Links between housing and health, Portsmouth City Council 3 February 2015. Includes Making Every Contact Count

1. Housing & Health Seminar
3 Feb 2015
The case for Social Housing and
Health to achieve better outcomes
and opportunities

8. 0
10
20
30
40
50
60
70
80
90
100
RDS Gardens Trips Events Youth asp Equipment
Funds 4 U - Number of approved applications 2014/15 - to 14/01/15

9. 0
2000
4000
6000
8000
10000
12000
14000
16000
18000
RDS Gardens Trips Events Youth asp Equipment
Funds 4 U - Spend on approved applications 2014/15 (£) - to
14/01/15

10. Activity v Effectiveness
Customer centred approach
Opportunity for Agencies to work with Housing
So is the question
What can Housing do for Health?
Or
What can Health do for Housing ?

11. Housing and health
What’s the connection?
Gill Leng, Housing and Health Lead
Health Equity and Place
Public Health England

12. Housing?
• The ‘bricks and mortar’ house
• Knowing who lives where, and the impact this has on
their health and wellbeing is essential;
• Housing-related services (all tenures)
• On offer to people to enable them to live in their own
home, or to move from crisis into their own home;
• A sector with an estimated workforce of up to
200,000 people
• Regular contacts with households facing some of the
greatest inequalities, living in the most deprived
communities

13. Good health: the work of a lifetime
Starting and developing well Living and working well Ageing well

14. What makes the difference?
Smoking 10%
Diet/Exercise
10%
Alcohol use 5%
Poor sexual
health 5%
Health
Behaviours 30%
Education 10%
Employment
10%
Income 10%
Family/Social
Support 5%
Community
Safety 5%
Socioeconomic
Factors 40%
Access to care
10%
Quality of care
10%
Clinical Care
20%
Environmental
Quality 5%
Built
Environment 5%
Built Environment
10%
Source: Robert Wood Johnson Foundation
and University of Wisconsin Population
Health Institute

15. Health promoting homes & services
• Starting and developing well
• Safe & warm environment in which to learn, play & be
nurtured
• Living and working well
• Access to work; well to work
• Space to bring up a family
• Ageing well:
• Connected to friends and family
• Space for: hobbies; changing health; for caring
• All – housing-related services which:
• Inform healthy choices
• Support transitions in life, and enable independence

16. Risks to health & wellbeing
1. Unhealthy and unsafe homes
• Bricks and mortar impact
2. Unsuitable homes
• Home environment does not meet needs eg,
disabled people, changing health and care needs,
overcrowding
3. Precarious housing and homelessness
• Home is at risk, or household is homeless

17. Housing related PHOF indicators
17
Overarching 0.1 Healthy life expectancy
1. Improving
the wider
determinants
of health
1.01 Children in poverty
1.02 School readiness
1.04 First time entrants to youth justice system
1.05 16-18 year NEET
1.06 Adults with a learning disability/in contact with secondary mental health
services in settled accommodation
1.09 sickness absence rate
1.11 Domestic abuse
1.13 reoffending levels
1.14 % population affected by noise
1.15 Statutory homelessness
1.17 Fuel poverty
1.18 Social isolation: social care users
1.19 Older people’s perception of community safety
2 Health
improvement
2.05 Child development at 2-2.5 years
2.06 Excess weight in 4-5 and 10-11 year olds
2.07 Hospital admissions injuries in children
2.08 Emotional well-being of looked after children
2.11 Diet
2.12 Excess weight in adults
2.14 Smoking prevalence – adults (over 18s)
2.15 Successful completion of drug treatment
2.18 Alcohol-related admissions to hospital
2.23 Self-reported wellbeing
2.24 Falls and injuries in the over 65s
3 Health
protection
3.03 Population vaccination coverage
3.05 Treatment completion for Tuberculosis (TB)
4 Healthcare
public health
and
preventing
premature
mortality
4.01 Infant mortality
4.03 Mortality from preventable causes
4.04 Mortality from cardiovascular diseases
4.07 Mortality from respiratory diseases
4.08 Mortality rate communicable diseases
4.10 Suicide rate
4.11 Emergency readmissions within 30 days of discharge from hospital
4.13 Health-related quality of life for older people
4.14 Hip fractures in over 65s
4.15 Excess winter deaths
4.16 Dementia and its impacts
Key:
Mental health related indicators
in italics
Shared or aligned with NHS
Shared or aligned with ASCOF*
Relevant to ASCOF*
* Adult Social Care Outcomes Framework

18. Unhealthy homes
For example
• Cold homes & fuel poverty: respiratory problems,
mental health, accidents & injuries; higher mortality
• Unsafe: unintentional injuries
• Fire: eg, burns, cardio-respiratory problems and
reduced lung function, disability, loss of life
• Security: injury, shock, depression, fear
Who is affected?
• People who are at home the most: children,
disabled people, people with a long term condition,
older people, carers

19. Unsuitable homes
For example
• Overcrowding: tuberculosis (TB) and respiratory
infection; mental ill-health, anxiety & depression
• Changing health/care needs: falls & fractures;
social isolation and mental ill-health
• Shared accommodation: wellbeing and mental ill-
health
Who is affected?
• Generally the same as for unhealthy/unsafe
homes

20. Precarious housing or homeless
• At higher risk from unhealthy & unsuitable homes
• Children: in B & B more likely low birth weight &
miss immunisations; greater risk of infection;
mental ill-health & development problems
• Rough sleepers/single homeless: high rates of
physical health needs & mental illness; higher
risk of blood borne viruses
• All: existing health conditions can be
exacerbated eg, asthma, depression; new issues
can arise eg, substance misuse; wellbeing &
mental ill-health

21. Impact of homes across lifecourse
B & B?
Overcrowded? Sharing? On own &
Isolated?
Can’t get upstairs?
Paying the
mortgage?
Cold home? Cold home?
Poor PRS?

22. Who lives where? Dementia example
• Most people with dementia live in the community
• Most want to live in their own home for as long as
possible
• The alternatives of residential care, or hospital, are
more costly.
• 2/3 of people with dementia live in community, 1/3 alone;
• 85% would want to stay at home for as long as possible
• For every person who is able to live at home rather than
in residential care there is a saving of £11,296 p.a.
• Delay of just 5% of admissions to res. care would create
a net saving of £55 million per annum (E, W & NI)

23. The problem? Dementia example
• Majority of older people own their home (82%)
• A disproportionate number of owner-occupied
homes are
• Poor condition and/or
• Unsuitable for changing health & care needs (one
in three)
• There are few alternatives
• Many older households are low income (two thirds
are owner occupiers)
• Shortfall of purpose-built specialist homes (240k)

24. The problem? Dementia example
• There are inequalities in access to homes and housing
services for many older people
• Older people experiencing the greatest inequalities in this
respect are
• Rural communities
• BME
• Disabled people
• Offenders
• Gypsies and Travellers
• LGBT
• People with a learning disability
• People with a mental health problem
• Homeless people

25. The solution? Dementia example
• ‘Who lives where’ locally
• Home Truths recommendations
• Reforms in health and social care
• The Health and Social Care Act 2012
• The Care Act 2014
• The Better Care Fund
• Partnership working with the housing sector

26. Contact
• Gill Leng
• Tel: 07766 660799
• Email: gill.leng@phe.gov.uk

27. MECC overview
Holly Easlick
Health Development Officer
Public Health Portsmouth

28. Public Health Portsmouth
What is MECC?
 Using appropriate opportunities to talk about health & wellbeing
 Taking into account lifestyle choices and wider influencing factors
 Professional duty of care to adopt client-centred ways of working
 Supporting people to improve their own health & wellbeing

29. Public Health Portsmouth
MECC levels/process
All
service-
users
All staff
Fewer
service-
users
Fewer
staff
Stage/level one
Promote the benefits of healthy living. Ask an
individual about their lifestyle, if they want to make a
change and respond with appropriate action.
Stage/level two
Identify the focus of a change by
supporting an individual to review their
lifestyle.
Stage/level three
Increase motivation and
clarify the support needed
Stage/level four
1:1 using
SMART goals /
specialist
support

30. i. Enable people to access appropriate information to manage
their self-care needs
ii. Empower people to make informed choices to manage their
health & wellbeing
iii. Feel confident in providing opportunistic brief advice
Learning Outcomes (L1)
30 - PHP & IWT

31. Determinants of health
31 - Public Health Portsmouth

32. Public Health Portsmouth
Housing link…
 Holistic approach to addressing health inequalities
 Many opportunities to Make Every Contact Count
 Housing has a huge impact on health & wellbeing
 Public health is everybody’s responsibility!

33.  Somerstown pilot (phase 1)
 Holistic approach
 Links with MECC approach
The new wellbeing service

34.  Good practice examples from housing sector…
 Challenges & opportunities
 Innovative!
Examples

35. Jane Leech - Programme Manager
Somerstown Neighbourhood Health
& Wellbeing Programme

36.  The Somerstown Programme is Phase 1 of a wider Public Health
initiative – piloting, creating, learning…
 To consolidate key current public health improvement services
into one integrated service so that lifestyle and behavioural issues
can be co-ordinated and provided on an individual basis.
 The Wellbeing Service will be a locality based service focusing on
the most deprived areas of the city, close to the people that need
them most.
The Somerstown Programme context:
Integrated Health & Wellbeing Service

37.  A key worker role - Health & Wellbeing workers - The service will
support individual residents and their families with lifestyle
issues, e.g. smoking, alcohol misuse, poor diet and lack of
exercise as well as emotional wellbeing.
 Underpinned by Community development initiatives and activity
to stimulate and support participation
- "without citizen participation and community engagement fostered
by public service organisations it will be difficult to improve penetration
of interventions and to impact on health inequalities".
Marmot Report 2014
The Health & Wellbeing Service

38. The Somerstown Programme team.
The model in action -
In addition, this service
will work with other
council services to
provide help and
support with issues that
are interrelated and
tend to be contributory
or underlying causes of
poor lifestyle including
debt, housing and
unemployment

39. October 2014 - our programme team have been busy building
the relationships and mechanisms necessary to facilitate
interrelated working based on the MECC model of making
every contact count.
We have been able to secure a hot desk arrangement in the
Somerstown housing office. We have also created a referral
and assessment process specific to this Housing office.
Building on the assumption that our Programme could
ultimately support their work, improve the quality of life for
their customers –
The Somerstown model & Housing –
sharing outcomes: A case study

40.  December 2014 - our Health & Wellbeing workers and many of the Somerstown
Housing officers began to work together in earnest. Referrals from Housing into
the programme stands at c.10 Somerstown residents
 One such referral came through to Julie, one of our Health & wellbeing workers
whose specialism is in health eating/weight
 What is clear this that the Housing officer in question, in their meeting with their
customer identified that she may need additional support and that our programme
may well be able to support her (opportunistic)
 They offered her our service and she accepted the invite to engage (appropriate)
 (Holistic) She started work on a 1:1 basis with Julie, incidentally it was the national
Change4life 'Sugar Swaps' that started her thinking about her levels of sugar
consumption. (In the business we call this pre-contemplation).
 Together Julie and her client they have created an action plan to take small steps in
reducing the amount of smoking (with the help of Pompey Quits) and drinking
sugary drinks and she has also agreed to gradually increase her level of physical
activity (walking).
 She can work with achieving these targets with Julie up to 12 months.

41.  Meanwhile…Julie has also been working with Marshada - the
Programme’s Community development lead who has been
instrumental in brokering many of the professional relationships
required to pilot and test a collaborative and integrated outcomes
way of working
 One of these relationships has been with Housing’s resident
participation team (rpt)
 Julie is now collaborating with Racheal from the rpt as they share
outcomes for this customer/client - Racheal is working with her
customer on her employability skills. Julie, with her client identified
that as a result of all the sugary drinks and smoking her teeth are
stained, this is impacting on her confidence, in turn impacting on
her confidence and ability at interview
 Julie & her client have identified a dentist who is taking clients.
Racheal is prepared to fund her clients’ descaling as extra with this
dentist, working in tandem towards a shared outcome