Housing associations already deliver a range of services to promote health, wellbeing and independence for many different populations including older people and those with enduring mental health problems. Recent reforms to the health system, including measures to increase co-operation and joint commissioning of services with the social care sector, will both create opportunities for housing associations and have implications for the ways in which housing associations enter into the healthcare market.

1. • Amy Swan, Project Manager (Health Partnerships),
National Housing Federation
• David Mcdaid, Research Fellow at LSE and Editor of
Eurohealth,
Exploring housing’s place in the
local health economy

2. Understanding the NHS and the
housing association offer

3. ‘The NHS needs no more unresourced sticking
plasters. Neither will it benefit in the long run from
“handouts”, however generous.’
Alastair McLellan, editor of HSJ
‘We are about to run out of cash in a very serious
fashion.’
Tim Kelsey, NHS England's Director for Patients and Information

5. Demand outstripping supply

7. NHS begging bowls
• £30 billion gap in funds
• Better Care Fund
• Diversion of funding
from acute sector
• Demands for more staff
and the workforce crisis

8. Priorities for health
commissioners
• Persistent health
inequalities
• Ageing population
• Unmet mental
health needs
• Premature deaths
• Complex conditions
• Prevention
• Health promotion
• Self-care
• Shifting resources
out of hospitals
• Designing
integrated services
• Early intervention

9. Show me the money!
NHS providers
Lottery funding
DH innovation funding
Small CCG grants
CCG healthcare
contract
Public health tenders

10. A clear vision
Joint venture or
partnership with an
NHS provider
Host NHS services or
co-locate with health
Monitoring, health
checks, and signposting

11. So how can
economics help
strengthen case
to invest in
housing for
health?

12. Economic
arguments have
long been
embedded into
NHS decision
making

13. Immediate funding pressures

14. Economic arguments embedded
Since 1999 the National Institute for Health and
Care Excellence has assessed case for investing in
health care interventions
2005 – extended to health promotion and public
health
2013 – extended to social care
Interventions need to be shown not only to be
effective but also cost effective

15. Cost
effectiveness
also a concern
for local
government
commissioners

16. Economics can be one important
input into decision making process
Resources are not unlimited;
economic information can help
determine how best to make use
of resources but……
Cannot be used in isolation; many
other factors (fairness, equity,
political concerns etc) influence
Economics

17. What types of
economic issues
do housing
associations need
to be aware of?

18. Cost of hip fractures from falls in
Ireland
27%
1%
35%
6%
21%
10%
Hospital costs
Primary Care
Long-term care
Informal Care
Poor Quality of
Life
Drug Costs
6,813 fracture hospital
admissions
85% from falls
€260 million
€38,000 per case
O’Shea and Gannon, Irish Medical Journal, 2

19. Valuing the socio-economic contribution of older
people in the UK (2011)
• In 2010 positive
net contribution to
UK economy £40
billion rising to
£77 billion by
2030.
• Costs: takes
account of pension,
welfare, health
costs.
• Benefits: Tax
revenues, Consumer
Spending, Provision
http://www.goldagepensioners.com/Uploads/PDF/main-report.pdf

20. The costs of action
• The costs of action: What would it cost to intervene by
providing a preventive measure or treatment delivered by
a housing association?
• Estimating the resource requirements, staffing,
equipment, premises etc required to deliver a service by a
housing association
• Could compare this with cost of same service delivered
by other providers
• Can services be delivered more efficiently?

21. The cost effectiveness of action
• The cost-effectiveness of action: What is the balance
between cost of intervention and better outcomes, e.g.
health status, improved quality of life, educational
performance etc?
• Important to identify benefits of housing interventions
• Interventions can cost more money but they must then
achieve better outcomes
• Is it worth the extra cost to achieve this benefit?

22. Economics is about choice
CCG
Budget
More Mental Health
Services
More
Hip Replacements

23. Economic evaluation
The effectiveness question:
Does this intervention
work?
The economic question:
Is it worth it?

24. Two Basic Needs: (A) Costs and
Outcomes; (B) 2+ Alternatives
Outcomes e.g
Quality of Life
Years (QALYs);
Independent
living; delayed
entry to nursing
Costs of usual
intervention
Costs of
Housing
Association
intervention
Outcomes (e.g
Quality of Life
Years (QALYs);
Independent
living; delayed
entry to nursing
homes
Traditionally NICE
considered cost per QALY
circa £30,000 considered
good value; But budgetary

25. Cost-Effectiveness Possibilities
CNew >
COld
New housing
intervention is
less effective
and more costly
New housing
intervention is
less effective
but less costly
New intervention
is more effective
but also more
costly
New intervention
is more effective
and less costly
ENew > EOld
CNew <
ENew < EOld
The
‘no go’
zone?
Cost-saving
0
No right or wrong answer: Each
society must decide how much it
is willing to pay for additional
?????
Uncertainty
So … is
it worth
it?

26. What do we know
about the
economic case
for investing in
housing to
promote and
protect health?

27. Limited but growing evidence base on effectiveness
Health commissioners most influenced by large
scale, well designed studies (usually randomised
controlled trials)
Limited but growing examples of interventions
that could be delivered by housing sector
Economic outcomes attached to some of these
studies

28. Limited but growing evidence base on effectiveness
Some examples:
Extra care housing
Reablement services
Floating support services
Independent housing for people with mental health
needs
Financial advice services
Home adaptation, insulation schemes

29. er

30. High chance of being very cost effective
Baumker et al 2011

32. Reablement: Long term
returns

33. How can housing
associations make
use of this
evidence?

34. Making use of economic evidence
• When making a case refer to published studies on the
costs of poor health
• Report resources required to deliver housing intervention
and how this compares with current service costs if
possible
• Helpful to refer to any published studies on value for
money of intervention – doesn’t have to be delivered by
housing association
• The more rigorous the study – the more credibility it will
have with commissioners

35. Where to look for economic evidence
• Three useful starting points
• NHS Economic Evaluation Database
• US National Library of Medicine (Medline) database
• NICE website – guidelines on interventions
• Work with economists to model cost effectiveness –
opportunities for the housing sector to partner
universities in housing and health research

36. NHS EED
http://www.crd.york.ac.uk/CRDWeb/

39. How to present
the economic
case: some tips

40. Presentation Tips
• Refer to robust evidence on effectiveness
• Apply local unit cost data when estimating
costs of service delivery
• Be transparent on strengths and weakness
of evidence
• Be conservative and cautious on strength
of evidence
• Present information on the economic case
for reaching specific population groups

41. Presentation Tips
• Focus on impact on quality rather than on
arguments that interventions will reduce
costs to the NHS
• Present some information on the costs of
the status quo
• Tailor the economic argument to different
stakeholders
• Look at budgetary impacts as well as cost
effectiveness
• Commit to ongoing monitoring of a service

42. Questions?
• @natfedamy
• @dmcdaid
• website@housing.org.uk