Housing for health – the ICS challenge

By Phil Hope and Steve Barwick | 08 November 2023

The September Health Devolution Commission roundtable concluded that making improvements to poor housing must now be put high on the agenda of Integrated Care Systems (ICS).

The new ICS structures provide a unique opportunity for local system partners across the public, private and voluntary sectors to break out of the silos between housing and health, and to have a rapid and effective impact on the poor housing that creates poor health.

Senior fellow, public health and inequalities at the King’s Fund, David Buck, emphasised the evidence that poor housing causes poor health is clear, well researched and fully documented. He stressed the importance of the NHS working with district councils in two-tier areas as well as unitary authorities and metropolitan boroughs, and called on all ICSs to place poor housing at the top of their list of priorities for preventing ill-health, particularly improving children’s health and reducing health inequalities.

Lord Richard Best, co-chair, housing and care for older people APPG; vice-chair, homelessness APPG; and vice chair healthy homes and buildings APPG, described housing as the ‘third leg of the stool’ for improving people’s health; health services, social care and housing. He reminded us of the policy spelled out in the Government’s 2021 White Paper People at the Heart of Care to make every decision about care a decision about housing. He pointed out that very basic causes of ill-health and injury to older people such as damp rooms, high-sided baths and icy steps could and should all be dealt with easily and quickly by system partners working together.

The development of a tripartite strategy on housing and health developed by partners in Greater Manchester in 2021 called ‘Better Homes, Better Neighbourhoods, Better Health’ was described by Noel Sharpe, chief executive, Bolton at Home, and health and housing lead for Greater Manchester Housing Providers. This is the first of its kind, with housing providers, the NHS, social care and local government agreeing to joint priorities for action in a formal partnership. It builds on successful existing joint housing and health projects including:

• A bed every night

• Housing first

• Let Us – the Greater Manchester ethical lettings agency

• Work to meet the housing needs of mental health patients

From this evidence and the discussion, chaired by Imelda Redmond CBE – co-chair of the Health Devolution Commission, former national director, HealthWatch, and member of the North East London ICS – five main recommendations emerged:

1. The commission believes better housing must be higher on the agenda of ICSs as the direct causal link between poor housing and poor health is now clearly established.

2. The commission recommends every ICS develops a ‘Better Housing for Better Health’ strategy for their area with clear joint goals by the system partners to be achieved.

3. The commission would like to see every ICS develop its own combined health and housing data – a set of quantitative and qualitative information that shows the causal links and priorities for action on poor housing to improve people’s health in their specific area.

4. The commission identified some immediate areas for action that ICSs could be taking now to improve housing for better health in their area while a comprehensive joint strategy is being developed. These include:

a) Working with housing providers and housing improvement agencies to focus immediate action on the houses and homes already known to be at highest risk of causing ill-health.

b) Using population health data to identify and address privately rented homes that have hazards that might be affecting the health of the tenants.

c) Working with local councils to support their work in identifying and enforcing housing quality regulations.

5. The commission calls upon the Government to create an internal cross-departmental working group from the Department of Health and Social Care and the Department for Levelling Up, Housing and Communities to put into practice measures that will support better housing for better health at every level within Government.

The commission very much hopes these recommendations will now be discussed at each Integrated Care Partnership and Board as well as within every council, and across government departments.

Steve Barwick and Phil Hope are the secretariat to the Health Devolution Commission

X – @HealthDevo

For more information, including details of the Commission’s next meeting in January 2024, contact stevebarwickpc@outlook.com. For the full report of the roundtable held on the 14th September see https://healthdevolution.org.uk

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