Want to improve health and social care? Address homelessness and bad housing

Health and social care is a hot topic in the upcoming general election. Lack of suitable housing options push up the costs of care.  For example, London Borough of Southwark calculates it’s spending over £7m a year (or 35% of the total budget for these services) to unnecessarily accommodate adults and children in residential or supported housing because they’re unable to find a suitable home to move into.  Last week saw the publication of two new reports showing the terrible impact that our housing crisis is having on the health of children and adults.

First, a report from the Royal College of Paediatrics and Child Health and Child Poverty Action Group starkly illustrates how paediatricians are once again seeing the sort of health problems that were thought relegated to a bygone era. Rising homelessness and poor housing conditions are again directly damaging the wellbeing of children in low-income households.

More than two-thirds of the 266 UK paediatricians responding to an on-line survey said that homelessness or poor housing contribute either ‘very much’ or ‘somewhat’ to the ill health of children they work with.

Housing problems are often delaying hospital discharge: almost half of the responding hospital doctors had difficulty discharging a patient in the last six months because of concerns about housing or food insecurity. For neonatologists dealing with very young babies – some of the most vulnerable children – the figure rose to almost two-thirds.

‘I have seen a number of babies being unable to be discharged from the Special Care Babies Unit due to parents being homeless’

The study found that housing problems get in the way of focussing on health and well-being. Paediatricians reported that when parents are struggling to keep a roof over their heads or stuck in unfit temporary accommodation, it is extremely difficult for them to meet the needs of their sick or disabled children as well.

‘Homelessness or the threat of homelessness impacts enormously on a child and family. Securing a decent place to stay becomes the overriding priority for the family that places all other considerations on the backburner. It is telling in a consultation how no progress can be made in managing a child’s health concerns until I make a commitment to assist the family in their search for new accommodation’

A second report by the Guys and St Thomas’ Charity, looking at health issues effecting people living in urban, diverse and deprived areas, likewise found that people living in deprivation don’t always have the resources or headspace to think about health, often instead thinking foremost about earning money to sustain their lives and those of their families.

In particular, the Guys and St Thomas’ study found that the instability of housing affects people’s ability to prioritise their health. It provides fresh insights that being part of a close community can be good for health when this provides informal and preventative support.  But lack of autonomy over where they live, insecure housing and having to move had a significant impact on people’s ability to establish and maintain the social support networks that could help prevent health problems.

This is borne out by our own research which shows that homeless people report that unmet emotional and mental health support needs are often supported informally by family members or friends; temporary accommodation can impact on health and children’s physical and mental wellbeing and that health can be compromised by the instability of short-term rentals.

Recent guidance for local public health system from Public Health England is clear that investing in improving the home or housing circumstances can be an effective means to reduce health inequalities. It points out that the right home environment is essential to delivering NHS England’s Five Year Forward View, and local authority plans for social care by:

  • delaying and reducing the need for primary care and social care
  • preventing hospital admissions
  • enable timely discharge from hospital, and preventing re-admissions
  • enabling rapid recovery from periods of ill health or planned admissions

And the last strategic review of health inequalities in England post-2010 (the Marmot Review) recommended that ‘investment in new and existing housing is needed across the social gradient’ because bad housing conditions – including homelessness, temporary accommodation, overcrowding, insecurity, and housing in poor physical condition – constitute a risk to health.  Whereas ‘improvements in housing conditions have been shown to have a number of positive impacts on health, including lower rates of mortality, improved mental health and lower rates of contact with GPs’.

Investment in new and improved housing has long been recognised as the key to easing the pressures on our health and social care system.  We’re now starting to see positive moves towards integration, with the new statutory duty on CCGs to consider the integration of health-related services like housing and new homelessness legislation placing a fresh emphasis on ensuring that services are working together to prevent homelessness.

Innovation is starting to bear results. Instead of prescribing medication to homeless patients, housing prescriptions are being used in Hawaii to get much more effective results.  Closer to home in Sunderland, a ‘boilers on prescription’ scheme cut GP visits by 60%.

This week’s political manifestos will reveal how the parties intend to address growing health inequalities and the crisis in social care.  We urge them to prioritise investment in tackling our housing crisis.