Health & Housing

1. Health & Housing Jim McManus, Director of Public Health

2. Health is primarily determined by factors beyond just healthcare

3. 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

4. The National State of Housing Unhealthy Homes: • 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) Unsuitable 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)

5. 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

10. Working strategically

11. The Housing and Health Network

12. Raising the profile at leadership level • growing areas of challenge that need to be dealt with collaboratively • Housing teams 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).. • many 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.

13. 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 • 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

14. Bethan Clemence, Healthy Places Health Improvement Lead In Practice…

15. Health & Housing – Excess Cold 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

16. 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

17. Excess Cold – Herts Healthy Homes visits 74% = below 21° 13% = below 16° 46% = respiratory condition

18. 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 singlehealth 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

19. Hertfordshire Warmer Homes Scheme

20. 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.

21. 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)

22. Who benefits? High energy bills • 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 Low income Poor energy efficiency

23. 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

24. 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.”

25. Referral Process District top-up funding may be offered. Other grant schemes considered. Emergency heating available by Fire & Rescue if required.

26. How to refer into Hertfordshire Warmer Homes scheme • 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