Housing: a home for STPs looking to influence the wider determinants of health

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Last year I blogged on my reflections about the potential role of housing in sustainability and transformation partnerships (STPs) following a roundtable discussion  at The King’s Fund. That was in the context of the majority of STPs mentioning the role of housing in their plans for the future, but very few putting any flesh on those bones. We have now written a short report, supported by the National Housing Federation, setting out in more detail areas where, in our view, STPs can make more of the potential contribution of the housing sector to improving health.

It is our contention that STPs, and the integrated care systems (ICSs) starting to develop in some areas, should work more closely with local partners to improve the wider determinants of health. This report focuses on how stronger partnerships with the housing sector can help in the short term, in terms of sustainability, and in the longer term as STPs and ICSs transform into population health systems.

In the short term, the housing sector can offer much that can help STPs. We look at three areas where the NHS, social care and the housing sector can work together: to prevent and reduce hospital admissions, length of stay, delayed discharge and readmission rates; to make best use of surplus NHS estate to provide appropriate housing; and to provide good-quality supported housing that supports people with mental health problems to live independently in the community. But as STPs think beyond the short term, the prize is maximising the role of good housing across the life-course, from the early years (eg, by reducing childhood accidents and incidence of respiratory conditions) through working life (eg, by preventing homelessness) and as we continue to age (eg, by tackling social isolation and preventing falls). The prizes are great: better health and potential savings of at least £2 billion per year for the NHS.

Our recommendations include how STPs can gather and make use of the existing evidence and practice. However, as I said last year, sharing good examples and evidence is not enough. The small scale of many housing providers and the variation in their offers is often a barrier to STP engagement. The offer from the housing sector needs to be clearer and, where appropriate, more standardised. STPs also need to be supported by better financial incentives in terms of revenue (eg, capitation that incentivises innovation in who provides services) and access to capital (eg, decisions on capital funding for transformation are based on decisions that take into account how surplus NHS estate is used for housing need). We set out a small number of recommendations for NHS England, NHS Improvement and the housing sector to help make these things happen.

Serendipitously, our report comes hot on the heels of Improving health and care through the home: a national memorandum of understanding, which has been refreshed in the light of significant changes – including the establishment of STPs – since its original incarnation in 2014. The MoU, signed by 26 housing and health organisations, including NHS England, sets out principles for joint working for better health and wellbeing outcomes and to reduce health inequalities; a framework for national and local cross-sector partnerships to provide healthy homes, communities and neighbourhoods; conditions for developing integrated and effective services to meet the needs of individuals, carers and families with a range of local stakeholders; and what shared success might look like.

Our hope is that our report will be a useful starting point for STPs who are serious about acting on the wider determinants of health and want to demonstrate this commitment by taking the principles of the MoU forward locally.

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