1. The Housing Health and Safety Rating System
The Healthy Homes Rating System

2. Interactive tool
Windows only

3. Aims of the Session
Learn about the use of the Healthy Homes Rating System in England
Focus on health impacts from housing and their relevance from an English perspective
See two software tools
Interactive house
Health Cost Calculator

4. Aims of the Session
Learn about the use of the Healthy Homes Rating System in England
Focus on health impacts from housing and their relevance from an English perspective
See two software tools
Interactive house
Health Cost Calculator

5. What is the healthy homes rating system?

6. Principle behind rating system
A dwelling, including the structure and associated outbuildings and garden, yard and/or other amenity space, should provide a safe and healthy environment for the occupants and any visitors.

7. What is it...?
It’s how we evaluate potential risks to health and safety that may arise from deficiencies in a dwelling
It looks at:
Likelihood of harm
Probable severity of that harm
It assesses 29 different hazards
Comfort does not matter!

8. Categories of hazard Physiological requirements
e.g. damp and mould growth, excess cold, excess heat, carbon monoxide, lead, VOC’s
Psychological requirements
e.g. entry by intruders, lighting, noise
Protection against infection
e.g. food safety, sanitation
Protection against accidents
e.g. falls, fire, structural collapse

9. All The Hazards Damp and mould growth Excess cold Excess heat
Asbestos (and MMF)
Biocides
CO and combustion products
Lead
Radiation
Uncombusted fuel gas
VOCs
Crowding and space
Entry by intruders
Lighting
Noise
Domestic hygiene, pests and refuse
Food safety
Personal hygiene, sanitation and drainage
Water supply
Falls associated with baths
Falling on level surfaces etc.
Falling on stairs etc.
Falling between levels
Electrical hazards
Fire
Flames, hot surfaces, etc.
Collision and entrapment
Explosions
Position and operability of amenities
Structural collapse and falling elements

10. Hazard profiles For each hazard: Definition is offered
Potential for harm is identified
Vulnerable groups are identified
The ‘ideal’ is identified
Relevant features are described
Guidance is developed

12. Health outcomes Four classes of harm identified Class 1 – extreme
Class 2 – severe
Class 3 – serious
Class 4 - moderate

13. Class 1 Examples include: Death from any cause; Lung cancer;
Mesothelioma and other malignant lung tumours;
Permanent paralysis below the neck;
Regular severe pneumonia;
Permanent loss of
consciousness;
80% burn injuries.

14. Class 2 Mild stroke; Cardio-respiratory disease; Chronic confusion;
Regular severe fever;
Loss of a hand or foot;
Serious fractures;
Serious burns;
Loss of consciousness for days
Cardio-respiratory disease;
Asthma;
Non-malignant respiratory diseases;
Lead poisoning;
Anaphylactic shock;
Crytosporidiosis;
Legionnaires disease;
Myocardial infarction;

15. Class 3 – serious harm outcomes
Eye disorders;
Rhinitis;
Hypertension;
Sleep disturbance;
Neuro-pyschological impairment;
Sick building syndrome;
Regular and persistent dermatitis, including contact dermatitis;
Allergy;
Gastro-enteritis;
Diarrhoea; Vomiting;
Chronic severe stress;
Mild heart attack;
Malignant but treatable skin cancer;
Loss of a finger;
Fractured skull and severe concussion;
Serious puncture wounds to head or body;
Severe burns to hands;
Serious strain or sprain injuries;
Regular and severe migraine.

16. Class 4 Regular serious colds or coughs Pleural plaques;
Occasional severe discomfort;
Benign tumours;
Occasional mild pneumonia;
Broken finger;
Slight concussion;
Moderate cuts to face or body;
Severe bruising to body;
Regular serious coughs or colds.

17. Linking deficiencies to hazards
Once identified, deficiencies must be allocated to a hazard
A deficiency may contribute to more than one hazard
Several deficiencies may contribute to one hazard

18. Deficiencies to Hazards
It is the cumulative contribution of the deficiencies to the hazard that should be assessed
It is a whole dwelling assessment for each hazard
Assumes the ‘at risk group’ inhabit the property

19. BOX 1
Similar Hazards, with Differing Outcomes
Example –
There is a window with a low internal sill (about 250mm above the floor). A small child could climb onto the sill and open the window relatively easily and could fall out through the open window. The likelihood of this occurring over the next twelve months is judged to be around 1 in 180.
If that window is on the ground floor with grass immediately below, the outcome would be relatively minor – 99% Class IV (bruising) and perhaps 1% Class III (a strain or sprain). This would give a Hazard Score of 7 (Band J).
However, if that same window is on the 2nd floor with a paved area immediately below, the outcome would be major – 10% Class I (paralysis or even death), 80% Class II (serious fractures) and 10% Class III (a strain or sprain). This would give a Hazard Score of 1,016 (Band C).
Although in both cases the likelihood is the same, the Hazard Score reflects the dramatically different outcome.

20. Use of the healthy homes rating system in England and wales

21. Housing Act 2004 HHSRS (HHRS) is enshrined in legislation
England and Wales assessment system for all housing
Stock condition surveys
Decent Homes Standard

22. Issues with UK housing Excess cold Falls on stairs Falls on the level
Falls between levels
Fire, damp and mould, hot surfaces, radon, pests
Overcrowding, electrical, CO, sanitation, noise

23. Increasing awareness Attitudes Ignorance Political will
Prevention vs cure
Old housing
Fuel poverty

24. Interactive tool
Windows only

25. Quantifying improvements and justifying your work
Hard to measure something that has not occurred
Justify expense of interventions
Interventions can vary in cost considerably

26. BRE, 2008

27. Quantifies poor housing Providing a tool for policy
The next big link a bit further adds in the cost savings to health
Quantifies poor housing
Providing a tool for policy
Funded by BRE Trust and carried out by BRE in partnership with the Universities of Warwick and Brighton

28. Costs to society of living with HHSRS hazards
Issue
Cost
Poor physical/mental health/social isolation
Higher healthcare costs
High home fuel bills
High building heating costs
Uninsured contents losses
Spending on building security/possessions
Living with repairs needed
High housing maintenance costs
Under-achievement at school
Extra costs on school budgets/tutors
Loss of talents to society
Loss of future earnings
Personal insecurity
High policing costs
More accidents
High emergency services costs
Poor hygienic conditions
High environmental health costs
Costs of moving
Disruption to service providers
Adopting self-harming habits
Special health-care responses
(adapted from BRE, n.d.)

29. Typical Healthy Homes Rating System outcomes and 1st year treatment costs (40% of total costs)
(BRE, n.d.)
Hazard
Class 1
Class 2
Class 3
Class 4
Damp and mould
N/A
Type 1 allergy
(£1998/$3342)
Severe asthma (£1120/$2040)
Mild asthma (£180$301)
Excess cold
Heart attack, care, death (£19851/$33206)
Heart attack (£22295/$37295)
Respiratory condition (£519/$868)
Mild pneumonia (£84/$140)
Radon
Lung cancer, death (£13247/$22159)
Lung cancer survival (£13247/$22159)
Falls on the level
Quadraplegic (£59246/$99106)
Femur fracture (£25424/$25424)
Wrist fracture (£745/$1261)
Treated fro cut/bruise (£67/$112))
Falls on stairs and steps
Quadraplegic (£59246)/$99106
Treated fro cut/bruise (£67/$112)
Fire
Burn, smoke, care, death (£11754/$19662)
Burn, smoke, care (£7652/$12800)
Serious burn to hand (£2188/$3660)
Burn to hand (£107/$178)
Hot surfaces and materials
Serious burns (£4652/$7781)
Minor burn (£1234/$2064)
Treated very minor burn (£107/$179))

30. Health Cost Calculator
Building Research Establishment & RHE
‘The Trust commissions research into the challenges faced by the built environment and publishes project findings which act as authoritative guidance to the construction industry’
(BRE, 2014)
Uses direct costs of medical treatment and aftercare (<1yr)
Robust data
Probably accounts for 40% of total costs

31. Health Cost Calculator
Uses reduction in probability of category 1 hazardous event and severity of outcomes
Provides projected savings on healthcare costs based on NPV calculations
Gives account of costs vs savings
Payback period
Cumulative record for area based work

32. - = / = How it all works Expected Cost to NHS (£) HAZARD Work
Cost of work (£)
Expected Cost
to NHS (£)
HAZARD Mitigated = /
Saving (£) =
Payback period

33. Example Cost to fit banister £400/$669
Annual savings on healthcare £146/244
Payback 2.7 years

34. Area based work (courtesy of Bristol CC)
HAZ areas there is a focus on referrals for free loft and other insulation measures, installing free smoke alarms and carbon monoxide detectors, free home security locks etc. and installing free handrails, grab-rails, bath-rails etc. where there is a concern about an occupier falling.

35. Savings from five officers working across a 460,000 person city (courtesy of Bristol CC)

36. Payback period for officers’ work (courtesy of Bristol CC)

37. Cases can be added one by one
You can identify dwellings by address, UPRN or both
HHRS system uses representative scale points
NHS costs and costs to society appear at the bottom of the screen

38. Thank you for listening
Henry Dawson
Thank you for listening