It was clear from Stevens that it’s quite novel for the NHS to be involved in planning right from the start, deciding how these new sites develop and piloting creative solutions for the health and care challenges that society is facing, including obesity and dementia. And he was right – the NHS is usually late to the table and as a result health and care needs can be an afterthought in new housing developments.
The programme offers important opportunities to embed healthy living into everyday lives – one argument being that if we enable healthy living, thus preventing ill health, we’ll reduce the burden on the over-stretched NHS. Healthy New Towns is a sensible programme but it’s also a long-term one, and we might not be able to measure the benefits of this approach for a number of years. In the meantime, how else should we improve health and care through one of the most fundamental parts of our lives – our homes?
Where we live, the homes we live in and the stability of our housing situation can have a profound impact on our health, and also potentially on the need for – and the finances of – the NHS. According to recent estimates, investing £1.6 billion annually in housing-related support services generated net savings of £3.41 billion for the public purse – including £315.2 million in health service costs.
For example, a project set up in the north east between a housing association and clinical commissioning group allowed people with respiratory diseases living in cold, damp homes to be ‘prescribed’ double glazing, boilers and insulation. The ‘Boilers on Prescription’ project reported a 60 per cent reduction in the number of GP appointments needed by people taking part.
About a year ago The King’s Fund set up a learning network with the National Housing Federation to consider approaches to integrated housing, health and care. This brought together housing associations with care providers in order to: share 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 raise the profile of the housing sector’s contribution to better health and care outcomes. Following on from this we have produced a set of infographics to show how housing associations and other organisations have an important role to play with the NHS and care sector in improving and maintaining people’s health. I’d always assumed that housing organisations were there primarily to plug the gap in the housing market – to provide bricks and mortar – but I was so very wrong.
Over the past 12 months I’ve heard about innovative examples of housing associations working with local health care commissioners and providers to develop new packages of care for people requiring health care outside traditional settings such as hospital.
One housing association works with the local acute care provider to develop new care pathways for homeless people, who often have complex needs coupled with issues around mental health or addictions. After an episode of inpatient care, individuals are discharged into the care of the housing association, which then provides ‘step down’ care – a package of interventions and support ranging from sheltered accommodation units to independent housing, with the aim of helping them to remain healthy and stable.
Another housing association works with its local NHS trust to provide community-based support to more than 9,500 people with mental health challenges through an initiative called the Brighton and Hove Recovery College. The college provides a range of opportunities to help people to manage their mental health; courses are co-produced and delivered by people with lived experience of mental health challenges and those who have gained experience through training or work. With opportunities ranging from one-day workshops to eight-week courses on subjects such as ‘managing depression’ and ‘work and wellbeing’, this model turns the concept of recovery on its head by treating everyone as a student rather than a patient.
Initiatives such as these are paving the way for ongoing development in this area – I’ve heard about some great integrated working between the health and housing sectors, and I have been struck by the enthusiasm of colleagues from both sectors coming together to find the best outcomes for individuals.
Here at The King’s Fund we have learnt a lot so far from our network with the National Housing Federation and other activity such as our event on housing and health in partnership with Public Health England, and we are continuing our work to help maximise the contribution of housing to health and care.