Housing and health: ships that pass in the night?

We have known for many years that good-quality housing is critical to health. Research evidence tells us this, our common sense tells us this, the NHS and wider health and care sector knows this, and the housing sector knows this.

But, despite this knowledge, and many good intentions, the housing and health sectors are too often like ships that pass in the night. Why is that, and what needs to be done to change it?

Recently, there have been efforts to bring the two sectors together: broad policy ambitions, such as the focus on place-based planning and new models of care in the NHS, devolution within England, the Better Care Fund and transfer of public health responsibilities have all been helpful, as have the signing of the Improving health through the home memorandum of understanding and joint conferences, events and resources. NHS England’s support for Healthy New Towns, and the wider focus on better use of public sector estate are also promoting closer working.

Today, three reports are published, based on work commissioned by the National Housing Federation from The King’s Fund and the New NHS Alliance, that focus on local relationships between the NHS and the housing sector. The reports cover three closely related issues: the differences between the sectors’ views on what counts as evidence; useful examples for making the economic case for closer co-operation between the housing and health sectors; and guidance on making a good business case to health organisations

These reports are based on interviews with health and housing professionals, literature reviews, an analysis of the National Housing Federation’s audit of its members’ work with the NHS, and case studies. One thing that leaps out to me, as a health policy specialist, from all this research is the extent to which housing associations are already working with the NHS, not just in relation to their residents, but across wider communities. Increasingly, housing associations have at their disposal high-quality evidence of the impact of their actions on people’s health and use of the NHS from randomised controlled trials, cost-effectiveness studies and cost–benefit analyses.

The first report sets out examples of how different economic arguments and evidence are being used in practice locally. The insight from this is that there is no single argument or piece of economic evidence that is guaranteed to win over health colleagues. Sometimes, straightforward operational arguments, such as ‘we have beds with high-quality care support, at a lower price than your hospital bed, available now’, work; at other times, the ‘we have a cost–benefit analysis, showing the return on investment for long-term health of investing in X’ approach could be more effective. The critical thing is identifying with whom and under which circumstances each approach is likely to work.

To do that, the housing sector needs to have a deeper understanding of how the health sector views evidence and where to direct its case. The second report considers health professionals’ attitudes to evidence, busting the longstanding myth that the NHS will only listen to evidence from randomised controlled trials. It also sets out which sort of evidence is likely to be accepted by whom and how to spot the opportunities to make a business case. These insights are brought together in the final report, which outlines the questions that the housing sector needs to address when developing a business case aimed at health colleagues.

In our work on these reports, we have also encountered and been challenged by differences in what counts as evidence, in the approach to economics and in the language that professionals use. We have learned from this experience and hope that others will too.

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#548266 Pearl baker
Independent Mental Health Advocate and Adviser/Carer

We have to be clear about what we actually understand or know how Housing/Health affects the various vulnerable groups within the Social Housing sector, and why many are 'falling' through the 'Gaps' EXAMPLE:
Supported accommodation is where my expertise lies, 'unregulated'.

Housing Association fail to understand that to charge rent to someone subject to Section 117, placed into Supported Accommodation by the LA is 'illegal' not only by charging but also by claiming 'intensive Housing/Service Delivery. WHY 'aftercare' is FREE to those subject to Section 117. Case Laws exists. Where the LA Fund the SUPPORT but the Property is owned by a Housing Association this also confirms the FACTS you cannot charge for the same service twice?

The most serious consequences is that often these vulnerable groups receive little support, due to the inadequate funding by the LA, secondly the residents have no CHOICE who provides the INADEQUATE support, and no Personal Budget.

More individuals are being taken out of residential care and placed into this 'unregulated' accommodation, and who is MONITORING the actual support given to this client Group.

The Care Act play a significant part in who is responsible for providing what in LAW re: Section 117.

The Homes & Community Agency are partly to blame in allowing HA to charge 'illegally' for Support Services Funded by the LA, due to insufficient knowledge in relevant Case LAW.

Health and Housing go together but it has to be MONITORED by an Independent Organisation on a Local Level, then you will notice a difference in both.

#548302 APhill
My Landlord

"[...] the differences between the sectors’ views on what counts as evidence[...]" Unfortunately, this is a common issue with many organizations and the way to solve it is by testing, in my opinion. Experience is what will show the successful methods in each situation.
Housing issues remind me of vacation rental problems: https://tackk.com/airbnb-vacation-rental-cleaning

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