Written evidence submitted by Dr Hannah Fairbrother

Eleanor Holding and Dr Nicholas Woodrow (TH0017)

A review of research evidence about the impact of housing insecurity on children’s health and wellbeing

Project team members: Emma Hock (lead), Lindsay Blank, Hannah Fairbrother, Mark Clowes, Diana Castelblanco Cuevas, Andrew Booth & Elizabeth Goyder

We brought together findings from qualitative literature (studies that focus on people’s experiences and perspectives) exploring the relationship between housing insecurity and the health and wellbeing of children and young people (aged 0-16) in the UK.

Studies included the perspectives of children themselves, parents / close family members (e.g. grandparents) and other people with insight into children’s experiences (e.g. teachers).

We integrated accounts of housing insecurity within 59 pieces of evidence from studies conducted over the UK as a whole and specific locations including London, Birmingham, Fife, Glasgow, Leicester, Rotherham and Doncaster, and Sheffield.

Project funder: National Institute for Health and Care Research Public Health Research Programme.

A qualitative study with children, parents and local authorities to explore experiences and drivers of housing insecurity

Project team members:

University of Sheffield: Hannah Fairbrother (lead), Mary Crowder, Eleanor Holding, Nick Woodrow & Elizabeth Goyder

University of Birmingham: Kiya Hurley & Peter Kraftl.

University of Cambridge: Anne-Marie Burn (co-lead)

We carried out over 70 interviews with children, parents and local authority colleagues across South Yorkshire, the North West and London.

We asked about:

- current experiences

- factors driving housing insecurity

- local authority approaches to tackling housing insecurity and supporting families.

Project funder: National Institute for Health and Care Research School for Public Health Research.

This submission responds to two focus areas: i) the causes and costs of homelessness and ii) the response of and support for local authorities.

i) The causes and cost of housing insecurity and homelessness: the health and wellbeing impact of housing insecurity and homelessness on children and young people .

A complex interplay of factors is driving increased homelessness and housing insecurity among families in the UK. Intersecting disadvantages are playing out in the context of wider crises (e.g., COVID, the cost of living crisis, after effects of austerity, continued cuts to services). Key drivers of housing insecurity include:

- Economic factors: High levels of poverty, unemployment, low wages, welfare cuts (with housing benefits not keeping up with costs) and rising housing costs (including rent and mortgage costs.)

- Social factors: Relationship breakdowns, domestic violence, mental health issues and substance misuse

- Structural factors: a lack of affordable housing, particularly housing suitable for families and a lack of funds / capacity among local authorities to repair older properties, and insufficient rights for renters.

Housing insecurity and homelessness has enormous costs for families and local authorities.

For parents and children impacts include:

- Physical and mental health impacts: including increased anxiety, depression and sleep issues as well as challenges accessing healthcare, including vaccinations.

- Economic impacts: additional costs associated with housing insecurity and homelessness include travel costs and challenges to maintaining employment,costs of purchasing food in temporary accommodation or hotels due to a lack of cooking facilities, as well as new furniture and white goods for unfurnished properties.

- Education: education can be disrupted with children having to travel long distances to school or change schools and having insufficient space or limited access to the internet to complete homework.

- Social impacts: children and parents may need to move away from their family and friends and wider community networks and may feel stigmatised and isolated living in temporary accommodation.

Supporting homeless families represents a significant cost for local authorities, including paying for the cost of temporary accommodation as well as wider support (providing furniture, white goods, food vouchers, etc.) for families.

ii) The response of and support for local authorities.

We undertook 43 interviews with local authority staff members and VCSE employees with a remit related to housing insecurity and homelessness across 6 councils in England. Local authority staff described several challenges in responding to homelessness and housing insecurity:

· Family homelessness is putting immense pressure on councils with skyrocketing costs. Council budgets and the availability of social housing has been decimated in recent years, whilst complexity of need and demand has steadily risen.

· This is exacerbated by external pressures and policy changes, such as the Ukraine war and targets to house displaced families, and the Right to Buy scheme which has reduced local authority owned housing stock. This, alongside reduced welfare benefits and rising costs of rents, has created a housing crisis at boiling point.

· Local authority practitioners discussed primarily focussing on strategies which dealt with the immediate crisis, despite being aware of the need for prevention to reduce housing insecurity. For example, a large amount of resources and funding is spent on moving families between hotels and temporary accommodation (often multiple times), where families can remain for a significant amount of time. When accommodation is offered, this may be out of their local area and away from social networks, employment and schools. Families may choose to remain in their current accommodation or move into new accommodation with the hope to move in the future. This creates a continuous cycle of housing insecurity without addressing the upstream causes.

· The availability of skilled staff to deliver the support needed for the high levels of demand and complexity of need is a key challenge for services. A lack of resources alongside high pressure on staff due to the workload and emotional demands of the role has resulted in high staff turnover in some areas. Services are dependent on short term, piecemeal contracts which affects staff retention as employees may leave in search of more stable work.

· Front facing, in person support provided by housing officers as a single point of access was considered good practice, but was difficult to operationalise with limited resources. The traditional role of housing officers (providing personalised, one to one support) has evolved in recent years to deal with influx of demand.

· It is widely known that partnership working across services is essential to address the complex causes of homelessness and housing insecurity. However, our findings indicate a lack of shared responsibility for homelessness and fragmentation of services. There is a disconnect between national/local policy development and the realities of service delivery. Despite policy ambitions to focus on prevention, services often revert to crisis management by transferring the responsibility of housing insecurity to other parts of the system (e.g. by referral to other support agencies, or movement of families between hotels).

· Although practitioners were aware of a lack of good practice in several areas, reduced funding and continued disinvestment in the sector makes it extremely challenging to address the challenges. It is impossible for local authorities to address the myriad of challenges alone. This requires a system level approach involving stakeholders across the housing pathway.

Recommendations

Housing is a human right. Safe, stable and secure housing is a key foundation for families’ health and wellbeing. There is a housing insecurity/homelessness crisis in the UK. We need:

- More social homes and more affordable homes

- Renting reform (increased security of tenure, restrictions on rent and better enforcement of housing quality standards)

- Multi Sector partnership at a national and local level with shared responsibility for preventing housing insecurity

- Welfare benefits that enable people to afford essentials and social participation

- Early interventions to prevent homelessness

- Interventions to support the mental health and well-being of homeless and housing insecure families

- Investment in housing workforce

Sources

Anderson, J., Trevella, C., & Burn, A-M. (2024). Interventions to improve the mental health of women experiencing homelessness: A systematic review of the literature. PloS one, 19(4), e0297865. https://doi.org/10.1371/journal.pone.0297865

Fairbrother H, Burn A, Crowder M, Goyder E, Holding E, Kraftl P & Woodrow N (2024) OP13 Tackling housing insecurity: a qualitative study with children, parents, and professionals working in local authorities in England, UK. SSM Annual Scientific Meeting (pp A6.3-A7) https://doi.org/10.1136/jech-2024-ssmabstracts.13

Hock, E.S., Blank, L., Fairbrother, H. et al. Exploring the impact of housing insecurity on the health and wellbeing of children and young people in the United Kingdom: a qualitative systematic review. BMC Public Health 24, 2453 (2024). https://doi.org/10.1186/s12889-024-19735-9

Joseph, N., Burn, A-M. & Anderson, J. (2023). The impact of community engagement as a public health intervention to support the mental well-being of single mothers and children living under housing insecure conditions – a rapid literature review. BMC Public Health 23, 1866.

McNally, X. & Lally, C. (2024) Housing insecurity in the private rented sector in England: drivers and impacts. POST Research Briefing. https://doi.org/10.58248/PN729

National Institute for Health and Care Research School for Public Health Research (NIHR SPHR) Living with Housing Insecurity project page https://sphr.nihr.ac.uk/research/housing-insecurity-for-families-with-children/

November 2024