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Integrating housing and health: a tough nut to crack?

The connection between housing conditions and health has a long and well-evidenced historical provenance. But if integrating health and social care is a tough nut to crack, does the prospect of engaging with another massive system risk adding another layer of complexity?

The NHS and social care system sometimes attracts attention for the wrong reasons, but the same cannot be said of the burgeoning interest of the housing sector in health, care and support.

‘Can housing crack health?’ is the intriguingly titled plenary session at the National Housing Federation’s annual conference later this year, and the Chartered Institute of Housing is dedicating an entire conference stream to health, housing and care. It is not just one-way traffic. The NHS Alliance, for example, has just produced a new resource to help health commissioners understand and work with housing organisations. In October, The King’s Fund is hosting an event with Public Health England on bringing together housing and public health.

In one sense this is no surprise. The connection between housing conditions and health – both of individuals and populations – has a long and well-evidenced historical provenance. 'Decent housing makes a fundamental difference to mental and physical health and wellbeing and has a critical contribution to make to the value and effectiveness of the health and care systems. But these services do not always join up well, and housing can sometimes be left out of the equation.' This statement is from Delivering lifetime homes, lifetime neighbourhoods, the seven-year-old national strategy of housing in an ageing society but it could have been written yesterday. More recently, a memorandum of understanding – signed by government departments and agencies, professional and trade bodies, and leading learning networks – set out a shared commitment to collaborate for better health and wellbeing outcomes. This chimes with our recent work on population health systems.

Housing organisations account for some 17 per cent of the nation’s homes, worth around £400 billion. Along with their independence as registered social landlords and/or registered charities, they have a degree of financial flexibility denied to local authorities and the NHS. Increasingly housing organisations see their role not merely in terms of bricks and mortar but as helping to promote the wellbeing of local communities in a much broader sense – housing as a service, not stock. Their potential to shape the health of populations is huge. For example, poor housing is said to cost the NHS at least £2.5 billion a year in treating people with illnesses directly linked to living in cold, damp and dangerous homes.

But if integrating health and social care systems is a tough nut to crack, surely the prospect of engaging with another massive system – with completely different governance, funding and regulatory regimes, not to mention professional cultures and ways of working – risks adding another layer of complexity? Is it all just too difficult?

The barriers are real yet this has not stopped many housing providers from developing innovative local schemes from the bottom up. These range from neighbourhood support and prevention initiatives, such as handyperson services, through to reablement services and supporting hospital discharge. Some providers are developing specialist and generic expertise and capacity in dementia care that also involves a creative mix of housing, digital technology and personal care. Examples are legion – see for example the ‘Health Intel’ pages of the Housing Learning and Improvement Network.

I am struck by how much innovation in integrated care is coming from housing providers. Like other pace-setters in this field they have managed to find a way through national and inter-organisational difference and achieved small successes – despite national policy fault lines.

As with the broader challenge of integrated care, how do we scale-up these local successes so they become a consistent and mainstream feature of services everywhere? How did housing providers overcome the obstacles? Why do some places, and people, find it harder than others? Systematic efforts to support, share and consolidate this learning at a national level are limited. That is why, in partnership with the National Housing Federation, The King’s Fund is launching a new national learning network for providers of housing and housing with care to:

  • share and consolidate 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 the emergence of new delivery models

  • raise the profile of the housing sector’s contribution to better health and care outcomes.

The high number of applications for this learning network reflects a keen appetite from housing providers to learn from each other and find ways of turning problems into solutions through closer working with NHS and social care colleagues. We are looking forward to disseminating the lessons and learning that will emerge from this work.