Unhealthy Housing: Cost to the NHS

Melanie Onn Excerpts

Tuesday 26th February 2019 Westminster Hall

[Melanie Onn (Great Grimsby) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this important debate on a critical issue related to housing. It is reflective of the crisis in housing. From the contributions we have heard today, it is painfully clear that alongside the families left waiting for social housing, the young people unable to get on the property ladder and the thousands of rough sleepers on our streets, the NHS is suffering as a result of an ongoing housing crisis in which one in three people in the UK live in poor-quality housing.

If we take a short trip down memory lane, we will recall that the last Labour Government’s decent homes programme invested £22 billion and brought 1.4 million social homes up to a habitable standard. Contrast that with the position now: the English housing survey gave us data across the whole housing sector showing that 20% of homes in our country were considered non-decent in 2016. More than 500,000 social homes failed to meet the decent homes standard in 2017. That perhaps comes as no surprise when we consider that just £1.6 billion was spent on the decent homes programme between 2011 and 2015, when funding was stopped altogether, with the Government expecting councils, which are stretched to breaking, to pick up the pieces.

Cold and damp houses have a detrimental effect on health by increasing the risk of cardiovascular, respiratory and rheumatoid conditions. They can exacerbate the symptoms of arthritis and reduce dexterity among elderly people, thereby increasing the risk of falls. They cause mould, colds and flu. Being cold can impact a person’s ability to cook, shower and clean.

My hon. Friend the Member for Coventry North East (Colleen Fletcher) painted a clear picture of how poor housing also affects our mental health. Our homes are places where our children grow up, where we celebrate milestones and where we spend a great deal of our time, so it is completely understandable that the state of our houses can have such a detrimental effect on our mental health. Research by Shelter indicates that 20% of adults have experienced mental health issues in the past five years as a result of housing problems. Further research by the Sustain project has found that the physical condition of someone’s home is strongly predictive of their mental health. According to Mind, people with a mental health condition are four times more likely to report that poor housing has made their health worse.

The Government’s failure to build anywhere near enough new and appropriate homes—my hon. Friend the Member for York Central (Rachael Maskell) recognises this only too well from her constituency—ends up in a direct cost to the NHS: unhealthy homes affect our mental and physical health, leading to increased pressure on the health service, whether that is on GP appointments, hospital bed spaces or carers. The NHS even has a diagnosis code for inadequate housing, which was listed as a secondary diagnosis in almost 3,500 hospital episodes in 2017-18. More than half were among those aged 65 or over.

Poor-quality housing has particularly disastrous effects on those on low incomes, many of whom lack the means to replace out-of-date boilers and central heating systems, or end up renting off unscrupulous landlords who let their homes fall into disrepair. My hon. Friend the Member for Huddersfield (Mr Sheerman) made some excellent points about the difficulty of getting private rented sector properties up to standard, and reminded us all of the dangers of the silent killer that is carbon monoxide poisoning, which can often happen in homes of a lower standard. Those things all inevitably lead to avoidable GP appointments and hospital stays.

The cost of the lack of accessible housing cannot be overstated. Elderly and vulnerable people across the country struggle every day in homes that do not meet their needs. As Members have pointed out, some cannot afford to heat their homes properly. Just 7% of homes have basic accessibility features. Those who feel they can no longer live safely or comfortably in their homes are forced into care homes at a cost to their family, the state and their independence.

According to the Royal College of Physicians, falls cost the NHS £2 billion every year. However, many falls are not the inevitable result of ageing and could be easily avoided by removing hazards around the home. Fitting grab rails in bathrooms, building houses with walls strong enough to support grab rails, making sure homes have level access and building stairs with an easy-going pitch are all cost-effective ways to avert extremely damaging falls. Research by the Building Research Establishment indicates that removing category 1 hazards that lead to falls would save more than £400 million every year and would pay for itself within just five years. If we make those changes pre-emptively, the number of hospital bed days lost due to delays in hospital discharge while a suitable home is found will be dramatically reduced.

One of my constituents is a nurse at Scunthorpe General Hospital. She reported to me that she routinely has patients in her care who are forced to wait in hospital for up to three weeks longer than they should for changes to be made to their homes, or for a carer to be assigned. My local hospital trust says that one of the worst things for patients, particularly elderly patients, is to be in hospital longer than they should be. They are at increased risk of infection, and unfortunately that increases mortality rates. That really brings home how important getting housing right at every stage is to individuals’ life prospects, and NHS statistics reflect that.

An NHS annual report on delayed transfers of care in England in 2018 found that nearly 50,000 bed days were lost because of delayed discharges due to housing inadequacy, with patients waiting for major home adaptations, alternative housing arrangements, manual handling equipment such as a hoist, living equipment, a bed, deep cleaning, decorating, or basic decluttering.

The NHS is already on its knees. NHS doctors, nurses and workers deserve better than to be burdened by the failure of the Government to provide healthy homes. The Government cannot ignore the impact of their cuts to local government on the state of our housing. Environmental health departments have not been protected from very severe cuts, and many simply do not have the resources to enforce housing standards fully in their area. The hon. Member for Strangford raised concerns about people slipping out from under the microscope, and that is a prime example of ever-widening gaps in social policy. It is people, not statistics, who end up falling through those gaps.

The Homes (Fitness for Human Habitation) Act 2018, introduced by my hon. Friend the Member for Westminster North (Ms Buck), presents a real opportunity for tenants to take some control over their housing standards, but it will not replace the need for proper council enforcement, and the Government must consider whether cuts to local government truly offer value for money when they stop councils protecting tenants from unhealthy housing, and lead to less money in the pockets of our NHS.

We must take the health impact of our homes into account as we build for the future. The current state of affairs is unsustainable and places too much of the burden on the NHS. A change in the way that we build houses will reduce the cost of social care, give people a sense of independence, and allow the elderly to live an active lifestyle at home well into their 80s and 90s.