Retrofitting council stock will lead to better health outcomes for those in social housing

Housing is a big issue for Folkestone & Hythe District Council, but here we are not talking about building more social housing, but rather retrofitting their existing stock of 3,393 homes, which is estimated at a cost of £129m, according to the Council’s Housing Asset Management Strategy

Poor standards of housing costs the local NHS Trust – East Kent Hospital University Foundation Trust (EKHUFT) money it doesn’t have. It does this as there is a substantial link between poor quality housing and increased emergency hospital admissions by those who live in them, according to a variety of studies. As such retrofitting the Council’s social housing is a no brainer as it will place less demand on the NHS.

The first study undertaken by the NHS National Institute for Health Research and ran over eight years, found that meeting national housing quality standards through multiple home improvements was associated with reduced emergency hospital admissions.

The study sought to answer if improvements to housing standards could lead to better health in people. Housing improvements and hospital visits are expensive, and the study wanted to see if there was a reduction in the number of people going to hospital for emergencies among those living in homes that received improvements, compared with people whose homes did not receive those particular improvements.

The results discovered that meeting housing quality standards is related to a reduction in emergency hospital admissions for people living in social housing. The study calculated the costs associated with the reduction but, beyond cost savings, a reduction in emergency admissions is most likely to make hospital beds available to others in need.

In the first study undertaken by the NHS National Institute for Health Research the study showed that residents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 39% fewer emergency hospital admissions than those living in homes which were not upgraded. It also found reduced emergency hospital admissions were also associated with upgrading windows and doors, wall insulation and gardens and estates for those living in homes; which were upgraded. There were no associations of change in hospital emergency admissions with upgrading heating, loft insulation, kitchens or bathrooms.

Coming back to the Council’s Housing Asset Management Strategy the over 60 population is expected to increase by 37%. This means that the number of people aged 75 and over will change from 1 in 10 in 2018 to 1 in 5 by 2043. As such the age increase will affect emergency hospital admissions and cost EKHUFT more. 

As one can see from the retrofitting programmer costs over a 30 year period, the retrofitting which needs doing is substantial.

That said there are issues which ought to be prioritized as these will reduce the number of emergency hospital admissions. What needs to be done is

1 Electrical Installations as these show the largest % fall in the NHS National Institute for Health Research

2 Upgrading windows and doors

3 Wall insulation

4 Gardens & Estates

These four issues must be addressed first by the Council as the evidence from the NHS National Institute for Health Research shows these reduce emergency hospital admissions the most. If the Council were to follow the evidence, it would create a win-win for the Council & EKHUFT, and the residents of the district, as it would free up more capacity in the Trusts services.

In another study undertaken by The Gentoo social housing and sustainability group undertook a pilot study of the health impacts of housing improvement in people with COPD living in 12 homes with poor insulation. Information on health status and use of NHS resources was collected (by survey) from residents, who had their home energy efficiency ratings increased through the installation of double glazing, efficient boilers, and loft and cavity wall insulation. Outcomes for intervention home residents were compared with those for people with COPD in the area who did not have their homes improved. The researchers compared health-care utilisation in the winter period pre and post installation and found that residents had fewer attendances post installation. Over an 18-month period, participants self-reported that GP appointments reduced by 60%, accident and emergency attendances reduced by 30%, outpatient appointments reduced by 22% and emergency admissions reduced by 25%. Pg 44 NHS National Institute for Health Research

A further study by Warm Homes for Health cofunded by Gentoo and Nottingham City Homes, found that 176 people who were on an income of < £15,000 per year, about half of the average household income for the UK. After installation of housing improvements, health service use reduced and NHS cost savings were estimated at > £50,000. The authors suggest that this can be extrapolated to potential savings of £1billion per year in health service use costs if the 4.8 million ‘unhealthy’ UK homes were to receive similar housing improvements. Pg 44 NHS National Institute for Health Research

A sample of 814 Energy Performance Certificates for Social Housing owned by the Council, across the district showed that 150, or 18% of them had an EPC of D or E, and 75 (9%) had no valid EPC at all.

These are all significant indicators in poor energy performance in these homes, as well as making them more costly to residents to heat and maintain that heat. As such the worst first policy adopted by the previous Council, makes most sense as it will reduce the number of emergency hospital admissions for local residents in the Hospital Trust

Given the evidence the Council need to prioritize the retrofitting of Social Housing, as set out in 1 – 4 above. Putting these things first will reduce the burden on EKHUFT. If they fail to do this at pace, it, will end up costing the Trust we all rely on in East Kent, more than is necessary, and that will affect us all. It is all these small things added together which will make such a difference to us all, especially those in Folkestone & Hythe District Council Social Housing.

The Shepway Vox Team

Prioritise Social Housing retrofitting to reduce the burden on EKHUFT