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Housing and health: ships that pass in the night?

David Buck reflects on work carried out with the New NHS Alliance to promote closer working between the health and housing sectors.


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.