The direct link between poor housing and poor health is clearly established, yet the extent of local health, care and housing integration still represents something of a postcode lottery. After joining PPL with a background in housing and homelessness, I’ve been working with a number of local areas to help turn evidence into action.

The 3rd leg of the stool

In a recent roundtable for the Health Devolution Commission, Lord Best described housing as the ‘3rd leg of the stool’ for improving people’s health – health services, social care and housing.

I know a lot of colleagues in local housing and planning authorities would argue their leg on the stool is slightly misunderstood by the other legs, and there is still ample opportunity to create a more safe, stable and less wonky stool!

The roundtable concluded that Integrated Care Systems will not be able to achieve their four primary aims without improving poor housing in their area. Add to this the estimated £1.4 billion annual cost to the NHS from poor housing, and the case is hard to ignore.

So, what can we do about it?

Areas for action

These conclusions should drive a number of longer term, strategic priorities at a local level: combining health and housing data sets, developing integrated strategies and improvement plans, ensuring “housing” (providers and authorities) are embedded in relevant local governance and partnerships; and developing a local evidence base.

There are also some immediate, practical actions for local areas:

  1. Get housing in the ICS strategy. If it’s not in the strategy, get it in the action plan. If it’s not in the action plan, make explicit links to the things that are.
  1. Start somewhere in the system and grow. There are many touchpoints in local systems where integration of health, care and housing are fundamental – timely discharge from hospital, to name just one. There is always good practice already happening. Build on this, identify the next shared priority and “start doing” to catalyse system change.
  1. Bridge the sector divides. Language and mental frames are important. The immediate action is to find the people that “get housing” within integrated care structures, open the communication channels and build a common language. The ideal is dedicated housing leads within ICSs, including secondments from the sector to support this.
  1. Follow the money. Investment is needed to drive greater integration of housing, health and care at the local strategic level. Funding streams like the Rough Sleeping Initiative have been used by a number of areas to develop integrated health and social care services for people experiencing homelessness. These are time-limited and intended as ‘scaffolding’ while commissioners secure available resources. Other areas are using funding streams from a wide range of non-housing sectors. In short, despite the incredibly difficult funding environment, there are pots out there to support integration work; a key question is are you exhausting all of them?

We’ve seen how effective this four-pronged approach is in our work with local areas. We’re currently supporting a London Borough to develop and roll out a housing, health and care joint working protocol. The initial focus is crisis intervention within the community and hospital discharge; both current sources of frustration for local partners. It’s one of many projects we are delivering to make significant impact in this area and power positive, societal change.

If not now, then when?

With the large, sector-wide transformation and investment taking place across the health and care landscape, now is an opportune time to invest in and make explicit the relationship between health, care and housing. With the principles of integrated care systems and the “People at the heart of care” adult social care reforms; it does feel like we have another window of opportunity which many areas are seizing.

The current environment makes the shift upstream to the drivers of population health all the more important. As a major determinant of health, it’s time to right the housing leg of the stool. We’re always keen to learn and hear from local areas, so get in touch if you want to continue the conversation.