Housing solutions from a public health perspective Gill Leng Housing & health lead, PHE

Our vision The right home environment is essential to health and wellbeing, throughout life A home in which to ‘start, live & age well’ Key features of home (permanent & temporary): Warm & affordable to heat Free from hazards, safe from harm Enables movement around the home and is accessible Promotes a sense of security and stability Support available if needed

MoU delivery plan outcomes 15/16 1.The vision is integral to the activities of each of the national signatories 2.The model is used at a local level to improve health & wellbeing & reduce health inequalities 3.Local areas understand their populations, their housing and health needs 4.Evidence of the impact of the home/housing on health and wellbeing is more widely understood 5.Effective, efficient, innovative and integrated health, care and support, and housing interventions adopted

MoU delivery plan outcomes 15/16 1.Learning opportunities by each partner, involving others – housing as one voice 2.Support local areas and organisations piloting/implementing new models 3.Homeless Link health needs audit & evidence review, and CIEH housing and health resource 4.Consultation on standards for evidence (HACT) 5.SITRA wider workforce learning resources, LGA/SITRA integration publication, Care & Repair Home Adaptations, Housing LIN

Local implementation? DevoManc

Devolution in Greater Manchester Three agreements Greater Manchester Devolution Agreement - powers over areas such as transport, planning and housing, and a new elected mayor. Ambition for £22 billion handed to GM. MOU Health and Social Care devolution NHS England plus the 10 GM councils, 12 CCGs, NHS and Foundation Trusts. Estimated budget of £6 billion each year from April Prevention (place based) Agreement to cement prevention as a core strand of devolution signed on

Prevention at the centre Fastest possible improvement to the health and wellbeing of the 2.8 m citizens Substantial reduction in demand for health and care services Supports NHS 5 year forward view Links prevention & health improvement to economic growth and jobs Local leadership to improve health and wellbeing in the local population

Prevention MoU Five transformation programmes Public health, reform and growth – Place based approach to public health, employment and prevention Nurturing a social movement for change - Enabling & engaging people to make informed life-style choices Starting Well – Early Years – improve school readiness & address determinants of service demand Living Well - Work and Health - tackling complex dependency & supporting residents to be work Ageing Well – Age- & dementia friendly communities Four enabling priorities Housing & health Place based intelligence, evidence, workforce development

Review - housing enabling priority Does the plan communicate how The right home environment for health and wellbeing, across the life course, will be enabled? The housing sector will be engaged in improving outcomes and reducing inequalities? Considered Health priorities and programmes of transformation Plans: full range of local ambitions but not lengthy Reflection of strong local discussion & agreement GM Strategic Plan will draw on best examples & propose new strategic frameworks Likelihood that enablers will need to be collectively developed eg, workforce

Home and housing confident? Extent to which home and housing circumstances recognised in relation to ambitions? Unhealthy homes: primary focus on older people Fuel poverty (4) Home safety (5) Unsuitable homes: primary focus on older people Lack of supply of alternative options (5) Home adaptations / falls service (4) Technology (6) Precarious housing/homelessness Multiple and complex needs (2) Extent to which housing sector potential recognised? Scope and extent not reflected Limited to existing eg, development, adaptations

Opportunities – across life course Shifting to prevention & care closer to home Self-help & self care Enable informed decisions about housing options Action to improve quality/suitability of private sector Demand on health care and better outcomes Impact of homelessness on health and social care Hospital discharge End of life at home Mental health and wellbeing, and work Carers Enabling priorities Community engagement & building capacity Workforce development & integrated working

Opportunities – life course Starting & developing well School readiness & determinants of long term demand A strategy to support this through the home & housing? Living and working well Harmful drinking: workforce opportunities? Multiple and complex needs Unemployment & good employment Ageing well In existing homes? Dementia – beyond friends, existing home, discharge etc, Falls: systems based approach

The GM plan The right home environment is essential to health and wellbeing, and economic wellbeing. To secure the greatest and fastest possible improvement to health, we need to realise the salutogenic value of the home. Immediate priority to reduce demand for health care through integration of housing interventions at the points of hospital admission and discharge Will identify further opportunities to prevent and delay the need for health care and social care for other populations,

Our focus

The GM plan Why are we doing it? Unhealthy, unsuitable, precarious housing and homelessness affect the health and wellbeing of Greater Manchester citizens Housing interventions are effective in improving health and wellbeing What is the cost? What are we going to do? (next) Who will direct and enable?

The GM plan – what? Systems leadership Research & intelligence Evaluation and revision Implement new/revised models Establish integrated pathways, protocols, data sharing to underpin Workforce development of health, care and housing sectors

Action ‘No new ideas’ ‘Working with housing is so positive’ ‘Vertical integration does not cost less’ Horizontal? Do it with and not to people Co-produce & commission You can do most of this already We don’t need permission Build and they will come!

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