‘Better Housing, Better Health’ for Oxfordshire

Author: Dale Hoyland 11/12/2014

We don’t need all the government, academic, policy institution and other reports to tell us what we already know, but they certainly confirm our existing understanding: the quality of housing is one of the most significant determinants of health.

Excess winter deaths

Firstly, one of the most alarming statistics: excess winter deaths (EWDs). In 2012/13, an estimated 31,100 EWDs occurred across England and Wales. The figures reflected an increase on the five and 10 year averages, which are both around 27,000. The trend is accelerating, despite the early years of this century producing some of the hottest years on record. The latest figure – 2013/14 – has gone down (to 18,200), but this was clearly because of an exceptionally warm winter. The same period has seen multiple reports claiming that vulnerability itself is increasing, as fuel poverty rises and rises.

The World Health Organisation estimates that between 30% and 50% of EWDs can be attributed to cold indoor temperatures. This would mean an average of at least 8,100 additional deaths each year have resulted from cold buildings – and nearer 9,300 in 2012/13.

However, the EWD numbers should be seen as a symptom of a wider trend. Whether or not a resident is at risk of death from the environment which they are in, there are many ways in which health can be adversely affected either temporarily or permanently, very often requiring serious medical treatment.

How this affects the NHS

NHS figures demonstrate that health conditions exacerbated by cold and damp homes – including asthma, COPD, and slips and falls – spike in the winter months. Those most vulnerable to these – mostly the very young and very old, as well as those living with disabilities – spend disproportionate amounts of time indoors; this leads to additional vulnerability where the property is not sufficiently prepared for cold weather. Research backs this up, showing that, of the additional incidents recorded over the cold period, a disproportionate number occur in domestic properties.

No one has created an estimate of the cost that these unnecessary incidents create across the country. We can reliably assume that, because the average admission to an NHS bed costs around £3,000, we’re looking at huge numbers, particularly amongst the small number of most vulnerable people who return to the service again and again.

Despite this, as we’ve seen, the numbers at risk and affected are actually going up. At a time when NHS funding is such a sensitive issue, avoidable spending on this scale can hardly be justified – particularly where it is increasing rapidly and so easily targetable.

There’s a real frustration for many campaigners here. Research conducted for the Chief Medical Officer for England and Wales demonstrates that for each £1 spent on energy improvement measures, an average of £1.42 is saved in health spending. Quite apart from the quality of life opportunities offered by improvements, there’s a real financial case for investment by our statutory public services. We need to get across that this kind of preventive spending is a good investment for our national health – both financially and for our wellbeing.

It’s worth noting that there is a strong, recognised correlation between the numbers in fuel poverty and the numbers of annual EWDs. Having seen some improvement in the early 2000s, the numbers in fuel poverty have been steadily around 10% for the last decade (although are now rising again). Incentivising policies and initiatives have come and gone in this time but the basic figures don’t change. Therefore, we have to assume that there are other barriers: poor access or fear of credit, challenges of communication, aversion to institutions, or perhaps something which could be labelled ‘extreme inertia’.

So, what can be done?

Many will say that spending on home improvement is a private matter, which should be achieved through government-provided incentives, for example. They’ll also point out that the range of barriers, particularly prohibitive tenure types such as tenant/landlord properties, is too great.

However, given the immovability of the fuel poverty and EWD statistics, we want to see more proactive and innovative approaches come forwards. Targeted schemes run collaboratively by relevant collaborators are amongst the most demonstrably effective in improving the health outcomes in local areas. So many examples of this could be given. How about these two?

Gentoo Housing has worked collaboratively with local NHS Clinical Commissioning Groups (CCGs) to deliver a project called ‘Boiler on Prescription’ in which local residents were provided with simple measures with the aim of lowering their required interactions with the health service. Early evidence shows that this has radically reduced NHS interventions amongst a pilot target group.

Liverpool City Council set up the broad ‘Healthy Homes Project’ as part of its proactive approach to identifying priority in-need households across the city. 927 serious cold hazards were removed and 1,405 referrals were made for energy efficiency. Projected overall NHS savings for the project were £852,000 per annum for excess cold hazard alone (£8.5 million over 10 years) and NHS savings of £440,000 per annum – more than £4.4 million over 10 years.

Bringing a health and housing project to Oxfordshire

The county has roughly the national average figures for fuel poverty – approximately 10% of households – but it has a major issue with health inequality, which Oxfordshire CCG has placed top of its agenda. Recent projects have been targeting the delayed transfer of care – the return to home of patients who have received medical treatment.

Our project, ‘Better Housing, Better Health’, will be a county-wide effort to target those suffering poorer health as a result of their homes. Working with partners across the county, including health organisations such as the CCG and doctors’ surgeries, community groups, local authorities, councillors and others, we’ll identify those most at risk and advertise to them opportunities to receive energy advice and, in some instances, offer free or heavily subsidised interventions. The buy-in, across the required groups at these early stages of the project, is exceptional and extremely encouraging. There’s a real will to mend this problem with time, money and expertise. NEF and – we hope – its partners will be here solving it until it’s gone.

The launch for this event – on 30th January – is a chance for us to explain to all participants the problem and the solution. This will include, of course, those who could benefit from the project. Fuel poverty and health inequality require rigorous public discussion and concern – it is deeply complex and multi-faceted, rooted in a plethora of accompanying social and economic factors. We hope to shine a light on this in Oxfordshire, before getting underway with changing the situation.