Part of the BRE Trust

Using national housing data & evidence to model health gains

Helen Garrett, garretth@bre.co.uk01923 664544Principal Consultant, BRE Housing and Energy June 2016

Purpose of the Cost of Poor Housing research and related projects

– To quantify poor housing across all tenures and estimate how much money could be saved by tackling the worst housing conditions in England

– To develop a tool for policy makers/deliverers to explore the impact of targeting improvements at different types of properties and different types of people.

– Health cost calculator https://www.bre.co.uk/page.jsp?id=3021

– CPH in England to NHS estimated to be £1.4 billion– All substandard housing £2 billion

Methodology has been adapted to new areas– PHE briefing paper on Homes and Ageing in England includes CPH

for 55+ years http://www.bre.co.uk/page.jsp?id=3611– The cost-benefit to the NHS arising from preventative housing

interventions

Linking Poor Housing and Health

English Housing Survey – older households (55+)

– 9 million homes: 77% owned, 6% privately rented, 17% social sector

– 16% live in homes over 100 years old. 19% lives in homes built since 1980

– Around a fifth households live in rural areas

– Around a fifth of households live in a non-decent home

– Only 5% homes fully visitable (level access, flush threshold, WC at entrance level, sufficient circulation space in hallway)

– Nationally around100,000 new homes provided each year, just 20,000 demolished.

WE HAVE WE NEED TO MAKE THE BEST OF THE HOUSING STOCK FOR OUR AGEING POPULATION!

Visitability under Part M building regulations

Housing Health and Safety Rating System (HHSRS) Category 1 hazard = ‘Poor Housing’

Physiological RequirementsDamp and mould growth etcExcessive coldExcessive heatAsbestos etcBiocidesCO and fuel combustion productionsLeadRadiationUncombusted fuel gasVolatile organic compounds

Psychological RequirementsCrowding and SpaceEntry by intrudersLightingNoise

Protection Against InfectionDomestic hygiene, pests and refuseFood safetyPersonal hygiene, sanitation and drainageWater supply

Protection Against AccidentsFalls associated with baths etcFalling on level surfacesFalling on stairs etcFalling between levelsElectrical hazardsFireFlames, hot surfaces etcCollision and entrapmentExplosionsPosition and operability of amenities etcStructural collapse and falling elements

1. How likely a hazard is to effect a vulnerable person over the course of 12 months: 1 in:

2. What is the most probable spread of harm outcome taking into account the of 4 classes of harm:

Applying the formula gives a numerical hazard rating.1000+ =CAT 1

Weighting

Extreme - 10,000

Severe - 1000

Serious - 300

Moderate - 10

Levels of harmClass Examples Weightings

Class 1Death, permanent paralysis below the neck, malignant lung tumour, regular severe pneumonia, permanent loss of consciousness, 80% burn injuries

10,000

Class 2Chronic confusion, mild strokes, regular severe fever, loss of hand or foot, serious fractures, very serious burns, loss of consciousness for days

1,000

Class 3

Chronic severe stress, mild heart attack, regular and persistent dermatitis, malignant but treatable skin cancer, loss of a finger, fractured skull, severe concussion, serious puncture wounds to head or body, severe burns to hands, serious strain or sprain injuries, regular and severe migraine

300

Class 4

Occasional severe discomfort, chronic or regular skin irritation, benign tumours, occasional mild pneumonia, a broken finger, sprained hip, slight concussion, moderate cuts to face or body, severe bruising to body, 10% burns, regular serious coughs and colds.

10

HHSRS Category 1 hazards (EHS 2011)

1.4 million (15%) of English homes with older households have a Category 1 HHSRS hazard

Cost of poor housing comparisons

Category 1 (1000+)

Actionable (500+) Average Building

Regulations

– Cost to repair to average housing

– Benefit to the NHS by repairing to average housing

The cost of making poor housing acceptable

– Low cost work includes:– Re-locate cooker (£157)– Install 2 wired smoke detectors (£194)– Install handrail to staircase (£295)

Medium cost work includes:– Replace lead piping (£1,890) – Rewire house (£3,657)– Redesign staircase (£4,325)

High cost work includes:– Re-fit kitchen (£7,000)– Damp remedial works (£10,940)– Solid wall insulation (£20,000)

Approx. total cost of making all HHSRS Cat 1 hazards acceptable = £4.3bn

Average cost = £2,990

Cost to repair - £4 billion problem

Costs to society of living with HHSRS hazardsResidents Costs External Costs

High annual loss of asset value if property owned (H)

High annual loss of asset value if property rented (H)

Poor physical health (H – M) Higher Health Service costs (H – NQ) Poor mental health (M – NQ) Higher Health Service costs (H – NQ) Social isolation (NQ) Higher care services costs (M) High home fuel bills (H) High building heating costs (H) High insurance premiums (H) High insurance payments (H) Uninsured contents losses (M) Spending on security devices (H) Spending on building security (H) Living with repairs needed (NQ) High housing maintenance costs (H) Under-achievement at school (NQ) Extra costs on school budgets (H) Homework classes at school (H) Loss of future earnings (M) Loss of talents to society (NQ) Personal insecurity (NQ) High policing costs (H – M) More accidents (M) High emergency services costs (H) Poor hygienic conditions (NQ) High environmental health costs (H) Costs of moving (M) Disruption to service providers (M) Adopting self-harming habits (M) Special health-care responses (H) Government and EU programmes, SRB, New Deal etc

(H)

Typical HHSRS outcomes and 1st year treatment

HHSRS OutcomeHazard Class 1 Class 2 Class 3 Class 4

Damp and mould growth

Not applicable-

Type 1 allergy(£2,034)

Severe asthma(£1,027)

Mild asthma(£242)

Excess cold Heart attack, care, death(£19,851)

Heart attack(£22,295)*

Respiratory condition(£519)

Mild pneumonia (£84)

Radon (radiation) Lung cancer, then death(£13,247)

Lung cancer, survival(£13,247)*

Not applicable-

Not applicable-

Falls on the level Quadraplegic(£92,490)*

Femur fracture(£39,906)*

Wrist fracture(£1,545)

Treated cut or bruise(£115)

Falls on stairs and steps

Quadraplegic(£92,490)*

Femur fracture(£39,906)*

Wrist fracture(£1,545)

Treated cut or bruise(£115)

Falls between levels Quadraplegic(£92,490)*

Head injury(£6,464)*

Serious hand wound(£2,476)

Treated cut or bruise(£115)

Fire Burn ,smoke, care, death(£14,662)*

Burn, smoke, Care(£7,435)*

Serious burn to hand(£1,879)

Burn to hand(£123)

Hot surfaces and materials

Not applicable-

Serious burns(£7,378)

Minor burn(£1,822)

Treated very minor burn(£123)

Collision and entrapment

Not applicable-

Punctured lung£5,152

Loss of finger£1,698

Treated cut or bruise£115

Not applicable = HHSRS class very rare or non existent* = Costs after 1 year are likely to occur, these are not modelled

More detail can be found in the Public Health England report

Cost of poor housing among older people to the NHS = £624 million

Hazard Savings to the NHS per annum if hazard fixed

Excess cold £441,564,353

Falls on stairs £71,609,794

Falls on the level £34,700,172

Falls between levels £17,519,361

Fire £12,725,126

All other 20 hazards £45,660,759

Total £623,779,566

The cost to society of poor housing (summary)

– Cost of direct medical treatment resulting from leaving older people in poor housing = £624 million p.a.

– Total costs to make safer = £4.3 billion – Payback period of 7 years

Health cost-benefit of home interventions for households with a long term sickness or disability

Consider only hazards that can be mitigated through common interventions/adaptations

Only among households who are most likely to need support of some kind

Estimate the reduction in first year treatment costs to the NHS

and the subsequent reduction in costs of home adaptations (through DFGs) by preventing likely harmful events

Homes where someone has long-term illness or disability

Population (22 Million)

Long-term illness or disability (6.4 Million)

Category 1 (845,000)

Actionable (2.2 Million)

Only for a limited number of hazards

Adaptations Type of adaptation Falls Kitchens Bathrooms HeatingExtension of homeRedesign kitchenRedesign bathroomGraduated floor showerStairliftExternal rampNew bath / shower roomShower replacing bathWheelchair accessible parkingAdjustable bed or related aidHoistWide doorwaysAdditional relocate toiletLow level bathRelocate bath / showerAdditional heatingShower over bathWide pathsEntry phoneOther external adpatationOther modification of kitchenIndividual alarm systemExternal rail to stepsInternal rampBath / shower seatVisual / hearing impairment relatedWide gatewayElectrical modificationsGrab rail or other railToilet seat

– Linked with:– Falls– Kitchens– Bathrooms – Heating

Cost-benefit of hazards

type of hazardNumber of cases

Total cost to mitigate

Total benefit potential (2011 cost)

Benefit to Adaptation budget Total benefit Payback

falls on stairs 819,134 701,997,838£ 115,147,096£ 27,815,080£ 142,962,176£ 5.9falls on the level 395,008 308,106,240£ 56,105,215£ 19,151,301£ 75,256,517£ 5.2falls between levels 520,564 482,562,828£ 20,655,296£ 2,720,910£ 23,376,206£ 23.2flames and hot surfaces 170,990 416,531,640£ 9,270,359£ 27,246,284£ 36,516,643£ 42.0damp 342,661 2,529,523,502£ 4,797,718£ 10,818,784£ 15,616,502£ 525.0baths 116,451 60,670,971£ 8,929,491£ 2,251,656£ 11,181,147£ 6.5food safety 79,031 194,495,291£ 5,312,239£ 7,934,975£ 13,247,214£ 35.1personnal hygiene 150,731 173,943,574£ 9,613,602£ 4,567,771£ 14,181,373£ 17.6domestic hygiene 168,493 323,675,053£ 9,417,670£ 3,153,494£ 12,571,164£ 34.0ergonomics 81,518 39,373,194£ 4,974,041£ 324,431£ 5,298,472£ 7.9excess cold 259,589 1,187,360,086£ 169,676,603£ 9,403,479£ 179,080,082£ 6.9Total 3,104,170 6,418,240,217£ 413,899,331£ 115,388,164£ 529,287,495£ 15.2

Payback example: Falls on stairs

– Installing two handrails and undertaking repair work to the cellar steps =£350- £450.

– Graspable handrails to the main stairs at a cost of £200

– The mitigations suggested would result in a typical health cost savings of around £930

– If the prevention of a fall also removed the need for future home adaptations, then this benefit could increase by £315 to about £1,250

– Payback period of less than 1 year

– May also save on home care services

Payback example: excess cold

• Mr and Mrs C - COPD and rheumatoid arthritis.

• Enquired about a stair lift

• Home visit – no form of working heating as boiler was broken (they couldn’t afford to mend it) and only heating, a gas fire was malfunctioning and poisoning them. Category 1 hazards= excess cold and carbon monoxide

• New gas fire and replacement boiler installed partly through charitable funding

• The cost of work to improve their home through a new condensing boiler and a gas fire is estimated to be £1,800. Annual savings to the NHS alone are estimated to be £650 / payback period of 2.8 years.

• The improvements also reduced the risk of poisoning from Carbon monoxide, a further annual benefit of £97, reducing the payback to 2.4 years.

Case study: courtesy of Aster Living

Relevance of research to the NHS

– Demonstrates the health benefits of investing in good quality housing:– Can influence design of new housing developments– Can demonstrate value of housing refurbishment

– Investment will save money over time, and continue to accumulate

– Where resources are limited, investment can be planned and targeted according to the health benefit

BETTER HOUSING = LESS HOSPITALS!

– See also http://careandrepair-england.org.uk/wp-content/uploads/2014/12/Off-the-Radar-2016-Final.pdf