Digging the foundations for better population health

Source: NHE Jan/Feb 18

Unstable homes cost the NHS billions, whilst good housing schemes can relieve pressure from health services. It’s time health and housing started talking, says David Orr, chief executive of the National Housing Federation.

Housing-related costs to the NHS are staggering. Cold homes, poor-quality housing and insecure tenure cost the NHS in England between £1.4bn and £2bn each year. These figures don’t even factor in the housing-related costs of poor mental health, which costs England at least £105bn overall each year.

Poor-quality housing is a significant part of the problem, whilst research shows that good-quality, affordable, warm and stable housing improves the quality and length of people’s lives.

Housing is therefore a key part of the puzzle of relieving pressure on the NHS as another winter crisis dominates the headlines.

In December 2015, NHS England launched sustainability and transformation partnerships (STPs), which are ‘place-based plans’ designed to look at the future of health and care services in their area. Their aim is to shift delivery away from acute to community-based care. They provide an opportunity to look beyond the short term and take a longer-term view, and they will have to work in collaboration with local partners to tackle the causes of poor health and spiralling health spend at their root.

Meaningful collaborations

These fundamental principles behind the STPs are spot on. However, it is proving incredibly challenging to put these ideas into practice.

The STPs – in their current form and as they evolve in accountable care systems (ACSs) – won’t succeed if they are driven by an approach that looks only to the immediate future and seeks only to alleviate financial pressures.

Equally, they will fail to achieve their vision if they omit working with potential key partners, such as housing organisations. A recent review of the 44 STPs by Care & Repair England found that only a few of them meaningfully feature housing. Without involving key partners such as housing organisations, they have no chance of achieving the ambitious vision, or savings, that the NHS is aiming for.

Of all providers in the housing sector, housing associations are ideally placed to help relieve pressures on the NHS, and are ready and willing to be involved. They are not-for-profit housing providers offering affordable homes with a wide-ranging offer tailored to local populations. Housing associations provide 2.8 million homes for more than 5 million people who typically have greater social or health needs than the general population. Those homes are more likely to be of a ‘decent standard’ than in any other housing sector.

Research shows that housing association homes promote good health: they are more energy-efficient, in a better state of repair than any other rented tenure, and on a par with owner-occupied homes. They are significantly more accessible to wheelchair users than any other tenure. They are also less likely to be located in poor-quality neighbourhoods than private rented and local authority homes.


Developing schemes in the community

Housing associations across the country have developed many schemes that benefit the health of both their own residents and the wider community. They are trusted brands operating ‘hospital to home’ initiatives and extra care schemes. Staff visit residents’ homes and can monitor people’s health and convey health messages. They often have expertise in delivering to specific population groups, such as older people or people with learning disabilities.

Unlike the NHS and local authorities, housing associations have financial flexibility, can plan long-term and access additional funds.

Housing associations should be regarded as key health delivery partners, with both an immediate and preventative offer to save money and improve health outcomes for people.

This is a critical moment for STPs and the NHS, with a chance to be truly transformational by working collaboratively. Although pending detail, the newly announced Department of Health & Social Care is promising. If health and social care are jointly funded, it could provide a system sympathetic to integration and the STP goals.

Changing healthcare from the bottom up

STPs and ACSs provide a vehicle for meaningful partnerships to ingrain new commissioning pathways, a better working culture and delivery systems and services to improve health outcomes.

Housing associations can and must be part of better health pathways and help build a movement to change healthcare from the bottom up. The opportunity to forge meaningful partnerships between health and housing cannot be missed.

Strategically including housing in the STPs is only the first step in creating truly collaborative system change. But starting a conversation with housing partners now will help revive the STPs, trailblaze integration, save money and – ultimately – radically improve the health of the nation.




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