Housing and Health work in Hertfordshire
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This presentation by Bethan Clemence and Jim McManus to the East of England Local Improvement Network for Housing provides a case study of health and housing work in Hertfordshire
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Housing and Health work in Hertfordshire
- 1. www.hertsdirect.org Health & Housing Jim McManus, Director of Public Health
- 3. www.hertsdirect.org Health is primarily determined by factors beyond just healthcare
- 4. www.hertsdirect.org 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
- 5. www.hertsdirect.org The National State of Housing •One in five homes is ‘non-decent’ – most private sector •3.6m children, 9.2m working age adults, 2m older people •15% homes in poor condition (has a category 1 hazard) •Society cost of £18.6bn including costs to education & employment (BRE 2015) Unhealthy Homes: • Only between 4-7% of homes in England fully accessible (English Housing Survey, 2015) • 1.1m homes overcrowded (Census 2011) • 16.1m ‘under-occupied’ (1 or more spare bedrooms. Census 2011) Unsuitable Homes:
- 6. www.hertsdirect.org Unstable Homes: •Significant shift in tenure – increasing market share of private rented for young people, families and people of working age •The average weekly rent for private rented is significantly higher than social rented •A significantly high proportion of those living in private rented have lived there for less than 5 years – in excess of 80% •The end of a tenancy in the private rented sector is the main reason for homelessness – 31% of all statutory homelessness
- 14. www.hertsdirect.org The Housing and Health Network
- 15. www.hertsdirect.org Raising the profile at leadership level • There are a number of growing areas of challenge that need to be dealt with collaboratively at the strategic level and across public sector organisations. • Housing teams around the county report growing pressures to deal with individuals who are vulnerable and have specific physical and mental health needs. • There is no local evidence base that can demonstrate the quantitative or financial impact of the housing and health relationship (but there is a wealth of national evidence). Further work would be needed to understand what the specific housing- health problems are, where they are most acute and on what scale. • There are many individuals and groups involved in numerous different aspects of the housing and health agenda, but there is no sole forum that offers strategic oversight, leadership or governance for all housing matters in Hertfordshire.
- 16. www.hertsdirect.org Agreed actions • Countywide CEO group has strategic responsibility • Formal governance framework established • Development of programme of work via Heads of Housing • Take steps to understand capacity levels and identify resources to help drive this key agenda forward • Develop an evidence base for the big housing and health challenges that Hertfordshire faces but cannot currently quantify • Review the various housing related groups to include stakeholder / gap analysis and identification of shared priorities • Seek to align groups and resources with the big, shared priorities – establish task and finish groups to deliver specific projects • Consider local application of the National Health & Housing MOU • Develop engagement with the STP workstreams
- 17. www.hertsdirect.org IN PRACTICE… Bethan Clemence, Healthy Places Health Improvement Lead
- 18. www.hertsdirect.org Excess Cold – Key Facts • Linked to respiratory and cardiovascular conditions, falls, strokes, flu, depression • Coldest quarter 5 times more likely to develop a mental health problem • Greater cause of premature death than lack of exercise & alcohol abuse • 30% higher risk for small infants of hospital or primary care admission Health & Housing – Excess Cold
- 19. www.hertsdirect.org Excess Winter Deaths • 32,500 excess winter deaths across the UK in 2016/17 (increase of approx. 10,000). • Of these, 1/3 attributed to cold homes and therefore entirely preventable • An additional 15,544 deaths occurred between 1st January – 31st March 2018 in England, during the ‘Beast from the East’. • 20.7% - Hertfordshire Excess Winter Deaths 2013-16
- 20. www.hertsdirect.org 74% = below 21° 13% = below 16° 46% = respiratory condition Excess Cold – Herts Healthy Homes visits
- 21. www.hertsdirect.org Early Winter Deaths Project (District led) • 60 elderly participants • 50% relied on winter fuel and cold weather payments • 15% unclear how to use their heating • 843 single health interventions over 12 months (excluding flu jabs) – including revisits to GPs and 65 emergency visits to hospital • 78% of those aged over 75 or lived alone; the most vulnerable people, with an average of 2.5 health conditions, had no visits. The healthier a person was, the more likely they had regular visits • 96% of those questioned did not drink the recommended amount of water increasing the likelihood of associated health consequences, including falls. The worst performing group were those aged 75 or over
- 24. www.hertsdirect.org Scheme Purpose • £1.4bn spent each year on the NHS treating health issues relating to housing quality • Recommendations from NICE: to provide a single-point-of- contact for people living in cold homes, to provide tailored solutions and identify people at risk of ill health from cold homes • Reduce the number of households living in fuel poverty – ‘heat or eat’ • Reduce the number of Excess Winter Deaths across Hertfordshire • Accessing Energy Company Obligation funding from Government to cover the cost of all or part of the works.
- 25. www.hertsdirect.org Aims • Install up to 700 energy efficiency measures across the County; tackling fuel poverty and improving energy efficiency in households • Estimated savings from installing measures is £112,000 saving of household energy bills and £193,000 saving to the NHS • Create a strong partnership between HCC, 10 district and borough councils and other key stakeholders • Identify a strong referral pathway via Herts Help (single- point-of-contact service)
- 26. www.hertsdirect.org Who benefits? • Private housing (owned or rented) • Low income – be on certain benefits • Some social housing if at or above market rent that are: • Living in fuel poverty or • Living on a low income and vulnerable to effects of a cold home FUEL POVERTY
- 27. www.hertsdirect.org Hertfordshire Warmer Homes Year 1 Review (January 2018 – Present) • Almost 1000 referrals received • Over 300 energy efficiency measures installed • Measures include: repairs to existing central heating systems, replacement boilers, loft insulation, cavity wall insulation, replacement lightbulbs, draught excluders and energy switching support • Savings to residents in excess of £88,000 in household energy bills • Reduction in carbon emissions by over 200 tonnes • Evaluation underway to identify health related outcomes
- 28. www.hertsdirect.org Case Study 77-year-old Welwyn resident Colin Felstead had an 18 year old boiler that didn’t work properly, resulting in a very cold home for him and his wife. Through the Herts Warmer Homes Scheme, funding was secured to provide Mr Felstead with a new combination boiler, smart clock technology and radiator controls, saving him an average of 25% a year on his annual gas bill. He said: “I can’t thank Herts Warmer Homes enough for their help. They were so quick to act on my first enquiry. “The radiators are on all the time and I’ve never known them to be so warm. I am very pleased with the whole installation.”
- 29. www.hertsdirect.org • 3 referrals from GP’s and Social Workers have been received to date • Widening the reach of the scheme and developing the brand • Aim to increase engagement with all health professionals to ensure households that may be living in fuel poverty and/or cold homes are identified as early as possible to reduce the demand on health services and possible admissions over the cold weather period • Anyone can make a referral via Herts Help Referrals and Engagement
- 30. www.hertsdirect.org Referral Process Emergency heating available by Fire & Rescue if required. District top-up funding may be offered. Other grant schemes considered.
- 31. www.hertsdirect.org • Contact Herts Help: 0300 123 4044 (either professional or client can do this) • Online via: www.hertfordshire.gov.uk and searching for Hertfordshire Warmer Homes How to refer into Hertfordshire Warmer Homes scheme
Notas do Editor
- Health and Housing – A regional example - Jim McManus, Director of Public Health, Hertfordshire and Bethan Clemence (or district lead)
- The importance of public health Our health is determined by our genetics, lifestyle, the health care we receive and our wider economic, physical and social environment. Although estimates vary, the wider environment (by this we mean everything outside at health care and genetics) has the largest impact. In simple terms this means addressing the complex causes of health inequalities at the community level by improving the places – the physical, built, natural and social environments - in which we live, work, learn and play Unique role of local authorities – can tackle and influence over 70% of determinants Spatial planning can influence the built environment, environmental quality, access to services (and provision of services) access to employment and education (and the provision of); through design, it can influence community safety issues, people’s behaviours around diet and exercise
- 93% of homes lack access features importance of people with limited mobility
- We have facts and figures that sit behind these statements – happy to share
- Picks up on wider social determinants which in turn can influence an individuals health outcome throughout the lifecourse
- Relationship between health and work - ill-health costs businesses and the economy Working age population is most affected by poor housing Ill-health costs the national economy £100bn pa. Society costs of leaving England’s poor housing unimproved is £18.6bn - includes lost education and employment
- Trying to understand who does what, to understand networks, duplication, gaps And this is just the County Council engagement with the agenda We are currently embarking on mapping the whole system –to include NHS partners – as a way of understanding roles and repsonsibilities.
- 4.1 A paper to the June 2016 PSCEO meeting agreed that housing is a crucial element of health and wellbeing, and has an impact on the provision of health and social care services. 4.2 Two reports in the months preceding that meeting had been delivered, considering housing issues for Hertfordshire, one linking to social care need issues and the other linking to housing quality and public health aspects. 4.3 Both reports engaged District and County partners and NHS partners, and were considered by the Health and Wellbeing Board, which identified Housing as a priority in its 2016 Strategy refresh and 2018 review of priorities 4.4 The PSCEO group previously agreed that affordable housing is a strategic priority because of issues such as rising homelessness and the lack of affordability within both the private rented and homeownership sectors. 4.5 In the last few years a range of joint projects have also been progressed, from the Warmer Homes programme jointly led and funded by all eleven authorities and programme managed by Public Health to projects led through the Herts Heads of Housing Group including Domestic Abuse, the Mental Health Concordat, Funding bids to Central Government and Single Homeless Funding from DCLG. 4.7 There remain, however, other strategic issues and opportunities to further join up work across the County for the benefit of its residents. Following a progress update on the housing and health workstream in March 2017, the PSCEO group asked for consideration to be given to how we could collectively navigate the complex housing landscape and work more effectively together to improve the housing and health agenda in Hertfordshire. 4.8 Following an initial discussion between Hertfordshire Public Health and Stevenage Borough Council (as the District Lead on the Herts Property Partnership), the following tasks were agreed: Update the Housing and Health governance network map, asses gaps/duplication and look for opportunities for strategic alignment Explore further national and local developments in the housing landscape that may influence the Hertfordshire housing and health agenda Seek to engage stakeholders and formulate proposals back to the PSCEO group
- Given the growing number of high level and cross boundary housing and health challenges across Hertfordshire it is recommended that the PSCEO group assumes strategic responsibility for housing related matters. Subject to the views of the PSCEO group this could be led by a nominated CEO. That a formal governance framework is established by the PSCEO group which (subject to the decision taken re recommendation one above) is led by the nominated lead and sets out shared goals against which various groups may be held accountable. That the Hertfordshire Heads of Housing Group should report directly into the PSCEO group and be tasked with developing a programme of work for formal consideration and agreement. Take steps to understand capacity levels and identify resources to help drive this key agenda forward Develop an evidence base for the big housing and health challenges that Hertfordshire faces but cannot currently quantify Review the various housing related groups to include stakeholder / gap analysis and identification of shared priorities Seek to align groups and resources with the big, shared priorities – establish task and finish groups to deliver specific projects Consider local application of the National Health & Housing MOU Develop engagement with the STP workstreams
- 32,500 deaths from BEIS 2018 – Annual Fuel Poverty Statistics Report. 15,544 additional deaths from NEA and E3G 2018 – Cold homes and excess winter deaths: a preventable public health epidemic that can no longer be tolerated. That’s in my booklet that was published today by NEA called the UK Fuel Poverty Monitor 2017-18. - 20.7% measure of increase in winter mortality from cold related illnesses and can directly linked to cold homes
- Figures from Herts Healthy Homes monitoring visits over a 17 month period (Nov 14-Mar 16) Within Hertfordshire the evaluation of the 2013 HHH project showed a cost avoidance/saving to society (including the NHS) of at least £688,485 - From 939 home visits which resulted in 4,452 direct actions
- The projects aim was to identify the trends and triggers for Excess Winter Deaths (EWD), following a high trend in Watford. 60 participants, were asked about their behaviours, circumstances and perceptions in-home interviews, 12 months apart, The temperature and humidity were tracked Issue around falls – dehydration, staying in bed, avoiding going to the toilet…1 in 3 pensioners fall each year (although significant cause is poor footware) Every hip fracture costs NHS c.£20,000.
- Reference from The Kings Fund and National Housing Federation (2018). Housing and Health: Opportunities for sustainability and transformation partnerships. NICE (2015) Excess winter deaths and illness and the health risks associated with cold homes. Report published yesterday (Fuel Poverty Annual Report, 2018) stated that since the Fuel Poverty Strategy was introduced in 2014/15, the number of households in fuel poverty had risen by 210,000 to 2.55 million.
- Evaluation to identify some of the following: Whether there has been a reduced demand on GP services, NHS services, Community Healthcare services and A&E attendance Whether the households have noticed any health improvements regarding pre-existing medical conditions since being warmer or less worried about expensive energy bills Assessing the overall effectiveness of the scheme delivery Whether the households overall wellbeing has improved since receiving support through the scheme
- Case study featured in our recent Horizon’s publication demonstrates the positive outcome that this scheme offers households in the County.
- Boilers on Prescription Scheme findings: https://www.gentoogroup.com/media/1061811/boiler-on-prescription-closing-report.pdf The trial was a partnership with Sunderland CCG and Durham Darlington Easington and Sedgefield CCG. After 6 months, findings were: 28% reduction in GP appointments, 33% reduction in outpatient appointments – in addition to costs and energy improvements After 18 months, findings were: 60% reduction in GP appointments, 30% reduction in A&E attendance and 25% reduction in Emergency Admissions. A further study (Warm Homes for Health Study) was also carried out to compare findings. It’s focus was ‘had improving thermal efficiency of a home affected the health and wellbeing of the individual(s) occupying the home’? Findings included: 4% reduction in anxiety, 2% increase in overall happiness and 2% increase in overall wellbeing of the respondents. Young families also included within the scope of the scheme – it is wide reaching with the overarching eligibility being anyone on specific benefits OR on a low income (less than £20,000 per year [total household] once mortgage/rent payments deducted).
- Emergency heating referral can be made to Fire & Rescue if the client appears to be with no heating at all, in order to safeguard against negative health impacts. Onward signposting is possible by utilising the single-point-of-contact Herts Help approach. Referrals into other services to improve social isolation, hoarding, debt relief/worries, crisis intervention, advocacy, community navigators etc.