Local authorities have substantial statutory responsibilities for housing, including providing accommodation for the homeless, the elimination and replacement of poor quality stock, and ensuring the availability of affordable housing to all those who need it.
Among the wide range of housing services provided by local authorities, we focus here on three areas that can have a significant impact on improving health: preventing accidents in the home, making homes warmer, and preventing falls among older people.
How can suitable accommodation affect health?
Suitable accommodation that is safe and warm is one of the foundations of personal wellbeing, whether in childhood or old age. It enables people to access basic services, build good relationships with neighbours and others, and maintain their independence – all resulting in a better quality of life.
Preventing accidents in the home among children
- Home accidents are the most common cause of death in children over the age of 1. More than 1 million children under 15 have accidents in and around the home every year that result in a visit to accident and emergency (A&E), with children aged 0–4 at highest risk (RoSPA 2013). Yet most accidents are preventable with improvements in the home environment, education or awareness-raising, and greater product safety.
Making homes warmer
- Each winter in England and Wales between 25,000 and 30,000 more people die than in the summer (Department of Health 2013; Office for National Statistics 2013), particularly those over the age of 65 (The Poverty Site, no date). Much of this is due to living in a cold house with an increased risk of cardiovascular disease, respiratory illnesses and stroke. Cold homes are usually due to poor energy efficiency and inadequate heating, mostly affecting those on low incomes. Just under 2.4 million homes were considered ‘fuel poor’ in England in 2011 (Department of Energy & Climate Change 2013).
- Warmth and energy improvements in poorer households with children can reduce respiratory problems, and even improve mental health (Thomson et al 2013; Marmot Review Team 2011; Liddell and Morris 2010).
- Caution must be taken to ensure that measures to improve insulation do not reduce ventilation, which leads to condensation, damp and mould and associated health problems among the young and old in particular, such as bronchitis and asthma.
Preventing falls among older people
As part of their social care responsibilities, local authorities may have a role to play in making homes safer.
- More than one in five homes pose risks to the people living in them. The needs of a rapidly ageing population (and the number of older people with disabilities, which is set to double by 2040 (Wittenberg et al 2008)) present specific challenges. Adaptations and mobility or other aids help people live independently for longer, yet only 2 per cent of owner-occupied homes have been adapted to meet people’s needs. About a quarter of people with a serious medical condition living in rented accommodation say their homes are unsuitable for their needs (Adams and Ellison 2009).
What are the possible priority actions for local authorities?
To prevent accidents in the home, local authorities can:
- implement guidance from the National Institute for Health and Care Excellence (NICE 2010) and the Safe At Home programme (Errington et al 2011), which includes:
- installing safety gates for stairs and doorways, window restrictors, and cupboard locks
- providing non-slip bath/shower mats, corner cushions, and fireguards
- training relevant staff (including health visitors and family support workers) and community members to run their own schemes
- prioritise high-risk groups, targeting interventions at:
- those with children under five
- those living in rented or overcrowded conditions
- those on low incomes.
To help people keep their homes warmer, local authorities can:
- support the residents most in need to access and benefit from warm home funding and related schemes such as the Green Deal (HM Government 2013a), the Energy Companies Obligation (Ofgem 2013), the Warm Home Discount Scheme (HM Government 2013b) and Affordable Warmth Solutions (National Grid Affordable Warmth Solutions 2013)
- help to reduce the number of homes with poor energy ratings by installing better insulation, focusing on the private rented and owner-occupied sectors, where people are at greater risk from cold (Sreeharan et al 2012)
- encourage homeowners and landlords to keep homes warmer by advising them on how to save energy (eg, through home energy audits and advice (Energy Saving Trust, no date))
- help people reduce their energy bills by organising ‘collective switching’ schemes; these should target poorer consumers to avoid unintended outcomes (EBICO 2012), and give people information about community schemes (Energy Saving Trust 2013).
To reduce the risk of falls among older people, local authorities can:
- develop specific strategies and programmes, which have been shown to reduce falls by up to 30 per cent (NHS Confederation 2012), working with the local NHS, housing agencies, and local authority social care and housing departments
- undertake targeted risk assessments and work with home improvement agencies to provide support for older people, people with disabilities, and those on low incomes. Aids and adaptations make it possible for people to remain independent and in their own homes for longer, particularly if integrated with other social care support provided by local authorities (National Housing Federation 2013)
- consider developing handyperson schemes, often provided by the local authority to support vulnerable people to improve the safety of their homes (Chaplin 2013), and link these with hospital discharge schemes to help prevent further accidents.
The business case for different interventions
Poor housing costs the NHS at least £2.5 billion a year in treating people with illnesses directly linked to living in cold, damp and dangerous homes (Friedman 2010). Treating children and young people injured by accidents in the home costs A&E departments across the United Kingdom around £146 million a year (National Institute for Health and Clinical Excellence 2010). Among the over-65s, falls and fractures account for 4 million hospital bed days each year in England, costing £2 billion (Royal College of Physicians 2011).
Meeting the NICE guidelines on safety assessments and installing safety equipment in homes would cost £42,000 for an average local authority. If this prevented 10 per cent of injuries, this would save £80,000 in prevented hospital admissions and emergency visits, with further savings in associated GP visits and for ambulance, police and fire services (NICE 2010). In the 10 best-performing Safe At Home scheme areas, hospital admissions fell by 29 per cent (Laser Alliance 2012). This equated to an overall saving of £27 million, while the cost of implementing the programme in these areas was just £1.7 million. Work for the Office of Disability Issues (Heywood and Turner 2007) shows that payback to health and social care of housing adaptation. Health impact assessment of housing improvements in Derby showed savings to the NHS and wider community (Building Research Establishment, no date). Birmingham City Council recently produced a health impact assessment of its two main housing-led programmes, Decent Homes and Supporting People (Birmingham City Council’s Housing Strategy and Partnership Team 2011). For a total outlay of £12 million, they achieved savings of £24 million a year. The quickest wins were from improvements related to excess cold and reducing falls among older people (whether on stairs or on level ground).
Further resources and case studies
- The Chartered Institute of Environmental Health has produced a toolkit on how housing improvements can contribute to better health, with case studies (Building Research Establishment 2008).
- The evaluation report of the Warm Homes, Healthy People Fund 2011/12 includes case studies (Sreeharan et al 2012). Interventions ranged from home checks and emergency repairs, to practical aids such as thermometers, cold alarms and warm packs.
- The Local Government Association has produced case studies showing how local authorities have helped people reduce their energy bills through collective switching schemes (Local Government Association 2013).
- The Energy Saving Trust has produced a guide to community-run heat- and power-saving schemes, with UK-wide case studies (Energy Saving Trust 2013).
- RoSPA and Public Health England’s handbook, Delivering Accident Prevention at the Local Level in the New Public Health System (Royal Society for the Prevention of Accidents 2013), focuses on accident prevention in the home and includes case studies of interventions targeted at children and older people.
- NICE has published guidance on preventing unintentional injury in the home for under-15s, which includes a costing report and template (National Institute for Health and Clinical Excellence 2010).
- The final evaluation report of RoSPA’s Safe At Home scheme (Errington et al 2011) includes case studies from across England, outlining the background and partners involved, key aspects of the scheme, barriers encountered, sustainability issues, and lessons learned.
- The Department of Health has produced a best practice guide on reducing the numbers of excess winter deaths among older people, which includes housing and other interventions (Health and Inequalities National Support Team 2010).
- Research by the Department for Communities and Local Government into the financial benefits of the Supporting People programme includes a spreadsheet for working out local paybacks (Department for Communities and Local Government 2009).
For references please see Improving the public's health: references appendix