This is an introduction to the Government’s policy and legislative framework for housing and health. Much of the information here is relevant to both physical and mental health outcomes. This is not exhaustive and is subject to change in light of the new Government: please refer back for updates.
The relationship between housing conditions and health has been of policy interest since 1842 when Chadwick noted the low life expectancy of cellar dwellers. The 1998 Acheson Report identified housing and environment as priority areas for reducing health inequalities, concerns echoed a decade later by Marmot in 2010. The Marmot Review: Fair Society, Healthy Lives 2010 is the definitive contemporary overview of the link between poor health outcomes and a range of underlying causes, including housing and the built environment.
Within Government the Department for Communities and Local Government (DCLG) have responsibility for housing policy, providing the framework for local authorities, partners and local communities to plan for and build better places to live for everyone. The Government presented a new Housing and Planning Bill to Parliament on 13 October 2015: this proposes a range of measures to increase home ownership, to speed up the planning process so that more homes are built, and to tackle rogue landlords.
The Department of Health (DH) is responsible for health policy, and works with DCLG on shared interests such as home adaptations, specialist housing and health, care and housing integration. Of particular relevance to housing and health are the Health and Social Care Act 2012: health related services are defined as “services that may have an effect on the health of individuals but are not health services or social care services” e.g. housing. Also, the Care Act 2014 and the statutory guidance to support implementation: suitability of accommodation must be considered as essential to wellbeing when carrying out any care or support functions; housing is described as a preventive health related service which must be integrated in health and social care commissioning and delivery.
Public Health England (PHE) is an executive agency of DH and is responsible for protecting and improving the nation’s health and wellbeing and reducing inequalities. PHE was established in 2013, legislated for in the Health and Social Care Act 2012 as part of the Coalition Government’s response to the Marmot review. PHE’s priorities are described in From evidence into action: opportunities to protect and improve the nation’s health. Relevant to health and housing, PHE runs a Healthy People Healthy Places programme and is responsible for the Government’s Cold Weather Plan and supporting guidance.
The Department of Energy and Climate Change (DECC) works to make sure the UK has secure, clean, affordable energy supplies and promotes action to mitigate climate change. It promotes interventions to improve energy efficiency in the home, for example to share learning it has produced a catalogue of health-related fuel poverty schemes that are targeting individuals with health problems with measures to improve energy efficiency and tackle fuel poverty. Cutting the cost of keeping warm, the fuel poverty strategy for England of the previous Coalition Government, incorporates relevant objectives which would improve the health and wellbeing of many.
The Memorandum of Understanding (MoU) to support joint action on improving health through the home sets out a shared commitment from Government departments, PHE and NHS England, national housing, public health and social bodies to taking joint action to improve health and wellbeing and reduce health inequalities.
Taking action to remove housing hazards
The Housing Act 2004 requires local housing authorities (lower tier) to:
• Keep the housing conditions in their area under review with a view to identifying any action that may need to be taken
• Inspect premises in specified circumstances with a view to establishing whether there is a ‘hazard’
• Take appropriate enforcement action where a category 1 hazard exists, and justify enforcement action for a category 2 hazard, including consulting with the fire and rescue authority for the area where a fire hazard exists
• Licence all Houses in Multiple Occupation that are of three or more storeys, housing five or more persons in two or more households
Local authorities are able to assess the local housing conditions in England and Wales through the use of the Housing Health and Safety Rating System (HHSRS), a risk assessment process that categorises the risks to health and safety from specific housing hazards. To make an assessment, local authority inspectors will make reference to the HHSRS ‘Operating Guidance’. Under the Housing Act 2004 they have a duty to take action of some kind if they discover a Category 1 hazard. Enforcement needs to be approached with consistency and local authorities must make reference to the Enforcement Guidance.
The HHSRS data can also be used to demonstrate the cost benefits of a proactive approach to resolving poor housing conditions with the use of the Building Research Establishment’s (BRE), Housing Health Cost Calculator. Local authorities and their partner organisations are using this data to inform their Joint Strategic Needs Assessment and local commissioning for improved health.