Integrating housing and health: a tough nut to crack?

The NHS and social care system sometimes attracts attention for the wrong reasons, but the same cannot be said of the burgeoning interest of the housing sector in health, care and support.

‘Can housing crack health?’ is the intriguingly titled plenary session at the National Housing Federation’s annual conference later this year, and the Chartered Institute of Housing is dedicating an entire conference stream to health, housing and care. It is not just one-way traffic. The NHS Alliance, for example, has just produced a new resource to help health commissioners understand and work with housing organisations. In October, The King’s Fund is hosting an event with Public Health England on bringing together housing and public health.

In one sense this is no surprise. The connection between housing conditions and health – both of individuals and populations – has a long and well-evidenced historical provenance. 'Decent housing makes a fundamental difference to mental and physical health and wellbeing and has a critical contribution to make to the value and effectiveness of the health and care systems. But these services do not always join up well, and housing can sometimes be left out of the equation.' This statement is from Delivering lifetime homes, lifetime neighbourhoods, the seven-year-old national strategy of housing in an ageing society but it could have been written yesterday. More recently, a memorandum of understanding – signed by government departments and agencies, professional and trade bodies, and leading learning networks – set out a shared commitment to collaborate for better health and wellbeing outcomes. This chimes with our recent work on population health systems.

Housing organisations account for some 17 per cent of the nation’s homes, worth around £400 billion. Along with their independence as registered social landlords and/or registered charities, they have a degree of financial flexibility denied to local authorities and the NHS. Increasingly housing organisations see their role not merely in terms of bricks and mortar but as helping to promote the wellbeing of local communities in a much broader sense – housing as a service, not stock. Their potential to shape the health of populations is huge. For example, poor housing is said to cost the NHS at least £2.5 billion a year in treating people with illnesses directly linked to living in cold, damp and dangerous homes.

But if integrating health and social care systems is a tough nut to crack, surely the prospect of engaging with another massive system – with completely different governance, funding and regulatory regimes, not to mention professional cultures and ways of working – risks adding another layer of complexity? Is it all just too difficult?

The barriers are real yet this has not stopped many housing providers from developing innovative local schemes from the bottom up. These range from neighbourhood support and prevention initiatives, such as handyperson services, through to reablement services and supporting hospital discharge. Some providers are developing specialist and generic expertise and capacity in dementia care that also involves a creative mix of housing, digital technology and personal care. Examples are legion – see for example the ‘Health Intel’ pages of the Housing Learning and Improvement Network.

I am struck by how much innovation in integrated care is coming from housing providers. Like other pace-setters in this field they have managed to find a way through national and inter-organisational difference and achieved small successes – despite national policy fault lines.

As with the broader challenge of integrated care, how do we scale-up these local successes so they become a consistent and mainstream feature of services everywhere? How did housing providers overcome the obstacles? Why do some places, and people, find it harder than others? Systematic efforts to support, share and consolidate this learning at a national level are limited. That is why, in partnership with the National Housing Federation, The King’s Fund is launching a new national learning network for providers of housing and housing with care to:

  • share and consolidate learning about existing innovations and developments
  • offer opportunities for practical and peer support
  • gain a deeper understanding and knowledge of how NHS and social care commissioning works and the emergence of new delivery models
  • raise the profile of the housing sector’s contribution to better health and care outcomes.

The high number of applications for this learning network reflects a keen appetite from housing providers to learn from each other and find ways of turning problems into solutions through closer working with NHS and social care colleagues. We are looking forward to disseminating the lessons and learning that will emerge from this work.

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Comments

#544192 Tim Buescher
PhD student and mental health nurse
University of Hull

I have atended events organised by housing associations and the nhf and have to agree. The level of innovation around providing solutions to complex problems which cut across agencies and disciplines (my interest is in compulsive hoarding) is fantastic. Look forward to seeeing what KF develops.

#544194 John Healy
Non -executive director
Brent Housing Partnership

I have been trying to influence the direction of my housing company to integrate Health and social care into our services without any success. I also chair a disability charity and I find people usually have health issues that are often combined with housing issues. I am interested in joining your network but I cannot see how to register.

#544195 Richard Humphries

Thanks John, I've received your email as well so will reply on Monday.

#544196 Pearl Baker
Independent Mental Health Advocate and Advisor/Carer
Independent Mental Health Advocate and Advisor

I am disappointed you failed to show my response, which did name and shame a LA. It is for me to worry about 'litigation' not the KingsFund.

#544204 Rhiannon Corcoran
Professor of pstychology
University if liverpool

Well done To King's Fund ( as always) for getting to grips with this. This is amongst the top priorities for addressing health inequality with preventative action via non- health policy. All involved in NIHR NWC CLAHRC are exploring this issue too up here in the North West of England.
I' d be intetested in widening the agenda to look at housing layout to explore how community connections and wellbeing are facilitated by some layouts and impeded by others. This is something that our Prosocial Place Programme is interested in and that the community evidence programme ( led from University of Liverpool) of the What Works Wellbeing Centre would like to learn more about.

#544209 Ben Benjamin
hospital doctor
SDHCFT

I was talking to some ambulance drivers the other day - they told me that it was unusual for them to be called to a house which was clean and in a good state of repair.

#544211 Martin Turner
Environmental Health Practitioner
Westminster City Council

Good to see some comment on the Kingsfund website on housing & health. Housing is a significant determinant of health (Marmot), amongst others. The connection isn't a new one, of course, as the author indicated. Readers might like to be aware that Public Health England has commissioned a digital resource tookit relating to Housing & Health, which will be hosted by Nottingham Trent University. I believe it's due to be launched in the autumn at the annual conference of the Chartered Institute of Environmental Health. The aim of the toolkit is to provide a growing online resource on this topick, building examples and evidence of good practice. There will be information on housing conditions, health and well-being, population and age, and housing as a gateway to health. More information from healthhousingtoolkit@gmail.com.
In Westminster Environmental Health is already proactively engaged with our health and social care partners, through established MDTs at GP Practice level. The housing environment is automatically included in considering Care Plans, and for other vulnerable patients too.

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