Making the connection between health and housing

Imagine not going outside your home at all for 7 years, except for essential hospital stays, because you are a wheelchair user and your flat is located on the second floor, with no lift. Imagine not even being able to go into your own children’s bedroom, because your home itself is not wheelchair accessible.

Imagine knowing that you are physically unsafe in your own home, all the time, because you have been waiting for more than a year for the funding to become available to enable essential adaptations. Imagine the pain of then having an accident in your home, and spending time in hospital as a consequence, perhaps for longer than medically necessary because you can’t be safely discharged to your own inaccessible home. After all that stress and trauma, imagine the frustration of knowing that a simple adaptation or repair could have prevented the accident from happening in the first place, at a fraction of the cost of your hospital stay.

Imagine the real fear that you may die while you are still waiting for your home adaptations to be made; or that you may be forced to move into a residential care home, against your own wishes, not because you are unable to live independently with support, but because there is no suitably adapted housing available.

Now imagine trying to remain active, healthy, and mentally well, in such a stressful, frightening and disempowering situation.

Many people are living these experiences, every day. This is powerfully illustrated by the Equality and Human Rights Commission’s recent report, Housing and disabled people: Britain’s hidden crisis, which provides a comprehensive, articulate and often heart-breaking overview of the many challenges in this area, and an urgent set of recommendations rooted in evidence and people’s lived experiences.

At a population level, the impact of housing on health and care outcomes – and indeed costs - is well evidenced, as exemplified through a wealth of research, exemplary practice and other resources on the Housing LIN website, as well as those of other organisations including Care and Repair England, Foundations UK, Public Health England and many more.

As outlined by the ‘Memorandum of Understanding, ‘Improving Health and Care through the Home’, which has been signed by more than 25 national organisations across health, housing and care (including the Housing LIN, ADASS, NHS England, and DHSC), the right home environment can:

• Delay and reduce the need for primary care and social care interventions, including admission to long-term care settings;
• Prevent hospital admissions;
• Enable timely discharge from hospital and prevent re-admissions to hospital; and
• Enable rapid recovery from periods of ill-health or planned admissions.

In recent years, the inclusion of the Disabled Facilities Grant within the Better Care Fund has provided a real starting point for local health, care and housing partners to take a more integrated approach locally, and there are some excellent examples of where local areas have done this, not just for DFGs but much more broadly.

For example, Nottinghamshire Health and Wellbeing Board have set out their ‘local vision for health, care and housing integration’, which among other related objectives, aims to address the need for ‘sufficient and suitable housing, including housing related support, particularly for vulnerable people’. Practical interventions to meet these objectives include the development of a common hospital discharge scheme across the STP footprint that supports residents with housing needs to access housing and housing support in a safe and timely manner.

Promisingly, it is not only in Nottinghamshire that housing services and providers are making a real contribution to supporting hospital discharge in their areas. For many more inspiring examples, do look at this new interactive map, jointly developed by the Housing LIN and Foundations UK, which highlights examples from across England of where housing organisations and services are, or have been actively supporting hospital discharges and helping to get people home.

The Better Care Fund 2017-19 Integration and Policy Framework states that:

“There is a growing evidence base on the contribution that housing can make to good health and wellbeing”.

This is clearly true, as exemplified by this map, as well as by the wealth of resources referenced above.

However, on a personal level, I would challenge anyone who continues to doubt the importance of housing for health, who feels that it is a relatively tangential issue, or who demands further evidence, to consider the experience of their own lives, their own homes, and those of their loved ones. Imagine trying to remain healthy, safe and independent in any of the challenging personal scenarios described at the start of this article.

And finally, imagine the relief of finally being able to wash yourself properly, go to the toilet independently for the first time in years, care for your children, or feel protected from the likelihood of having a painful accident in your own home, thanks to the most straightforward – and often relatively cheap - home adaptations or repairs, or as a result of finally being able to move into a suitably accessible home which meets your needs.

First published on NHS England’s Better Care Fund Exchange on 21 May 2018. Reproduced by their kind permission.

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