Unhealthy Housing: Cost to the NHS

Martyn Day Excerpts

Tuesday 26th February 2019 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Robertson, in what has been an interesting, consensual and informative debate that I am grateful to the hon. Member for Strangford (Jim Shannon) for having secured. All too often, we describe debates as important when they are not, but this debate is genuinely important, and it is good to see consensus about that across the Chamber. I thank the hon. Gentleman not just for his thorough opening speech, but for his work in chairing the all-party parliamentary group for healthy homes and buildings, and for the excellent report that it recently produced.

There is no doubt that housing is the foundation that connects people to their communities, or that healthy homes help empower full participation in community life. As the hon. Gentleman pointed out, healthy homes lead to better educational attainment, higher workplace productivity, reduced emissions, lower energy bills and a lower carbon footprint—objectives that we would all unite in supporting. Poor housing, on the other hand, detrimentally contributes to physical and mental health inequalities through the effects of housing costs, housing quality, fuel poverty and the role of housing in community life, and many Members have provided examples and case studies that have helped to illustrate that point. Many people do not live in a home that is warm, dry and affordable, and those on the lowest incomes are most disproportionately affected. The hon. Member for St Ives (Derek Thomas) made some good points about housing and fuel poverty, an issue that affects my constituency, and one that we should be doing a lot more to tackle in this modern age.

Income, wealth and the welfare system are undoubtedly at the heart of the relationship between housing and health inequalities. Poverty-related inequalities represent thousands of premature deaths every year. In Scotland, both housing and health are devolved. I have some Scottish figures that give a wee bit of flavour; they are pretty similar to those we have heard from Members from elsewhere in the UK. Figures from NHS Scotland show that men in the most deprived areas spend nearly 25 fewer years in good health than those in the least deprived areas; for women, the figure is 22 years. Housing clearly has the potential to reduce or reinforce those inequalities. In Scotland, all homes are required to meet the tolerable standard of habitability. It is estimated that 1% of all homes fell below that standard in 2017—that is down from 4% in 2012, so we are going the right way. Perhaps more worrying is that, as Members have mentioned, the private sector is lagging behind; the public sector is leading the way. Private homes, which are a different matter, are in between.

There is a lot of work that we need to do in all areas of housing tenure, and there are several linked factors in that, such as the number of properties available in an area. The quality of the homes is also a major factor—as is affordability, perhaps more importantly. In Scotland, the Scottish National party has delivered more than 76,500 affordable homes since 2007, and is investing more than £3 billion to deliver at least another 50,000 affordable homes during the current parliamentary Session. The Scottish Government continue to support the empty homes partnership, which has brought 3,200 empty homes back into use since 2010. There are empty homes all around our country that could be put to use in housing people. The Scottish Government have introduced the Fuel Poverty (Target, Definition and Strategy) (Scotland) Bill, which sets a target of no more than 5% of Scottish households being in fuel poverty by 2040. In my opinion, 5% is still too many, but if we can achieve that, it will be a step in the right direction.

Between 2007 and 2017, the average price of domestic fuel rose from £856 to £1,249 per annum—a rise of approximately 46%. That is a frightening figure over a decade; people’s wages certainly have not kept pace with that rise. Fuel poverty causes misery, ill health and debt, and living in a cold, damp environment can exacerbate health problems such as asthma and heart conditions, as a number of Members have mentioned. It is unacceptable in this modern age that any household should have to choose between heating and eating, yet people who are struggling to pay their bills often ration their use of energy, perhaps heating just one room, having to choose between cooking or heating their home, or limiting the use of washing machines and heating water for baths or showers, all of which can have an impact on people’s health and wellbeing. There is a correlation between fuel poverty and increased winter mortality, or excess winter deaths. Increased winter mortality is associated with low indoor temperatures, and the excess winter mortality figure for 2017-18 in Scotland was 4,800, a figure not significantly different from the English figures mentioned earlier.

To become a fairer and more just society, it is crucial that we end the scourge of fuel poverty. As technology moves forward, we should do a lot more on the “Big Mother” scenario, rather than the Big Brother scenario. Smart meters and other technology are growing all the time. It would not be impossible to have feedback from people’s homes on the temperature in their houses. Action could then be taken, particularly in areas where we know there are elderly people, or people with social conditions, to intervene and check why they are not heating their home properly. Perhaps we should even think about the health sector being able to prescribe heat. It may save money in the long run.

The worst housing position for anyone to find themselves in is homelessness. The health of people experiencing homelessness is significantly worse than that of the general population. The Library briefing provided for the debate highlighted a Local Government Association report that identified that 41% of homeless people have a long-term physical health problem, and 45% have a diagnosed mental health problem, compared with respective figures of 28% and 25% in the general population. That certainly fits with my experience locally; the people whom various homeless charities have been dealing with increasingly have mental health issues, as well as being homeless.

The last estimate of the healthcare cost associated with the homeless population was £86 million a year in 2010; the figure will undoubtedly be higher now. That shows that we can save money for the public purse by tackling homelessness. The Scottish Government are committed to eradicating rough sleeping in Scotland. They have allocated £21 million to rapid rehousing in the past year. The money came from their “ending homelessness together” fund. As a result of the Homelessness etc. (Scotland) Act 2003, local authorities in Scotland have a duty to find permanent accommodation for all applicants who are unintentionally homeless. Last year, The Guardian reported that the National Audit Office had stated that homelessness is

“likely to have been driven by welfare reforms”,

which brings us back to poverty, the issue at the heart of so much of the homelessness and housing issue.

It is not all bad news, though. A report authored by Crisis and PricewaterhouseCoopers estimated that allocating appropriate housing to homeless people improved their wellbeing, and increased economic output as a result of them entering employment. The same report stated that the Exchequer is projected to save a staggering £6,361 million as people are moved out of homelessness, through the reduced use of public services, ranging across everything from the NHS to criminal justice. We cannot afford to skimp on this. Austerity does not get us there. We need to spend money to save an absolute fortune by solving the problems.

Time is moving on, and there are so many aspects of the debate that I would have loved to have gone into. The debate is so wide-ranging, and the hon. Member for Strangford has picked a genuinely fascinating issue. I will touch briefly on overcrowding, which is at the opposite end of the homelessness spectrum. It has serious links to mental health, particularly for children and young people. Living in cramped conditions puts enormous pressure on family relationships. I have seen case studies in my constituency of marital break-ups and people forced to live with their extended family for an undue period. It causes depression, stress and anxiety. We need to tackle not only the extreme ends of the issue, but overcrowding. Fixing the housing problem is key to ensuring that everyone has their fundamental needs met and reducing pressure on our NHS. It can also bring in a huge amount of money for the public purse that we could put to better use.