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Blog Jon Rouse


Good health begins at home

Posted by: , Posted on: - Categories: Homecare, Integration

You don’t need to be a medical professional, carer or social worker to know that badly maintained or inappropriate domestic environments can have a long term, detrimental impact on the mental and physical health of the occupants. The onset of asthma is not going to be mitigated by a home with damp in the walls and mould growing in the bathroom. Likewise, rotting floorboards and absent stair rails do not lessen the likelihood of falls and injury among the elderly or otherwise infirm.

Housing and handThere is a growing evidence base for the contribution housing can make to good health and wellbeing. At a system level, poor housing costs the NHS at least £1.4bn per annum. I have now asked my team to explore ways to estimate the cost at a local level which might help concentrate the minds of those administering health and local authority budgets. On an individual level, suitable housing can help people remain independent for longer, and support them to perform the activities of daily living that are important to them – gardening, shopping, visiting friends and family for example.

But this awareness is nothing new. Some of the early public health work in the 1800’s sought to reduce overcrowding and improve basic sanitation. Later, in the 20th Century, philanthropists such as Joseph Rowntree embarked upon ambitious home building schemes – recognising the important role that housing plays in supporting healthy ageing and building strong economies. Later programmes such as the growth of the housing association movement, decent homes and affordable warmth programmes have all made a difference.

'Joseph Rowntree recognised the important role that housing plays in supporting healthy ageing.'
'Joseph Rowntree recognised the important role housing plays in supporting healthy ageing.'

Despite this progress, there is recognition that we could go further and faster in strengthening the links between housing and health. It is still surprisingly rare for health and care services to recognise the benefit of investing in housing improvements, despite the return flowing to their services in the form of reduced hospital admissions and the ability to remain at home longer.

So we must do more to drive joined-up decision making between housing and health and care services. For example, Directors of Public Health and their departments need to be more visible in this space. There are some positive examples around the country, but it is surprising that housing conditions don’t have greater prominence in Health and Wellbeing strategies where we know there are considerable problems with the condition of the housing stock, particularly in the private rented sector.

This year, the Better Care Fund is a minimum £3.9bn pooled budget promoting better social and integrated care planning, with another £1.5bn being added by 2019-20. But there also needs to an increase in targeted assistance, to help people become more independent in their homes, allowing them to live comfortably and care for themselves. This is what the Disabled Facilities Grant (DFG), routed through the Better Care Fund, sets out to do. Following the last Spending Review, we will more than double resources available through the DFG from £220m this year to over £500m by 2019-2020, for the simple reason that we know that if funds are invested well, we get a very good return.

This means though that we need Health and Wellbeing Boards to really engage on how to use this resource to its greatest benefit. This starts with ensuring local housing authorities are given the resources to meet their statutory duties, but we also want to see the resource combined with other pots to support broader, more innovative projects around housing and health.

We want to see more authorities integrate the provision of equipment and adaptations into hospital discharge services with rapid deployment. Get this right and the extra money could mean around 85,000 more people across the country benefitting from improved access to their property, fewer hazards, better heating and the latest technology to help them live independent, happier lives. Good health starts at home.

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  1. Comment by john glover posted on

    good health begins at home yet the most essential person to that has just yet again been stabbed in the back by this government im talking the actual carers whilst mps languish in there 17% pay rise [ which is = to 3 yrs on average carers allowance] carers get nothing yet again they are the back bone to the care system in the uk saving tax payer billions on average every year yet whilst cost of living goes up there income stays the same making them poorer

  2. Comment by Steve Palmer / SCIE posted on

    Very interesting. My friend runs a de-cluttering service in Essex. In January I wrote a Linked In blog about how his work can link to the Care Act and delayed transfers of care.

  3. Comment by Robin James posted on

    Dorset is working on developing our 'Safer Homes' scheme which gives health and social care professionals rapid access to Handyvan service to speed up discharge from hospital.

  4. Comment by Fabian posted on

    Unfortunately I know about this first hand because I'm living in it as well as my family. and have been complaining for years but the council and housing association does not seem to care there are many children on our estate being rushed to hospital for breathing issues many unexplained illness ect. We have done everything in our power to keep on top of things and to solve our issues but don't seem to be getting anywhere with it all we have had humidity readings as high as 82% in the bedrooms we have chemical and electrical dehumidifiers we ventilate the property. The problem lies with society it seems no one can be heald accountable and alot of game playing is being aloud to go on

  5. Comment by Anees Mank posted on

    Couldn't agree more with Jon. Focusing on prevention and early intervention through housing and health schemes tackling Fuel Poverty, providing timely Home Adaptations and facilitating prompt Hospital Discharge is key to reducing demand on the NHS. Many examples of good practice exist across the country, but need to work on changing the culture and mind set of front line health and social care practitioners to encourage them to consistently refer in to these schemes.

  6. Comment by Katharine Knox posted on

    There are also important links between housing and health in the context of climate change and public health has a key role to play in responses. See two new reports out from JRF which highlight the current and future risks of overheating in care homes due to high temperatures and problems with heat management

    And also a report highlighting existing public health responses to climate change

  7. Comment by Angela C-B posted on

    please read our disaster story of inappropriate housing for severely disabled gent. accident waiting to happen cant seem to get the right help.

  8. Comment by Rachael Shippam posted on

    In Nottingham housing is recognised as one of the wider determinants for promoting positive health and wellbeing. We have a draft Memorandum of Understanding between housing and health currently out for consultation. Comments welcomed:

  9. Comment by Pearl Baker posted on

    I welcome the emphasis on housing, however the Winterborne Tragedy has not gone away just 'underground' 'Supported unregulated accommodation' is causing serious concerns. Learning disabilities, mental health are all being effected by the lack of regulation. It is now approaching 2 years since the NHS Leadership Academy invited me to speak of the Neglect identified by me in this type of accommodation, nothing has changed. A Carer spoke of his concerns since the Winterborne Tragedy on the evening news last evening, had he not taken control of his son's care his life would be very miserable, and at risk.

  10. Comment by Toxicpotato posted on

    I asked sw to arrange ot to assess viability of new house last year. We are moving to new house in 2 weeks. The ot may come in 3 months. The ot and sw will doubtless argue that my cared for be in resisential care because the house is not suitable...because it takes too long to arrange ot

  11. Comment by Angela M Cavill-Burch posted on

    Please read about our struggles for medically appropriate housing for my Husband who has a high level spinal cord injury. the DFG is useless when you need adaptations for medical and access reasons.