1. Enabling homes in which to ‘start, live and age well’ in the North East Gill National advisor: homes and health 5 December 2016
Would you therefore be willing to do a short presentation to set the scene to attendees about how and why the tool was developed, the evidence base which led to its development,  where the tool is currently being used and any outcomes that have been seen as a result of using the tool.

2. Will cover A home for health and wellbeing National ambitions
Homes, health and wealth
Opportunities in the North East
How do we know these matter? Are the indicators used in national frameworks for health and wellbeing – PHOF, ASCOF, NHS……

3. Home for health & wellbeing
A  healthy home: warm, safe, free from hazards
A suitable home: suitable to size of the household, and the specific needs of household members eg, disabled people, and to households whose needs may change eg, as they grow up, or age
A stable, secure, home to call your own: without risk of, or actual, homelessness or other threat eg, domestic abuse
Statutory requirements
JSNAs
SHMAs
Homelessness reviews

4. National ambitions By 2020 we will have economic & national security
Returned to surplus
Higher wages, lower welfare
More people able to pay to meet their own needs
Devolution to rebalance the economy
Self sufficient local government
Reformed and modernised public services
Just how important is health and wellbeing, and the home, to wealth?
Economic gains eg, poor health costs national economy £100bn pa.
Source: Spending review & autumn statement 2015

5. Marmot review Giving every child the best start in life
Enabling all children, young people and adults to maximize their capabilities and have control over their lives
Creating fair employment and good work for all
Ensuring a healthy standard of living for all
Creating and developing sustainable places and communities
Strengthening the role and impact of ill-health prevention
Just how important is health and wellbeing, and the home, to wealth?
Source: Fair society healthy lives, 2010

6. Healthy life and work

7. Home impact on ‘wealth’
Starting and developing well
3.6m children living in non-decent homes
Readiness for school, absenteeism, attainment, life!
Working and living well
9.2m working age adults living in non-decent homes
Work absenteeism & productivity, parental capacity
Ageing well
2m pensionable age adults living in non-decent homes
Work absenteeism & productivity, caring capacity
Impact on mental health across life course
Costs
£18.6bn to society
Opportunity cost: spend in local economy
£1,300m higher energy costs
£340m higher insurance
A role for industry in tackling poor housing
A conversation for devolution, HWB and LEPs?
Mental health is a particularly significant barrier to work in the NECA area, with over half of those claiming Employment and Support Allowance doing so due to a mental health condition.

8. Opportunities? Commission recommendation:
Partners across the area should integrate preventative action and action to tackle inequalities in all decisions
The Commission therefore recommends that
public sector partners across the NECA area should integrate preventive action
and action to tackle inequalities in all decisions (recommendation 2). This will
ensure that health and wellbeing impacts are fully factored into decisions on
policies over which NECA partners have a degree of control i.e. public transport,
leisure facilities, housing, planning and skills. Partners will need to consider
how they can demonstrate that this recommendation is being met, for example
through an audit trail in decision documents.
Source: NECA (2016) Health and Wealth - Closing the Gap in the North East, Report of the North East Commission for Health and Social Care Integration

9. Opportunities?
Home is not just a wider determinant – action to improve health through the home can be secondary and tertiary
Intervention in each of these areas will yield improvements in wellbeing
outcomes over different timescales. While secondary and tertiary prevention
measures can yield savings in the need for acute care within months or years,
enabling financial savings to be reinvested in greater prevention, some actions
on the wider policy determinants of wellbeing will yield results over decades.
This is illustrated in the chart below.
Source: NECA (2016) Health and Wealth - Closing the Gap in the North East, Report of the North East Commission for Health and Social Care Integration

10. Opportunities? A ‘home’ strategy to achieve health and wealth
Not just new housing
Not just physical health but also mental health
Not just focussed on the long term
Targeting action to populations of interest
Post 16s, adults, furthest from work, individuals and families with complex needs
Considering ‘home’ in economic mechanisms
Human capital development
Supporting & attracting business & Innovation
Health and social care integration
Transport & other infrastructure eg, technology
Rural growth and stewardship
People who are ‘harder to help’ [“…claimants, many of whom are currently referred to the Work Programme and Work Choice”]
Individuals and families with complex needs [“to reduce high dependency on public services and support economic participation”]
Human capital development: Barriers may exist to accessing and sustaining a healthy home environment from which to go learn, develop skills and go to work. This will apply to all populations but particularly ‘harder to help’ claimants, individuals and families with complex needs
Supporting and Attracting Business and Innovation: inward investment may depend on the availability of healthy homes and neighbourhoods to attract and retain a new workforce and/or to enable the resident workforce to be as productive as possible.
Health and Social Care Integration: the home is a wider determinant of health, impacting on physical and mental health, linked to health inequalities and worklessness. Housing interventions can enable NHS efficiencies and improve outcomes, particularly through integrated approaches; NHS capital investment could be made in alternatives to hospital beds eg, step-down housing; the housing workforce can contribute to improvements in relation to obesity, smoking and substance misuse; housing interventions, including supported housing and housing related support contribute to improved substance misuse treatment outcomes;
More and Better Homes: new homes and neighbourhoods should provide a healthy home environment and be developed in a sustainable way; existing homes may need to be improved to provide a healthy and suitable home environment.
Transport: location and connectivity impact on the attractiveness and sustainability of homes and neighbourhoods
Rural Growth and Stewardship: rural homes do not always provide the healthiest home environment, for example they may be ‘off mains’ or have listed status, preventing improvements to affordable warmth; lack of affordable homes in rural areas may present a challenge to enabling a health and social care workforce to meet the needs of vulnerable people in rural areas; lack of affordable homes may necessitate the movement of young people and families with children away from their communities, potentially reducing support networks and increasing isolation amongst those who remain; connectivity in rural areas may prevent the option of working from home.
Other areas: potential to improve health and wellbeing through faster housing growth and regeneration, initiatives and investment in energy efficiency and technological development.
Known relationship between home & mental health
Evidence that improvements have positive impact
For people who experience mental health problems safe, secure and affordable housing essential
2016 NHS England Mental Health Taskforce recommendations – role of home recognised
Better understanding of relationship locally for NHS commissioning by 2020/21
All HWBs should update JSNAs & joint prevention plans that include mental health and housing
Action to address existing fragmented pathways
2016/17 PHE developing prevention concordat to include housing

11. Opportunities Systems leadership & a common goal
“a home in which to start, develop, live, work & age well”
Harness community strengths
Connected communities are healthy and more resilient & create change
Market to others outside the region
Solutions developed in face of adversity
Research & innovation
Connected & empowered communities are healthy
Community mobilisation can lead to positive change
Involvement in community can increase resilience

12. Resources and support Sources:
Won’t be possible to cover all aspects of homes and health today but can signpost you to more information, beginning with PHE’s collection of evidence, guidance and other resources, and a space for you to engage with others who are interested
One of outcomes from today should be that you’re better equipped to go back to your local area and
Review local plans for health, wellbeing, wealth and other relevant outcomes eg, community safety to understand the extent to which the impact of the home and housing circumstances on health and wellbeing has been considered and planned for.
Inform local conversations that should lead to improved health and wellbeing as a consequence of taking action on the home or housing circumstances, and/or working with the housing sector and related professions eg, home care, Occupational Therapists etc.

13. Contact Gill Leng Tel: 07766 660799 @gill_leng