Targeted investment to reduce and mitigate housing-related hazards plays a key role in addressing associated health harms.

The largest recent example of a national scheme to improve conditions in the social rented sector is the Decent Homes programme, which has overseen improvements in over a million homes since 2001. The programme has thus improved the living standards of vulnerable people across the country and has been praised by the Public Accounts Committee. 6

A broad range of housing stock improvement programmes have also been led by local government, most of which have not been properly evaluated for their health impacts.  A systematic review of studies of these programmes found that the data were not amenable to meta-analysis, for a number of reasons, but came to the following conclusions.

‘Best available evidence indicates that housing which is an appropriate size for the householders and is affordable to heat is linked to improved health and may promote improved social relationships within and beyond the household. In addition, there is some suggestion that provision of adequate, affordable warmth may reduce absences from school or work.’ 7

The National Institute for Health and Care Excellence (NICE) has published specific guidance on reducing the health risks of cold homes, including a number of evidence-based ‘quality statements’ to improve the health and wellbeing of vulnerable affected groups, reduce the risk of fuel debt and improve the energy efficiency of homes (see Table 4). 8 A case study from Leeds on the practical application of these NICE guidelines is summarised in Box 5.

Table 4: Preventing excess winter deaths and illness associated with cold homes (NICE quality standard, 2016)

Statement Detail
Statement 1 Local populations who are vulnerable to the health problems associated with a cold home are identified through year‑round planning by local health and social care commissioners and providers.
Statement 2 Local health and social care commissioners and providers share data to identify people who are vulnerable to the health problems associated with a cold home.
Statement 3 People who are vulnerable to the health problems associated with a cold home receive tailored support with help from a local single point of contact health and housing referral service.
Statement 4 People who are vulnerable to the health problems associated with a cold home are asked at least once a year whether they have difficulty keeping warm at home by their primary or community healthcare or home care practitioners.
Statement 5 Hospitals, mental health services and social care services identify people who are vulnerable to health problems associated with a cold home as part of the admission process.
Statement 6 People who are vulnerable to the health problems associated with a cold home who will be discharged to their own home from hospital, or a mental health or social care setting, have a discharge plan that includes ensuring that their home is warm enough.

Box 5: Case study – ‘Warmth for Wellbeing Service’ (Leeds)

The ‘Warmth for Wellbeing Service’ was established in Leeds in October 2015, informed by evaluations of previous similar interventions, to support households with all their affordable warmth needs. The service provides tailored solutions to needs identified by/for vulnerable people living in cold homes, incorporating:

  • face-to-face advice
  • low cost energy saving improvements
  • heating serving or repairs
  • referrals to relevant support, such as large-scale energy efficiency improvements to their property.

The service is offered to residents living in private sector housing who are in receipt of any income-related benefit, on a low household income (under £21,000 per annum) and have little or no savings. The emphasis is on those who live in fuel poverty. Eligible residents must also fulfil one of the following criteria:

  • over 60 years of age
  • expecting, or have children under age 16
  • have a disability or cold-related illness.

Preliminary findings show that the service’s freephone telephone number has experienced a month-on-month increase in calls, there have been a higher than expected number of referrals from frontline council officers, and fruitful connections have been made with local social prescribing schemes. Benefits to householders include:

  • significant savings on utility bills, mainly as a result of successful Warm Homes Discount applications and switching suppliers
  • timely heating repairs and improvements, ensuring that they have not been left without heat or hot water for long periods of time
  • support to apply for free or subsidised replacements of obsolete heating systems and other large energy-efficiency measures.

It is now possible to calculate the health benefits of interventions to improve housing stock conditions using the Housing Health Cost Calculator, which has been developed by the Building Research Establishment (BRE) in partnership with RH Environmental.  This tool quantifies the health impact of works undertaken to reduce and mitigate hazards defined under the HHSRS, and monetises these impacts as savings to the NHS and to wider society. 9  See Box 6 for an example of how the cost calculator has been applied by a local authority.

Box 6: Case study – Using the Housing Health Cost Calculator (Derby) 10

Derby City Council facilitated housing improvements in Brindley Court, one of the poorer private sector accommodations in Derby. The council completed a retrospective health impact assessment to calculate the savings to the NHS and wider society achieved by these works, with measurements made using the Housing Health Cost Calculator.

The total cost of works carried out within the project was £65,709. This work is estimated to produce savings to the NHS of £23,191 and to wider society of up to £58,000 annually.  The largest estimated health cost savings were identified to arise from mitigating hazards associated with excess cold.

It is estimated that, in total, these works will save 36 incidents of harm over a 10-year period, some of which would be expected to involve hospitalisation or death.

References

  1. House of Commons Committee of Public Accounts, “The Decent Homes Programme,” March 2010.
  2. H. Thomson, S. Thomas and E. Sellstrom, “Housing improvements for health and associated socio-economic outcomes,” Cochrane Database of Systematic Reviews, no. 2, October 2013.
  3. National Institute for Health and Care Excellence, “‘Excess winter deaths and morbidity and the health risks associated with cold homes: NICE guidelines’,” March 2015.
  4. M. Davidson, M. Roys and S. Nicol, The real cost of poor housing, 2010.
  5. BRE, “A retrospective health impact assessment of housing standards interventions in Derby,” 2012.
  6. House of Commons Committee of Public Accounts, “The Decent Homes Programme,” March 2010.
  7. H. Thomson, S. Thomas and E. Sellstrom, “Housing improvements for health and associated socio-economic outcomes,” Cochrane Database of Systematic Reviews, no. 2, October 2013.
  8. National Institute for Health and Care Excellence, “‘Excess winter deaths and morbidity and the health risks associated with cold homes: NICE guidelines’,” March 2015.
  9. M. Davidson, M. Roys and S. Nicol, The real cost of poor housing, 2010.
  10. BRE, “A retrospective health impact assessment of housing standards interventions in Derby,” 2012.