How to connect housing and health services

Mr van Doorn, chief executive of the Housing Associations’ Charitable Trust (HACT), is one of a group that has gathered for an Inside Housing roundtable. In association with technology solutions provider Aico HomeLINK, the event has brought together professionals from across housing and the health and care sectors. Together, they are considering what more can be done to deliver homes that make a positive impact on the health of individuals and communities.

Impact on health

As Inside Housing editor Martin Hilditch highlights, it is a topic on which – rightly – there has been increasing focus. The death of toddler Awaab Ishak, resulting from damp and mould in his home, has incontrovertibly highlighted the interconnect between well-being and housing. “His tragic death has driven a lot of conversations and a lot of scrutiny about the impact of poor-quality housing on the nation’s health,” says Mr Hilditch, who is chairing the event.

“We’re increasingly dealing with damp and mould,” says Elly Hoult, chief operating officer and deputy chief executive at Peabody. “But we’re also increasingly seeing issues with noise-related incidents and how that impacts on people’s health, and with overcrowding.”

In short, housing has a complicated, multi-faceted and potentially severe impact on health. But Mr van Doorn does see some reason for optimism – namely, that there is a desire to address that issue. “The conversation about this is different than it has been. I would say there’s a much greater understanding of housing within the mental health space; an understanding that housing is a really key part of improving quality and improving the experience of inpatients and improving community services.”

The problem, according to our panellists, is that such understanding is not uniform. “I think social determinants of health, such as housing and mental health, are being discussed at the national level, but there’s a lack of follow-through,” says Kadra Abdinasir, associate director of policy at the Centre for Mental Health – a charity that seeks to bridge the gap between policy, research and practice, with a specific focus on tackling inequalities. “There’s rhetoric, but it’s not necessarily followed by action or joined-up planning from the top. I think where there are great examples of good local practice, those need to be shared and understood at the national level. It’s thinking about vehicles such as integrated care boards as places to bring partners together to collaborate, share learning and co-commission services.”

For Peter Molyneux, those partners must also build appropriate expectations of one another. “It’s important to think about what health can expect from our housing colleagues in terms of housing quality, in terms of promoting health and promoting healthy living, and promoting healthy neighbourhoods in which people can live at all stages of life’s journey, regardless of what life throws at them,” says Mr Molyneux, the England director for the Global Leadership Exchange – a network supported by governments internationally to promote better mental health and mental health services – and the former chair of six NHS trusts. “Then I think the next bit is what can we expect of each other at a neighbourhood level, in terms of the integration of services that actually promote and support the kind of healthy living we want to see?”

How can we establish those expectations and make them clear? Mr Molyneux suggests one way might be via national directives – in other words, explicitly stating that housing services are something that those working in health need to actively consider and help shape.

“I think the Department of Health and Social Care needs to include housing in the strategic outcomes framework for the NHS, because there’s nothing like putting something in the strategic outcomes framework to ensure it will happen.”

He argues that the strategic outcomes framework for integrated care boards needs to be changed in a similar way. “At the moment I think they are suffering from a framework that encourages them to be performance managers rather than the strategic thinkers that they want to be,” he says.

With only 18 months having elapsed since integrated care boards became statutory, conversations about how they can best influence outcomes for local populations remain live ones.

Nicola Kay is director of partnerships, population health management and reducing inequalities at North West London Integrated Care Board, which is part of a system that covers eight boroughs in the capital and unites their councils and NHS organisations. She leads a health equity programme of which a focus on the wider determinants of health is a key part.

“It’s about how we as the NHS can work with our partners to really tackle some of those inequalities that we see around the wider determinants. That includes housing, and identifying what our role is in that space. How can we best add value?”

There are hopes that a recent project on damp and mould in the local private rented sector may help start to answer that question. It has used data to drive a common understanding between the NHS and local authorities on the key issues at play.

“It looked at streamlining some of those links between the NHS and local authorities – we find people get passed around the system a bit and don’t know what to do when people have issues with damp and mould. It wasn’t a massive project, but it was something that shows we can kind of do some of that work together.”

There will undoubtedly be other areas on which such collaborations can be forged. Chris Jones is chief executive of Aico HomeLINK, which provides sensors to monitor the quality of indoor air. He says damp and mould has driven many social landlords to invest in the technology, but he points to other issues which technology can also help monitor: the likes of carbon monoxide levels, radon and particle pollution.