing and low incomes, says is needed to make a real difference to health. Good housing, Robson says, is about quality, stability and security, and about suitability, particularly when the home is a place of care.
“There’s a huge impact on schooling for kids who are in insecure accommodation, there’s clearly a knock-on to the NHS,” he says. “We could do with more integration of health, education, housing, all of the different agencies who are trying to work on their own to help the same people … This is where housing policy came from originally, it was born out of a concern for people’s health.”