Embed Size (px)
Citation preview
www.hertsdirect.org
Housing and Health: making the case
Association of Directors of Public HealthPolicy Workshop 26 May 2016
Teresa HeritageExecutive Member, Public Health, Localism and Libraries, HertfordshireCity Councillor, St Albans City and District Council
Jim McManusDirector of Public Health, Hertfordshire County [email protected]
www.hertsdirect.org
My Thanks to
• Watford Borough Council• Welwyn Hatfield Borough Council• Hertfordshire Heads of Housing• Alan Gough • James Barber, • Bethan Clemence,
www.hertsdirect.org
Housing as a Public Health Challenge• Significant History• DsPH in many cities often led large housing
programmes (Birmingham, 1840s, 1870s, 1930s)
• Growing evidence base
www.hertsdirect.org
www.hertsdirect.org
Recent Policy Work• BRE Housing Costs
Calculator, funded by Public Health for all districts
• Kings Fund Report on District Councils – used as a lever to whole County
www.hertsdirect.org
2 Reports for Hertfordshire
www.hertsdirect.org
The Big Ticket Issues
1. Identifying the challenge2. Making it real for all stakeholders3. Making it bite for members4. Finding a common language and terms5. Identifying the possible6. Taking a programme/portfolio approach7. The dangers of getting so interested in detail
you forget delivery!
www.hertsdirect.org
The language of the National Audit Office 2010 not on course!
www.hertsdirect.org
Elements of a Strategy on Housing
Housing Quality and affordability
The Lives people lead The Environment and amenities
•Decency standards•Thermal efficiency•Fuel Poverty•Financial Exclusion•Issues for social care and health care supported by housing (independence, falls prevention, telecare)
•Quality of Education•Life skills•Self-Efficacy•Accessibility•Social Isolation•Social Inclusion
•GreenCleanSafe•Environmental cues for healthy living
www.hertsdirect.org
A joined up vision
HealthierPopulation through shift to preventionEconomic Growth across population(keyworkers as much as science)
Housing and Infrastructure Growth over 20 years to meet this
Keyworker Housing
www.hertsdirect.org
The Concept
2. One Shared devolution plan with a role for every agency
3. The Rainbow Each agency
does its bit for the plan
4. The OutcomesHealthier and Wealthier
Hertfordshire
1. One virtual pot
of resource
5. One pot of Money comes in
www.hertsdirect.org
Programme and Governance• Programme Approach• Owned by all Public
Sector CEOs and several Boards
• Public Health recruiting to a post to co-ordinate
www.hertsdirect.org
Programme workstreams at presentWhat Aim Who
Housing Quality and Condition
Improve, reduce cost to system
Public Health Board and Districts
Housing Supply/ Accommmodation
Meeting new needs Health and Wellbeing Board, Strategic Accommodation Board
Excess Winter Deaths Reducing deaths Districts, Public Health, Herts Help
Mental Health Crisis Reducing admissions Crisis Care Condordat Group
www.hertsdirect.org
New workstreamsWhat Aim Who
Growth New Housing Devolution, Districts
Impact of Homelessness on admissions/attendances/discharges
Sensible system, shared data
NHS Acutes, Public Health, CCGs
Safe and Well Checks Reduce fires, falls and admissions
Fire Service, Public Health, NHS
Ongoing workstreamsWhat Aim Who
Hoarding and Mental Health
Reduce misadventure and nuisance and get people into services
Welwyn Hatfield Council , Public Health, Police, NHS
www.hertsdirect.org
Theme: Preventing harm from hazards in the home
Hazards in the home (such as excess cold, trip hazards , fire risks etc.) are associated with a number of negative health outcomes
relevant to the Public Health, NHS and Adult Social Care Outcomes Frameworks
Theme: Providing suitable housing for people with disabilities/older people
The provision of suitable accommodation can promote health & wellbeing and
prevent the need for more intensive support
Theme: Addressing the impact of homelessness and supporting
access to accommodationThere are negative health outcomes
associated with the absence of secure accommodation. Homeless people are more
likely to have poor health, and place a disproportionate burden on health providersa) Private rented housing
enforcement and regulationStakeholders: Public Health, District &
Borough Councils, Community Protection, NHS
a) The development of specialist housing
Stakeholders: Public Health, District & Borough Councils , Health & Community
Services, NHS b) Reducing the impact of hazards in
the homes of vulnerable peopleStakeholders: Public Health, District &
Borough Councils, Community Protection, Health & Community Services, Housing
Associations, NHS
b) Home adaptions and alterationsStakeholders: District & Borough Councils
, Community Protection, Health & Community Services, Housing
Associations, NHSc) Provision of home-based health and social care services
Stakeholders: Health and Community Services, Housing Associations, NHS,
District & Borough Councils
a) Homeless prevention and support to access accommodation
Stakeholders: Public Health, District & Borough Councils, Housing Associations, NHS
b) Housing services for adults with complex needs
Stakeholders Public Health, District & Borough Councils, Health & Community Services,
Housing Associations, NHS
Housing and Health on a Page (First Iteration) An overview of the main themes and sub-themes identified around housing and health, including the key stakeholders, potential tasks and forums for partnership working.
Potential Tasks• Develop JSNA and housing intelligence• Increase referrals into existing home
improvement services• Encourage partnership working on the
development of Safe and Well Visits• Explore business case for developing
home improvement services (such as around thermal efficiency)
Potential Tasks• Formalise structure between housing
providers, health and social care • Build on existing projects and
partnerships• Develop strategic approach to planning
and development• Develop community networks/leadership• Commission innovative accommodation
services
Potential Tasks• Improve hospital discharge coordination
for patients needing housing support• Develop multi-agency support for adults
with complex needs• Improve access to emergency night
shelter • Explore the business cases for protecting
or expanding existing homeless prevention servicesPotential forums for partnership
working1. Public Health Board2. Health & Wellbeing Board3. Herts Heads of Housing Group4. Housing Associations Chief Execs
Meeting5. Herts and Beds Housing Group
Potential forums for partnership working1. Public Health Board2. Health & Wellbeing Board3. Herts Heads of Housing Group
Potential forums for partnership working1. Dual District Accommodation Boards2. Housing Associations Chief Execs
Meeting3. Health and Wellbeing Board
www.hertsdirect.org
Housing Quality• Evidence of poor quality housingLocal services:• District & Borough Council housing
enforcement• Herts Healthy Homes• Fire Home Safety Visits/ Safe and
Well visitsIssues• Resources• Referrals/data sharing
Map: Hazardous housing in Welwyn-Hatfield
www.hertsdirect.org
Cost BenefitsHousing Energy Efficiency in England
In just the East of England 438,000 Dwellings have an ‘F’ and ‘G’ rating
Costing the NHS £23,360,000 per annum (in relation to the harms associated with excess cold in these house types)
www.hertsdirect.org
Housing Availability
• Rise in levels of homelessness in Herts since 2010/11
• Hospital discharge• Adults with complex needs• Access to emergency night shelter
www.hertsdirect.orgFrom a property January 2016
England EWM index is 12.9,
South East is 26.7
(i.e. 27% more winter deaths than summer)
How do we reduce the number of winter deaths in Herts?
www.hertsdirect.org
Following an Excess Winter Deaths spike in Watford and an above average EW Mortality for the region the project was commissioned by HCC to identify the trends and triggers for Hertfordshire
The project was delivered through the Herts Healthy Homes Project (formerly Keep Warm, Stay Well)
team delivers an on the ground projectThe HHHco-ordinated with the Herts Help call centre;
Helping to address features of the Health, Adult Care and NHS care agendas
www.hertsdirect.org
EWD – Figures
• England - One of the highest excess winter death rates in Northern Europe
• England has the oldest housing stock in Europe
• An estimated 43,900 excess winter deaths occurred in England and Wales in 2014/15
• EWD contribute to 1 in 20 of all deaths per year
Direct effects of winter weather include an increase in incidence of: heart attack influenza falls and injuries hypothermia stroke respiratory disease
England EWM index is 12.9, South East is 26.7 (i.e. 27% more winter deaths than summer)
Excess Winter Mortality Index is EWM/average non winter months x 100
www.hertsdirect.org
Cost Benefits
• 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
• Actions such as insulation supported vulnerable residents with £1.5 million of cost savings.
The hazard of excess cold on those aged over 65’s is considered to cost the NHS over £35 million annually
www.hertsdirect.org
Behavioural factors
Housing factors
AgeHealthHomelessness
Fuel poor
Houses with mould
Energy inefficient
Population factors Age Group % EWD0-64 9.665-74 9.275-84 27.585+ 53.7
Ability to heat
Not adapting
Not seeking help
Not accepting help
Not claiming benefitsEach year billions of pounds of benefits go unclaimed
Knowing where to get help
> 80%
£ £
£ £
What affects EWD
www.hertsdirect.org
The EWD Report• The projects aim was to identify the trends and triggers for Excess Winter Deaths (EWD), following a high trend in Watford.
• 60 elderly participants were asked about their behaviours, circumstances and perceptions in-home interviews, 12 months apart, The temperature and humidity were tracked
• Of the 60 interviewees over the last 12 months there were 843 single health interventions (excluding flu jabs) – including revisits to GPs and 65 emergency visits to hospital
• 96% of those questioned did not drink the recommended amount of water increasing the likelihood of associated health consequences. The worst performing group were those aged 75 or over
• 78% of those aged 75 or over 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 visitors
www.hertsdirect.org
A resourced working group, project sponsored, to deliver an EWD strategy (in accordance with NICE QS)
The report has a number of key recommendations:
To address these…..
www.hertsdirect.org
Develop a Herts EWD Strategy
NICE QS
Single point of contact
Support LA resource for referrals
Currently Delivered through
Herts Healthy Homes with improved referral systems to Herts Help by Health Services (embed in the culture)
Reduce falls
Combat loneliness
Fuel Poverty strategy
Hospital discharge presence
AssessBefore
discharge
……. ……
Community Navigators
Vol. Orgs
www.hertsdirect.org
Statement 1. Local populations who are vulnerable to the health problems associated with a cold home are identified through year-round planning by local health and social care commissioners and providers.
• Herts Help - by Health Services (embed) • Long term funding resource for HHH delivery (3 years??)
Statement 3. People who are vulnerable to the health problems associated with a cold home receive tailored support with help from a local single-point-of-contact health and housing referral service.
How the recommendations fit with NICE QS guidance
• Excess Winter Deaths Strategy??• a joined up approach to data sharing…
Statement 2. Local health and social care commissioners and providers share data to identify people who are vulnerable to the health problems associated with a cold home.
www.hertsdirect.org
Statement 5. Hospitals, mental health services and social care services identify people who are vulnerable to health problems associated with a cold home as part of the admission process.
Statement 6. People who are vulnerable to the health problems associated with a cold home who will be discharged to their own home from hospital, or a mental health or social care setting have a discharge plan that includes ensuring that their home is warm enough.
How the recommendations fit with NICE QS guidance
• Assessment at admission• Assessment before discharge (in part)
Statement 4. People who are vulnerable to the health problems associated with a cold home are asked at least once a year whether they have difficulty keeping warm at home by their primary or community healthcare or home care practitioners. • Planned targeted annual communications
www.hertsdirect.org
The next Challenge
“I want public health principles embedded in all housing and growth work so we have a future of health and independence, not problems” Robert Gordon, CBE
Leader of Hertfordshire County Council
www.hertsdirect.org
Some surprising and welcome alliances
• Andres Duany and Lord Salisbury
• Principles for all developers
