The NHS is teaming up with councils to improve health through better housing through home MOTs, quick homes grants, falls helplines, stair lifts and heating systems among others
A recently published King’s Fund and National Housing Federation report on housing and health says the cost of poor housing to the NHS is £1.4bn per year.
Cold housing can lead to chronic diseases like lung and heart diseases and poor mental health as well as heart attacks, strokes and falls.
The report says that reducing excess cold in homes to an acceptable level would save the NHS around £848m a year and reducing all falls in the home could save it £435m.
NHS costs could be reduced by £2bn per year if poor-quality homes with health hazards, such as cold, damp and falls hazards, were brought up to standard, it says.
Next Steps on The NHS’ Five Year Forward View said addressing the wider determinants of health, such as housing, affects demand for primary and acute services; it said it could only be done if the NHS and local government worked closely together to improve health and make best use of available funding.
This year marks the 70th anniversary of the NHS, and serves as a reminder that Aneurin Bevan was minister for both Health and Housing. At a time of rapid home building, he insisted on good housing design, increased space standards and the provision of an upstairs and downstairs w.c. – all revolutionary at a time when two-thirds of houses in the Rhondda valleys did not have an indoor toilet.
Simon Stevens NHS England chief executive said: “Well designed homes that are warm and hazard free reduce the risk of accidents and falls as well as major cardiovascular and respiratory hospitalisations. They are a key element of a healthy childhood and an independent old age. That’s why the NHS is stepping up to work with our council, voluntary sector and housing colleagues who can make a huge difference to the lives of millions of our fellow citizens.”
Three schemes alone are saving tenants hundreds of nights in hospital, visits to the GP, homelessness and more than £2m in savings is being reinvested into their communities.
Across the NHS’ Integrated Care Systems (ICS), where NHS and local government are joining forces to pool resources and budgets, more joint working is yielding patient and public benefit.
Wakefield District Housing (WDH), Wakefield’s biggest housing provider, have more than 31,600 properties housing about a quarter of Wakefield’s population.
Over 40,000 people live in the top 10% most deprived areas in England, and 21% of WDH tenants have a health problem.
As part of the area’s plan to tackle wider determinants of health, NHS Wakefield Clinical Commissioning Group and WDH have introduced four main schemes, jointly funded, to improve housing, tenants’ and community health.
They are saving the NHS and wider society by improving individuals’ health and have potentially reduced costs on the local health service of up to £1.5m a year.
3,200 tenants have the Care Link Responder Service, an alarm with a response team on the end, to help with crises mainly falls but also no response calls, manual handling and assistance and reassurance.
Of the 1,832 calls for falls from these people last year only seven per cent needed an ambulance saving the NHS more than £400k a year – more if an admission had followed – with 1,704 fewer ambulances needed taking the strain off emergency services.
People fresh out of hospital get free Telecare while they recover which is a free direct helpline to a team to get help with issues like falls and mobility, reducing pressure on the NHS.
Mental health navigators take referrals from the WDH Debt Team, Housing Officers and Community Safety Officers on problems like hoarding, poor tenancy management and antisocial behaviour.
They can prevent eviction and potential homelessness which place a greater strain on NHS mental health services and other secondary services. They engaged with over 150 clients and the wellbeing caseworkers carried out over 400 interactions yielding a social return of £1.1m.
There is also a new service based on local hospital wards so when tenants are admitted key workers begin addressing property barriers that might prevent a return home such as broken heating, cold homes or new mobility equipment needed. They reduce NHS delayed transfers of care by using their home improvements team to rectify any issues.
Sarah Roxby, Associate Director of Housing and Health Transformation at NHS Wakefield CCG and WDH, said: “We want to provide the best services we can for our tenants and residents of Wakefield and by linking more closely with health colleagues we’ve been able to reduce the main contributors to NHS admissions such as falls and help refer others with mental health problems who could have been at risk of homelessness. To us it’s an essential way of working – it improves people’s lives and it saves us all money which can be reinvested into improving other health and social care services.”
Seventy- five per cent of death related to falls happens at home and represent 10-25% of ambulance calls to older adults.
One study showed simple home modifications such as installing handrails, outside lighting and slip-resistant surfaces for outside, which cost as little as a few hundred pounds, resulted in a 39% drop in injuries and a 26% drop in medical treatment. Savills estate agents estimate the UK needs to build 78,000 adapted new homes for older people each year over the next decade.
In Blaby, Leicestershire, the county and district councils have worked with the NHS to develop and fund housing support service, ‘Lightbulb’. This provides housing ‘MOTs’ to identify immediate housing safety risks and make adaptations such as ramps or room alterations, and tackle problems such as poor heating and hoarding.
It provides grants, advice and information on wider support and works with Leicestershire hospitals to support discharge and prevent readmissions.
The project led to a reduction in use of some services by 66%, and lower A&E attendances and emergency admissions. 920 unnecessary bed days were saved from the Bradgate Mental Health Unit, 89% of service users said their physical and mental health had improved, 78% felt better about their home and 71% felt better able to get around their home and garden without the risk of falling.
Last September, the scheme was estimated to have saved the NHS more than £435,000 and has been extended across the county.
And in Buckinghamshire Wycombe District Council’s ‘Healthy Homes on Prescription’ allows medical or social care practitioners to refer patients for simple, fast-tracked housing solutions to support independent living at home such as stair lifts or a central heating system.
People with a long-term chronic health condition can apply for up to £5,000 without means testing to help support their physical and mental well-being at home, preventing hospital admission and GP attendances. It is already saving the NHS £53,476 and social care £132,984.