New national strategy needed on supported and specialist housing

Cross-party parliamentary report pushes case for closer integration of housing, health, and care.

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An all-party parliamentary group (APPG) calls for a national strategy on supported and specialist housing, with over two million older people living in poor-quality homes across England alone – and now costing the NHS £1.4bn every year.

Pushing the case for closer integration of housing, health, and care, the APPG for ageing and older people recommends government restores funding for national and local housing advice services, makes energy efficiency a national infrastructure priority, increases funding for adaptations and repairs, and works with PRS to allow for stock adaptations.

Released today (4th July), the report is the result of a year-long inquiry into the link between health and housing, home ownership, supported housing, and the private rented sector.

“This report shines a light on the devastating consequences living in a non-decent and non-accessible home can have for older people,” said APPG chair Rachael Maskell MP.

“Whatever tenure of home an older person lives in, it is paramount that the unique challenges they face are met and that they feel safe and secure in their homes.”

She continued: “For many older people their homes are rooted in their communities and support networks.

“However suitable a new home may be, having to move away from their homes would mean being uprooted and would have a devastating impact on their wellbeing.

“We need to improve the conditions of current housing stock, so that they work for the people living in them; we need to ensure that home improvement agencies have the capacity and resources to help older people, across all tenures, to carry out essential repairs and adaptations to their homes,” she said.

The report confirms poor-quality housing now costs the NHS a staggering £1.4bn every year with cold, damp, and other hazards causing falls and exacerbating conditions such as heart disease, strokes, respiratory illnesses, and arthritis, as well as contributing to poor mental health.

The government, the report says, must “exercise leadership” to ensure that the Department of Health and Social Care and MHCLG integrate housing, health, and care into their planning frameworks and strategies and report annually on progress.

The report references that success in addressing housing issues in national strategies on health and care is still patchy, citing a Memorandum of Understanding ‘Improving Health and Care through the Home’ issued in 2014 – and then updated in 2016 to include significant developments such as Sustainability and Transformation Partnerships.

But, as the Centre for Ageing Better pointed out in its presentation to the APPG, there was limited mention of housing and nothing on the importance of housing adaptation and repair in the NHS Long Term Plan.

While the report acknowledges recognition of the link between housing and health when funding for housing adaptations (the Disabled Facilities Grant, or DFG) was included in the Better Care Fund, it doesn’t see the importance of measures to increase the availability of decent accessible housing reflected in documents such as the Social Housing Green Paper.

And plans for further de-regulation of housebuilding, such as extending the scope of ‘permitted development’, where industrial and commercial buildings can be converted to housing without any building or planning regulations, suggest a lack of understanding of the importance of decent accessible housing for health and wellbeing, the report says.

The APPG’s analysis of Sustainability and Transformation Plans carried out by Care and Repair England in 2017 found the majority of these made little reference to housing, and very few approximated to the ambitions of the Memorandum of Understanding.

Similarly, the report says local housing strategies often don’t reflect measures housing authorities could take to address the health and wellbeing of residents.

The report references 2016, when 47% of authorities had not produced a Regulatory Reform Order that would have enabled them to flex the regulations governing the Disabled Facilities Grant funding to better meet the need for housing adaptations and repair.

Since 2004, London has built the requirement for all new homes to meet the lifetime homes standard into its Local Plan, but the report references Habinteg’s analysis of Local Plans outside London, which found only 22% of housing due to be built by 2030 planned to meet lifetime home standards.

Experts also predict that the numbers of older people renting in the private sector are set to soar in the coming years – often in unsafe, unsuitable, and unhealthy accommodation.

Currently, households aged over 65 account for fewer than one in 10 of all those living in the private rented sector, but their numbers are reportedly rising fast.

A recent survey by the National Landlords Association (NLA) found that the numbers of retired people in the UK moving into the private rented sector has increased by 200,000 over the last four years.

If PRS is to meet the needs of these numbers, the government “urgently” needs to push through with its proposed reforms where rising rent levels have a significant impact on older tenants, the report says, calling on government to work with private landlord organisations to increase the availability of PRS housing that is flexible and adaptable to both older and disabled renters.

And this, the report says, should include making the criteria for obtaining a DFG more inclusive of private renters, with increased council capacity and resources to deliver grants to the sector.

The report recognises the RLA as seeking to improve professional standards across its membership to improve the sector’s offer to older and disabled people.

This, the report says, will help the government’s commitment to reform security of tenure for private renters.

But the government and key housing agencies will need to “work together collaboratively” with both the RLA and NLA to offer training to landlords on how to make their properties more accessible to older and disabled people.

The Institute of Housing told the APPG that both work to raise awareness among tenants and the availability of DFG for adaptations is needed, as are levers to incentivise landlords to allow adaptations to be carried out.

And the NLA said 7% of DFGs that go toward private tenants will need to be dramatically increased if inaccessibility is to be addressed in a sector that has a high proportion of older properties.

Given that there is funding to address the issue, the report says “greater efforts” need to be employed toward exploring how private landlords can be incentivised to engage in order to understand the opportunity DFGs can offer.

In its submission, the LGA told the APPG: “There is a need to increase the awareness of private landlords about how adaptations work, so that the growing number of older people in private sector rental accommodation are able to secure appropriate adaptations.”

But even with future improvements in the private rented sector, the report says, for many vulnerable older people, PRS is unlikely to offer suitable low-cost accommodation, seeing a “growing recognition” that affordable social housing is a more suitable and cost-effective form of housing for low or modest incomes.

The report references the recent Shelter Housing Commission, which gained cross-party support for its proposed targets for new-build in the sector to provide better alternatives to private renting.

“We must build more general needs and supported housing in the social rented sector to provide real alternatives to those parts of the private rented sector that are completely unsuitable for vulnerable older people on low incomes,” the report says.

Baroness Greengross OBE, a crossbench peer, said: “Unless we work on sustainable solutions, vulnerable older people will continue to live in substandard accommodation, the implications of which could be devastating to their physical, mental, and social wellbeing.”

Barbara Keeley MP, Shadow Cabinet Minister for Social Care and Mental Health, said the report highlighted a clear link between housing, health, and care, and that living in poor quality housing can have a detrimental impact on older people’s physical and mental wellbeing.

“There are more than a million people aged over 65 in the UK with an unmet care need. For them, everyday essential tasks like getting out of bed, going to the toilet or getting dressed can be made harder by poor housing.

Keeley continued: “Poor housing puts increased strain on an underfunded care system and can result in unnecessary hospital admissions.

“We need to see action now to create decent and accessible homes that meet the needs of the ageing population – by providing suitable housing for older people, we can prevent their health from deteriorating,” she said.

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