enabling healthy homes in which to start, live, and age well · • 3.6m children, 9.2m working...
TRANSCRIPT
Enabling healthy homes in which
to start, live, and age well
Gill Leng @gill_leng National advisor: homes and health
28 February 2017
Purpose of today
“everyone has a home in which to start,
live and age well”
Resources and support
Sources:
https://www.gov.uk/government/co
llections/housing-for-health
https://khub.net/group/healthypeo
plehealthyplaces/forum
Checklist will:
1.Help you review plans for,
health, wellbeing, wealth & other
outcomes – has home & health
been considered?
2.Inform local conversations that
should lead to improved health
and wellbeing as a consequence
of action on the home or housing
circumstances
Format
10.15 The home & health relationship
11.10 Enabling healthy places for homes
12.00 Lunch
12.45 Enabling systems leadership
13.45 Effective housing interventions to improve
health through the home
15.10 Comfort break
15.00 Improving the health of people and
communities through home
16.05 Reflections, action and close
The home and health
relationship
Table exercise
1. Two facts about nature of homes & health
relationship
2. Two facts about scale of homes & health
relationship
3. Pool these on flip charts – relevant to
• All populations?
• Start and develop well?
• Live and work well?
• Age well?
Our health is the work of a life time
Source: Marmot (2010) Fair
society healthy lives
A framework for understanding
• A healthy home: warm, safe, free from
hazards
• A suitable home: suitable to household
size, specific needs of household members
eg, disabled people, and to changing needs
eg, as they grow up, or age
• A stable, secure, home to call your own:
without risk of, or actual, homelessness or
other threat eg, domestic abuse
• Healthy communities & neighbourhoods
Changing needs = changing home?
Adapted from:
Pennine LDP –
Emerging Models
of Care People enjoy a good quality of life, are
healthy and well
People with long
term conditions
are able to
manage their
health at home
People who become ill, face crisis or
other life change manage their health &
wellbeing at home
People leaving a
health, care or
other institutional
setting move on to
a healthy home
environment
Who experiences housing inequalities?
1. Protected characteristics a) Age
b) Disability
c) Race
d) Marriage and civil
e) Pregnancy and maternity;
f) Religion or belief
g) Sex
h) Sexual orientation
i) Gender reassignment
2. Others? a) Income & wealth & market forces/economy
b) Ill-health
c) Social
Tenure and populations Owner occupation • 64% homes – shrinking but ambition to grow
• Most unhealthy homes & least accessible
• Most under-occupied & stable accommodation
• Most older people live here!
Social rented • 17% homes - shrinking & expected to continue
• Healthiest & most accessible homes but most overcrowded
• Profile looks different for different areas and providers
Private rented • 19% homes – growth & expected to continue
• Highest prevalence of unhealthy homes
• Least affordable & stable
• Increasingly younger households live here
PHE checklist – local exercise
You think there should be evidence of an understanding of
home, housing circumstances, health and wellbeing
6. Is it clear where the intended beneficiaries of the plan live?
a) Has tenure been described?
b) Have living arrangements or household circumstances been
described? Eg, sharing, living alone
c) Has location (neighbourhood/community characteristics) been
described?
7. Have the following been described in terms of their impact
on the beneficiaries’ health and wellbeing?
a) The healthiness of current homes?
b) The suitability of current homes?
c) The stability of tenure of current homes?
Sources?
Housing and health:
understanding the local
relationship
Sarah McGrady, Forum Housing
Enabling healthy places for
homes
Andre Pinto
Healthy Places Manager, PHE
Enabling healthy places for
homes
Sarah Johnson-Griffiths,
Consultant in Public Health, Halton MBC
Enabling local systems
leadership to improve health
through the home
Purpose of today
“everyone has a home in which to start,
live and age well”
Do we have the homes for health?
‘Unhealthy’’ (DCLG English Housing Survey)
• One in five homes ‘non-decent’ – most private
• 3.6m children, 9.2m working age, 2m pensioners
• 15% homes in poor condition (Cat.1 hazard)
Unsuitable • Between 4 – 7% homes fully accessible (four visitability
features. EHS 2015)
• 1.1m homes overcrowded (fewer bedrooms than bedroom
standard. Census 2011)
• 16.1m ‘under-occupied’ (1 or more spare bedroom. Census 2011)
Precarious and homeless (unstable) • Rising for all populations (DCLG official statistics)
Cost of poor housing to the NHS
Sources: BRE (2015)
Available from
https://www.gov.uk/government/c
ollections/housing-for-health
Society cost
£18.6bn including
costs to education
& employment
Not enough homes!
• Mismatch in supply and demand – for quite
some time!
• Affordability & suitability issues across country
• Migration from more expensive areas
• Increasing number of working households need
social security
• Choice? Move or live in poor, unsuitable,
unstable home
• Inequalities growing between richest and
poorest
National ‘home’ framework
• Ambition for economic & national security • ‘Home’ = new housing = ownership
• Poor health costs economy £100bn p.a.
• Spending on poor housing not in community
• No national housing strategy but • Existing & emerging legislation • Housing is a health related service (Care Act 2014)
• Homeless prevention for all (Homeless reduction bill)
• Capital for supported housing & adaptations
• Revenue homeless prevention & rough sleeping
• NHSE programmes – ‘care closer to home’
• Housing White Paper implications?
Local challenge
Analyse
Plan Do
Review
Local housing authority:
• Housing strategy
• Landlord services (not all)
• Spatial planning
• Regeneration
• Economic growth
• Environmental health
• Homelessness
• Revenue collection
• Welfare
• Community safety
• Corporate planning
• Finance/asset management
Service delivery
•‘In house’ LA
•External organisations
• Procured by public body
• Funded by charitable source
• Funded by customers
Single, upper tier, met boroughs:
• Adult social care
• Children and families
• Public health, incl. DAAT
Housing as primary purpose:
• Social landlords
• Private landlords/lettings agents
• Developers & builders
• Housing support & improvement
• Information, advice & guidance
Housing essential but not primary
purpose - other public body:
• Health organisations eg, CSU,
CCGs, GPs, hospitals/Trusts
• Criminal justice bodies eg,
NOMS, NPS, CRCs, PCCs, YOT
• Immigration ie, NASS
Commissioners
PUBLIC
Local challenge – Exeter!
Courtesy of Simon Bowkett, CoLab Exeter, @SimonExCVS and @CoLabExeter
Shared understanding matters
• Enabling a healthy home is complicated
• Needs systems change but resources are limited
• Evidence for change is key to collaboration,
influence, persuasion (King’s Fund 2015)
• Coalition of the willing
• A focus on immediate priorities?
• A focus on those experiencing greatest ‘systems’
inequalities?
• A healthy home has many benefits….
• But who should ‘pay’?
Systems leadership… • Suited to
• Tackling complex underlying causes of social
and clinical problems
• Rethinking to put user at the centre
• Integrating services to improve value and
efficiencies
• Beyond traditional joint working
• Leading together
• Bringing energy, ideas, talent and expertise
together from across systems Source: Local Leadership Centre (2015)
https://www.leadershipcentre.org.uk/docs/Revolution%20will%20be%20improvised%2
0publication%20v3.pdf
Our vision & ‘home’
The right home environment is essential to
health and wellbeing, throughout life
A home in which to ‘start, live & age
well’
Key features of the home:
•Warm & affordable to heat
•Free from hazards, safe from harm
•Enables movement around the home and is
accessible
•Promotes a sense of security and stability
•Support available if needed
•Healthy neighbourhood and community
Effective interventions to improve
health through the home
Health, care & other institutional settings
End of life support at home
Hospital discharge, prison
resettlement etc,
Step down, specialist &
supported housing
Adaptations & equipment
Support
fro
m p
eople
with liv
ed e
xperience
Making every contact
count
Healthy h
om
es a
nd n
eig
hbourh
oods
People Intervention examples
Healthy communities and health equity
Housing support
In
tegra
ted ‘health a
nd w
ealth’ serv
ices
Info
rmation,
advic
e,
support
in P
IE
Homeless prevention
Home improvements
What might we see locally?
People leaving a health, care or
other institutional setting move on to
a healthy home environment
People who become ill, face crisis
or other life change manage their
health & wellbeing at home
People with long term conditions are
able to manage their health at home
People enjoy a good quality of life,
are healthy and well
A note on ‘what works’
• Not enough focus on creating and using
evidence that seeks to answer the
question: ‘what works?’ in housing
• Lack of robust casual understanding
between what intervention/project did &
whether this achieved outcomes
• Limits ability to demonstrate benefits of
interventions or understand if as effective
as could be
• Standards for producing evidence in the
housing sector but needs capacity,
capability & commitment • Sources: PHE collection (HACT),
http://www.housing.org.uk/resource-library/browse/connecting-
housing-and-health-three-new-reports/
Health through warmth in St
Helens
Lee Norman, St Helens MBC
The ‘safe and well’ initiative – the
role of Fire and Rescue
Mike Larking
Cheshire FRS
Enabling the right home for people
with experience of the criminal
justice system
Rachel Bennett
One Vision Housing
Improving the health of people in
their home and communities
Contributors to health outcomes
Smoking 10%
Diet/Exercise
10%
Alcohol use 5%
Poor sexual
health 5%
Health
Behaviours 30%
Education 10%
Employment
10%
Income 10%
Family/Social
Support 5%
Community
Safety 5%
Socioeconomic
Factors 40%
Access to care
10%
Quality of care
10%
Clinical Care
20%
Environmental
quality 5%
Built
environment 5%
Built Environment
10%
Contributors to health outcomes
Source: Robert Wood Johnson Foundation
and University of Wisconsin Population
Health Institute
Health from within communities
• Part of basis for returning public health to local government
• Connected & empowered communities are healthy
• Community mobilisation can lead to positive change
• Involvement in community can increase resilience
• Many opportunities to play an active part in supporting and
enabling others to improve their housing
• Peer information and support eg, Silver Links
• Role in identifying improvement needs eg, Liverpool
• Sharing homes eg, Shared Lives
• Volunteers connected to home improvement agencies
• Healthy home community ‘connectors’ or ‘champions’
• PHE (2015) A guide to community centred
approaches to health and wellbeing
Toria Buzza, Regeneration
Manager, Plus Dane
Action? What will you do next?
What do others need to do?
Action to improve health through the home
1) What will you do to:
•Communicate the importance of the home to others in the
local area, to inform local commissioning for better health and
wellbeing, and reduced health inequalities?
•Improve shared local knowledge of the understanding of the
home and health relationship?
•Understand ‘what works’ in improving health through the
home?
•Make best use of the policy and legislative framework as
levers to improve health through the home?
•Develop relationships with locally to make the difference?
2) What do you need others to do so you can be
effective?
Infographics – risks to health
by life course
Start and develop well
Live and work well
Age well
