Unhealthy Housing: Cost to the NHS

Barry Sheerman Excerpts

Tuesday 26th February 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the cost of unhealthy housing to the NHS.

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank right hon. and hon. Members for attending the debate, particularly the Scottish National party spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day); the shadow Minister, the hon. Member for Great Grimsby (Melanie Onn); and the Minister. I look forward to positive contributions from all those able to participate.

I am grateful to have been allocated the debate. As chair of the all-party parliamentary group for healthy homes and buildings, I am delighted to have the opportunity to raise awareness and concerns about the cost of unhealthy homes to the NHS. I thank the background staff, who are in the Gallery, who have given information to us all, myself in particular, to help us in the debate.

Our APPG was created to shed light on the many problems caused to our nation’s health, wellbeing and economy as a result of people living and working in unhealthy homes and buildings. Given that most of us spend some 90% of our time indoors, it stands to reason that our homes need to contribute positively to our physical and mental health and wellbeing, not diminish it. This debate is so important because it pulls together the critical issues. It is perhaps not a normal Westminster Hall debate, but it pushes very much to the fore the effect of the homes that we live in on our health and, ultimately, on the NHS.

The APPG, following a weight of written and oral evidence received, launched a report, “Building our Future: Laying the Foundations for Healthy Homes and Buildings”, in October last year. It was a well addressed report, to which there were many contributions, and it brought together those with a deep interest in homes and those with a deep interest in health issues. It is good to have the report finished.

I have given the Minister a copy of the report, which contains a series of excellent recommendations that are helpful to the Government and will help us to move forward. I hope the debate will be a turning point, and that those recommendations will lay the foundations for change. The report sets out what needs to be done to ensure that new and existing homes do not cause or exacerbate health problems, because they often do. Many of us here, as elected representatives, will have people coming to us every week to complain about their home and, more often than not, the health problems related to that.

This debate is long overdue. It is time to raise awareness of the extent of the problem, and to recognise the human cost to the United Kingdom of Great Britain and Northern Ireland of doing nothing. It is clear from the White Paper that unhealthy homes cost the economy and our society each and every year. Living in or occupying unhealthy homes directly and negatively impacts on human health. Unhealthy homes that lack daylight, or are cold, damp, poorly insulated, energy inefficient, overcrowded, noisy, badly designed and generate poor indoor air quality can, in the extreme, lead to unnecessary deaths.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

The hon. Gentleman is an old friend of mine. I think he knows that those of us who campaign on carbon monoxide poisoning really welcomed his excellent report. I have lost three constituents to carbon monoxide poisoning, which is one symptom of an unhealthy home. I assure him that we will work closely with him to ensure that no more people die of carbon monoxide poisoning.

[Jim Shannon]

The hon. Gentleman is absolutely right. My hon. Friend the Member for East Londonderry (Mr Campbell), who is sat to my left, also had constituents who passed away a few years ago due to carbon monoxide poisoning. That was in a holiday home, but it was none the less a problem. We in the APPG will take the comments of the hon. Member for Huddersfield (Mr Sheerman) on board, and we look forward to working with him.

Let me detail some of my concerns arising from the evidence that we heard. The effects of poor housing are estimated to cost the NHS £2.5 billion per annum; that rises when we consider all housing throughout the United Kingdom of Great Britain and Northern Ireland. The true cost lies in human misery and lives lost. Some of the figures are quite extreme, but they underline the issue. Some 43,900 excess winter deaths occurred in England and Wales in the winter of 2014-15, with cold homes causing one fifth of those. That is more than the number of deaths caused by road accidents, alcohol or drug abuse, which puts into perspective the need to make sure that homes are healthy. Children in cold homes are more than two times more likely to suffer from a respiratory problem. Cold homes increase the incidence of cold and flu, and worsen conditions such as arthritis and rheumatism. Again, we see that every day in our constituencies.

One in four adolescents living in a cold home is at risk of multiple mental health problems, so we are not always talking about physical issues; there can be emotional and mental issues as well. Those in poor-quality homes that lack effective ventilation suffer from indoor air pollution, which has been linked to allergies, asthma, lung cancer, chronic obstructive pulmonary disease, cardiovascular disease and, more recently, dementia.

[Jim Shannon]

If only we had that power! That is not to take away from the importance of the issue of social housing, which I will touch on later. Let us be honest: many people go into the housing that their pockets allow. As a result, they end up in housing that is not particularly in the right category, the right condition or the right shape. The hon. Gentleman is right that the benefit cap also dictates where someone can go. I will give the Minister plenty of time to get her thoughts together on that. However, that is an important point, and I will touch on it later.

Poor indoor air quality has an annual cost to the UK of more than 204,000 healthy life years. It causes thousands of deaths per year, and gives rise to health costs in the order of tens of millions of pounds. One third of people in the United Kingdom suffer from mould in their homes and are at increased risk of respiratory problems, infections, allergies and asthma. Just last week, I saw three constituents with mould growth issues in their houses—mould not caused by condensation, but ingrained in the walls. Sometimes ensuring that the housing associations or housing executive take those issues on board is quite a job.

There are more than half a million overcrowded households. The issue affects one in 10 children—something we cannot ignore. Overcrowding is linked to health and development issues, including meningitis, respiratory conditions, slow growth rates, accidents in the home, stress, anxiety, depression and poor adult health. Occupants of poor-quality housing are more likely to suffer from restricted daylight and noise pollution.

We cannot ignore noise pollution. In the news this morning someone put forward the idea of building houses and flats over railway lines. I am not sure if any hon. Member saw that. The first thing that came to my mind was the noise of the trains continually going underneath. How could those homes be adapted to mitigate that? We need to address noise pollution. Natural light helps to improve the recovery times of long-stay patients and reduces anxiety and the need for medication. Noise pollution can cause long-term health issues and increase stress and the risk of cardiovascular effects.

It is clear that there is a lack of public awareness of these problems, and limited knowledge of the facts. Too often, the homes we live in are, in so many ways, causing or aggravating health problems.

[Mr Sheerman]

The hon. Gentleman is making a very good speech, and I am nervous about intervening again, but will he accept this point? He talks about the noise pollution from living over a railway, and we know that private rented accommodation is a real problem. On the other side of the equation, very modern and expensive housing that is totally hermetically sealed could be as dangerous, because it traps all the gases and pollutants within the home—not only carbon monoxide, but many other emissions.

[Mr Laurence Robertson (in the Chair)]

Order. I ask hon. Members making interventions to address the Chair, and not somebody at the back of the room, not only so that I can hear but, more importantly, so that the Minister can hear.

[Mr Sheerman]

Will you forgive me, Mr Robertson?

[Mr Laurence Robertson (in the Chair)]

I would not want to miss anything that the hon. Gentleman said; that is the point.

--- Later in debate ---

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

What a pleasure it is to serve under the firm but fair chairmanship of your good self, Mr Robertson.

I will not be very political in my speech; I might make a couple of swipes at the Conservative Government about one little item that worries me. In 1963, the enlightened Conservative Government asked Sir Parker Morris to look at homes for then and for the future. He came up with a very good report that was accepted as guidance by that Government, but it was not until 1967 that a Labour Government made that guidance statutory in the Parker Morris standards for housing and homes. Those standards guided us well and provided a framework for the quality of our housing. People had to build according to those good standards—cavity wall insulation, the size of the living room, the size and accessibility of the toilet, and all the stuff we took for granted.

Unfortunately, in the 1980s another Conservative Administration abolished the Parker Morris standards. That was an age when a woman I knew very well—Margaret Thatcher—believed passionately in the private sector leading and delivering more effectively than the public sector. At that stage, when that was fashionable—I am not blaming anyone who is around today—the standards were abolished and we have suffered from that for many years.

I chair both the all-party parliamentary carbon monoxide group and Policy Connect. We have taken a strong interest in carbon monoxide, and it hits home hardest when one of your constituents is affected, especially if they die. A little 10-year-old boy, Dominic Rodgers, was found dead from carbon monoxide poisoning by his mother when she went to wake him for school, in a little terraced house in the middle of Huddersfield. The poisoning was not from that home but from a faulty boiler in the house next door. The silent killer had seeped, as it does, across the passageway and killed the little boy. A few months later, a couple who ran a Chinese restaurant were sleeping over the premises and they too died from carbon monoxide poisoning—a cowboy builder had blocked the chimney. Like all good campaigns, the carbon monoxide one started at the constituency level, and I have been campaigning for many years with a very good all-party team to make people aware. The more research we do, the more we know that carbon monoxide issues are related to healthy homes.

As I said in my intervention on my very good friend, the hon. Member for Strangford (Jim Shannon)—what a good debate he has initiated—the fact of the matter is that there are two worrying sectors. Huddersfield is the average, classic British town on all the criteria; what happens in Huddersfield is a symbol of what is happening in the greater United Kingdom. We have two problems in the town, one of which is old social housing. Over the years, that housing has been progressively upgraded and renewed. The situation has not been helped by some of the poor effects and unintended consequences of right to buy, but social housing has a much better record than private rented accommodation regarding healthy homes and intervention to ensure that people live in a healthy, safe environment.

The real problem, in Huddersfield and elsewhere, is private rented accommodation. It is a sad fact that the standard of private accommodation is very variable. Until recently, many of the students who came to university towns—certainly my four children—found themselves living in rented accommodation that was pretty awful. A parent would not want their children living in accommodation of that quality, and they were certainly not healthy environments: I am talking about accommodation in Cambridge, Bristol and Edinburgh. However, we have had a revolution in the private rented sector for students. At one stage, I teased the housing Minister, because in Huddersfield we had cranes, new blocks, and wonderful, posh, modern accommodation for students. I kept asking the various housing Ministers who came and went, “If we can do that for students, why can we not build those sorts of buildings—modern, high-quality accommodation—for elderly people in our constituencies and in our country?”

The fact of the matter is that private rented accommodation is difficult, and one aspect of that difficulty arises when we want to look at smart metering. We want to go into a house to fit smart meters, in order to bring down the cost of energy and the amount of money that people on low incomes spend on heating. Getting in for that purpose, or to check whether there is a carbon monoxide detector or a smoke alarm, is very difficult in private accommodation. A lot of people do not want us to know how many people are living in that accommodation; they want to be private, which makes it difficult. We know that a high percentage of gas appliances in those rented homes are very dangerous indeed. They have not been serviced every year, and they could very well kill the people living in that accommodation.

I do not want to concentrate just on carbon monoxide, so I will finish my remarks by saying that this morning, when I was getting up early in order to speak in this debate at 9.30, I was startled when I turned on the radio to listen to the “Today” programme and heard someone from the housing sector—I have to say, a rather complacent person—being interviewed. Mr Robertson, as a working politician like me, you probably shout at the radio sometimes, because you want John or one of the other interviewers to really push a particular question. This morning, I wanted that representative of the housing sector to answer this question: “What happened to the Help to Buy programme?” We know that that money did not flow into Northern Irish homes and housing, and it did not flow into homes and housing in my constituency: it flowed into the coffers of the big housing companies. We thought that those tens of millions of pounds were going to regenerate the market and provide homes for people who needed them, but it all went wrong. It is another bit of public policy that started with brave intentions and went awry. Those tens of millions of pounds could have been spent on investing in healthy homes, improving them and bringing them up to what was the Parker Morris standard.

That is the most political thing that I will say today. I have found that, across the House and in this very Chamber, there is a lot of consensus that there is a problem, and that the problem can be solved. However, we have to start focusing our energy and, for goodness’ sake, both parties need to show some real leadership in providing what people in this country deserve—great standards for homes and housing. The 1960s were pretty good for music; I think the Beatles’ first album came out in 1963. Some very good regulation and legislation also came out in the 1960s. I beg the Minister to listen to a bit more Beatles music, and to have a spring awakening to the fact that she has the ability and capacity to lead on this issue, providing healthy homes for all the people in this country who deserve them.

[Mr Laurence Robertson (in the Chair)]

I remind the Front-Bench speakers that I would like to leave two minutes at the end of the debate for Mr Shannon to respond.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Mrs Heather Wheeler)]

It is a pleasure to serve under your chairmanship, Mr Robertson. We have had an excellent debate. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate on the cost of unhealthy housing to the NHS. He is a long-standing advocate of healthy housing, and his knowledge and passion about the subject has been evident today. Indeed, I congratulate all Members who have spoken. The 11 contributors spoke with passion about the links between housing and health. I acknowledge and commend the amount of work that the hon. Gentleman has undertaken on behalf of his constituents and the public as chair of the all-party group on healthy homes and buildings. He has provided welcome scrutiny of one of this Government’s top priorities: safe, decent, housing. I have read the APPG’s white paper with interest and will use this opportunity to respond to that as well as today’s debate.

The APPG is carrying out very important work, and I commend my hon. Friend the Member for Walsall North (Eddie Hughes) and the hon. Member for North Tyneside (Mary Glindon) on their roles as co-chairs of the APPG, as well as my hon. Friend the Member for St Ives (Derek Thomas) and the hon. Member for Upper Bann (David Simpson) on their work in the APPG.

I cannot speak to figures relating to the cost of unhealthy housing to the NHS, because that is not within my gift as a Minister for housing, but that does not mean that the Government do not acknowledge the cost of poor housing on health, and the cost is enough to justify driving through changes. Everyone deserves a decent and safe place to live, and we have seen clear improvements under this Government. The number of private rented homes failing to meet the decent homes standard is down 15% since 2010, which is a record low, and the number of social homes failing to meet the standard is down 32% since 2010: a near-record low.

However, the Government want more action to be taken, which is why our recent social housing Green Paper asks whether we should reconsider what constitutes a decent home. We supported the Homes (Fitness for Human Habitation) Act 2018, introduced by the hon. Member for Westminster North (Ms Buck), which gives tenants the right to take legal action if landlords fail in their duties, freeing local authorities to focus on using their existing strong and effective powers against rogue landlords.

I want to speak about the actions that the Government are taking on each point of the system. Again, I congratulate all the Members who have contributed today. My Department is reviewing building safety regulations, mindful of the needs of people in fuel poverty and the importance of maintaining air quality in our homes, and we are working across Government to ensure an holistic approach to building regulations. To answer the question asked by the hon. Member for Huddersfield (Mr Sheerman), we take the risks and consequences of carbon monoxide poisoning very seriously, which is why we committed to review carbon monoxide alarm requirements. I am pleased to say that the first stage of the review is complete and we have gathered information on the falling costs of alarms and on uncertainty about the fact that carbon monoxide poisonings are perhaps under-reported. We are now considering the updated evidence and will respond shortly.

Local authorities have strong powers under the Housing Act 2004 to tackle poor property conditions that might impact on people’s health. They must take enforcement action where the most serious hazards are present, which are usually assessed through the housing health and safety rating system—the HHSRS, which I always have difficulty saying. Enforcement activity can range from informal work with the landlord to emergency repairs or even prohibition of the use of the whole or part of the property in extreme circumstances. The HHSRS is crucial to local authorities’ enforcement of decent standards and thereby the protection of people’s health. That is why on 26 October 2018 we announced that we were commissioning a review to assess how well the HHSRS works in practice and to ensure it remains fit for purpose.

To reply to the hon. Member for Strangford, in October we laid regulations to extend mandatory licensing of houses in multiple occupation, bringing a further 170,000 HMOs within scope. It is an important tool for preventing overcrowding and the harms associated with it. I again congratulate the hon. Member for York Central (Rachael Maskell) on her dedicated work on housing and her tenacity in fighting for her constituents.

Winter mortality is a result of many different factors, but it is clear that living in a cold home can lead to adverse outcomes for health and wellbeing. An investment of £3 billion a year demonstrates that it is not something that the Government take lightly. We have a comprehensive package of policies to support households over the winter months. All pensioner households receive winter fuel payments of £200 to £300, and more than 2 million low-income and vulnerable households receive a further £140 rebate through the warm home discount. Additional payments are made through the cold weather payment scheme during spells of cold weather. In addition, £640 million a year is currently available through the energy company obligation to upgrade homes, tackling fuel poverty in the long run.

[Mr Sheerman]

Can the Minister tell me what she thinks about going back to really firm standards, such as the Parker Morris standards? The review was originally a Conservative idea.

[Mrs Wheeler]

I congratulate the hon. Gentleman on managing to mention Parker Morris at least three times in this debate. We are looking at future standards. Sometimes we need smaller homes as starter homes, but equally we need better-quality homes all the way through. I will perhaps come on to that later in my speech.

The health impacts of cold homes and fuel poverty require action from a wide range of organisations across the health and social care sector. Partnership approaches are key. Local authorities are now able to work with the charitable and health sectors to determine which households should be eligible for support under a new flexible element of the £640 million-a-year energy company obligation energy efficiency scheme, which is focused on low-income and vulnerable households.

There has been significant improvement in the average energy efficiency of fuel-poor homes. The latest fuel poverty statistics showed that there were nearly 800,000 fewer fuel-poor properties rated E, F or G in 2016 compared with 2010. I can tell my hon. Friend the Member for St Ives that the role of housing will be a crucial part of our considerations in the forthcoming social care Green Paper. I also note his pitch for a pilot. That shows that the policies are working to help those living in the least efficient homes, who can least afford to keep warm.

There is no doubt that it is essential that buildings are well ventilated, as the hon. Member for Huddersfield mentioned, for the health of the people in the building, and the health of the building itself. It is not merely a means to resolve overheating, but a matter of air quality. For that reason, part F of the building regulations sets minimum requirements to provide adequate means of ventilation. As set out in the Government’s clean air strategy, we plan to consult in spring 2019

“on changes to standards in Part F of the Building Regulations relating to ventilation in homes and other buildings.”

In setting minimum ventilation standards, we take advice from across Government on indoor air quality, including from the Department of Health and Social Care, the Department for Environment, Food and Rural Affairs and Public Health England. Indoor air quality is a complex issue, and many factors determine the concentration of pollutants in a space. Ventilation is one such factor, but outdoor air quality, the location of the building, emissions from products and the activities of occupants in the building all play a role as well.

Health and wellbeing can be affected by what is outside as well as inside a home. The revised national planning policy framework therefore includes a dedicated chapter that deals with the creation of healthy and safe places. It states:

“Planning policies and decisions should aim to achieve healthy, inclusive and safe places which…promote social interaction…are safe and accessible…and support healthy lifestyles”.

At my Department’s recent national design quality conference in Birmingham, attended by more than 400 representatives of the community and housing sector, we had a dedicated session on healthy place-making, and we recognised the importance of creating places that have a positive impact on health and wellbeing. On that matter, too, there is extensive cross-Government collaboration. As the hon. Member for Strangford is aware, my Department has been part of the NHS England healthy new towns programme and sits on the steering group. I hope that he will be pleased to hear that in 2019-20, NHS England will build on that by working with the Government to develop a healthy new towns standard, including a healthy homes quality mark to be awarded to places that meet high standards and principles that promote health and wellbeing.

The Government recognise the importance of having safe and healthy homes and buildings, and provide common definitions and approaches to regulation and standards, consistently striving to ensure that they remain up to date and effective. MHCLG has taken the lead on many aspects, from undertaking a comprehensive review of building safety to strengthening consumer redress. There is extensive cross-Government work on healthy homes and buildings, from planning and place-making to design, delivery and standards and support. Again, we take on board the comment about Parker Morris.

Officials across all policy areas regularly engage across all levels of Government, industry and the third sector. For example, we are an active signatory of the memorandum of understanding on improving health and care through the home. That joins us up with 25 other signatories, including the NHS, the Local Government Association and the Royal Society for Public Health. We have positive relationships with our counterparts in the devolved Administrations, but always welcome the opportunity to deepen engagement.

Perhaps the APPG for healthy homes and buildings is the place to examine which specific relationships could be strengthened. However, the responsibility for ensuring that homes and buildings are safe and healthy is a shared one, lying with product designers, developers, building owners and managers and local authorities, as well as central Government and devolved Administrations. That is why the work that the hon. Member for Strangford has undertaken through the APPG is so valuable, and why Ministers from my Department would be pleased to meet the group, to ensure that no stone is left unturned in our mission to make the housing market fit for everyone.