Integrating housing, health and care

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Last month Simon Stevens announced NHS England’s Healthy New Towns programme. The programme, which is supported by Public Health England, will work with 10 new housing developments to shape the health of communities, and to rethink how health and care services can be delivered.

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.


Angela M Cavil…

Full Time Unpaid Carer,
Comment date
02 May 2016
We have experienced real problems with getting enough funding from the DFG system because the way the law is written it only covers adaptations that are of an access nature, some of things we need are for medical / care worker safety measures. Due to Hubbys low immune system we need 2 bathrooms one for him and one for visitors / care workers. He also needs space to use physio equipment such as a tilt table. We have also found that the building regs are useless and have resulted in bedroom sizes for couples with one full time wheelchair user being designed too small, we have found minimum workable space without storage is 4m x 4m for 2 single beds, room for care workers to work, room to back up from bed in electric wheelchair turn without banging toes. Living rooms in accessible units tend to be too narrow for electric chair users as well. Living in a communal nursing home setting would be a death sentence to my spinal injured hubby.

Stella Tsartsara

Consultant Integrated Care,
South East Europe Healthcare
Comment date
15 April 2016
I have to agree with Eric and Pearl.
It looks to me quite difficult on the one hand NHS to cut funding in social care and on the other to invest in the construction sector.
And I am not sure the benefits are the same.
I think social care can definitely guarantee more results than forecast (probable) falls prevention research study results out of housing case study. Can you please also provide the evidence demonstrating these numbers and methodology? Any publications?


Comment date
15 April 2016
The real reason the NHS is 'late to the table' is not because local partners don't want it there - it is because funding for primary care is always on a list basis and the NHS cannot bring itself to work with population projections and investing capital upfront.

Pearl Baker

Carer/Independent Mental Health Advocate and Advisor/trust Governor,
Comment date
15 April 2016
Absolutely nothing can really be achieved until their is a change in the LAW regarding 'supported un-regulated accommodation' there is no Monitoring of those owner/providers or indeed Housing Associations Properties/Support/Care, more vulnerable individuals are being placed there instead of residential care homes due to cost.

There is evidence of bullying, control of these vulnerable clients money as well as their ability to enjoy life.

I would like to suggest you take a 'Case Study' on what is going wrong and then look at ways in improving and protecting clients suffering from this Case Study.

I am afraid the Housing Benefit regulations: 'intensive Housing Management/housing service deliver' has made it TOO easy for unscrupulous owner/providers to make 'big bucks' at the expense of the vulnerable. This is easy money, and who is checking delivery? sometimes the services they are claiming for! have been funded by the LA

I offer my 'services free to explain a system that is costing the Tax Payer millions??

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