Unhealthy Housing: Cost to the NHS

Heather Wheeler Excerpts

Tuesday 26th February 2019 Westminster Hall

[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.