Don’t miss the link: how housing supports health targets, saves money and promotes better care

‘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 welcomed and endorsed the NHS England Quick Guide on Health and Housing published this October 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 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.

If we see all CCGs engaging 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. [Dec 2016]

Taking Stock – the outlook for housing & ageing

Hardly a day goes by without there being another story about housing from every side of the political debate. However, nearly all of these are about property price trends, affordability and supply shortages for first time buyers.

The current plight of ‘generation rent’ is undoubtedly a pressing issue as thousands of younger people struggle to find a place to live at all, let alone pay their ever increasing rents. However, homes really are more than bricks and mortar to those who live in them, and it is critical that we don’t lose sight of quality in the race for quantity.

Every home built will be there for much longer than its first occupiers – it is a resource for the future, hence the critical importance of creating sustainable, inclusive and flexible places to live, designed to meet current and future generations’ needs for healthy, accessible places to live.

There are real worries about a ‘race to the bottom’ with regard to space and design standards. The long term consequences of building extremely small, low design quality and inflexible homes are both costly to society and also to individuals.

A quieter but no less important housing issue is growing, and receiving far less attention – the wider social impacts of housing shortcomings for an ageing population. At a time when the fastest growing age groups in society is the over 80s and over 55s this seems remarkably short sighted to neglect housing for these generations, not to mention a missed opportunity by the private sector given that home ownership amongst older households is 75%.

And what of the adaptation of the current stock where most of us will live as we get older? The great news in 2015 of national government increasing its funding for adaptation grants [paid through the Better Care Fund] does not yet seem to have prompted local innovation in integrated delivery or adequate budget setting in most localities.

The full effects of the Housing and Planning Act 2016 are yet to be felt, but just some of the worries of housing providers are the future financial viability of sheltered and supported housing and the potential loss of the more suitable and adaptable stock for older and disabled people as a result of the new Right to Buy. In the case of the latter, there are specific concerns about the scope for financial abuse of more vulnerable older tenants, particularly in high equity areas.

Meanwhile the potential effects of future welfare reform are also giving social landlords sleepless nights, particularly the planned introduction of Local Housing Allowance (LHA) cap. With health and social care already under pressure, these sectors can ill afford to deal with the problems that could arise if older people, living in both supported and also general needs housing, start to face housing costs difficulties.

The Housing & Ageing Alliance is keen to stimulate debate about all of these and more issues that will impact on both individuals and also those involved in the ageing, housing, health and social care fields. It is organising a related policy seminar and will be inviting a range of sector leaders to share their ideas and thoughts in future blogs, so watch this space.

Also published on  the Housing and Ageing Alliance website. [Dec 2016]