Written evidence submitted by Professor Sarah Rodgers and the Housing and Health Study Team [RSH 015]

Dear Levelling Up, Housing and Communities Committee,

We would like to propose changes are made to the Decent Homes Standard. These changes are based on evidence generated through a project led by myself, funded through the National Institute for Health Research, Public Health Research programme (project number 09/3006/02). The full report acknowledging the whole project team is accessible here: https://www.journalslibrary.nihr.ac.uk/phr/phr06080#/abstract

The project examined the impact of social homes being brought up to a national quality housing standard. We compared the health of residents living in homes that had received improvements, compared to those who were living in homes that had not yet been improved. We would like to draw your attention to these results because they have important implications for the current Decent Homes Standard, which we argue needs updating.

Damp removal as a safety feature:

The first outcome we examined was a combination of cardiovascular, respiratory and injuries admitted to hospital as emergency admissions. We found that residents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 39% fewer admissions than those living in homes in which they were not. The incidence rate ratio (IRR) was 0.61, which is within a 95% confidence interval of 0.53 to 0.72.

We then examined only emergency respiratory admissions. We found that residents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 47% fewer respiratory admissions than those living in homes that were not upgraded. The IRR was 0.43 (95% CI 0.33 to 0.57).

Components of the electrical system upgrades included extractor fans in kitchens and bathrooms, as part of a whole home improvements to meet the Welsh Housing Quality Standard, a standard similar to Decent Homes Standard. The smaller IRR for the associated reduction when restricted to only respiratory admissions suggests that the removal of damp, an important consideration for respiratory conditions, is an important health consideration for older adults and should be made a priority. This is likely to have the effect of releasing hospital beds that could be used for planned admissions or other emergencies that are unavoidable.

The current Decent Homes Standard lists large components such as electrics, windows/doors, and storage heaters. Our study using a large set of anonymised routinely collected health data, allowed us to move towards understanding the mechanisms for improving health. Thus, extractor fans, in conjunction with whole home improvements, are important components for social housing residents. There should be recognition by landlords along with a mechanism to repair small but important safety components of homes such as extractor fans. I note the new Social Housing White Paper mentions fire safety but does not cover damp removal. Damp is detrimental to many vulnerable older adults and we saw similar results for all ages, which includes children (electrical & combined admissions IRR=0.66, electrical & respiratory admissions IRR=0.60, see full report).

Utilisation of central heating boilers:

Additionally, the results we evidenced indicated there is an issue with heating system standard. This system included central heating boilers and suggested that either the length of time these are expected to be serviceable is too long, or, that incoming residents need advice on how to use their boiler. We made this interpretation from the results for people who moved into a home that was deemed to have an adequate boiler (according to the standard). We evidenced that these residents were associated with 23% more hospital admissions for cardio/resp/injuries, and 31% more respiratory admissions (See Table 17 in our full report appendix). Using the anonymised quantitative data we are unsure of the exact mechanism but note that although efficient heating is mentioned in the Decent Homes Standard, there is no mention of providing new residents with appropriate training to use their boiler systems. Many could have concerns about energy bills and carbon emissions.

All social housing providers, and private rented landlords too, should register with a regulator. There would then be the potential to evaluate the health of residents and demonstrate the effectiveness of new policies using linked anonymised health, housing and other administrative data.

Finally, as a co-director of the UK Prevention Research Partnership, GroundsWell, I welcome the discussion on the importance of safe, open, and green spaces for people’s health and wellbeing. Over the next 5 years we intend to add important evidence of the benefits for our most vulnerable residents utilising green spaces, having helped to improve their spaces and transformed them to be appropriate for their needs and wishes.

Yours sincerely,

Sarah Rodgers, PhD | Professor of Health Informatics

Public Health, Policy & Systems, Second Floor, Block F, Waterhouse Building

University of Liverpool, 1-5 Dover Street, Liverpool, L69 3GL

References:

Rodgers SE, Bailey R, Johnson R, Poortinga W, Smith R, Berridge D, et al. Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study. Public Health Res 2018;6(8)

The GroundsWell Consortium, a new UK Prevention Research Partnership: https://ukprp.org/what-we-fund/groundswell/ 

Disclaimer for NIHR PHR project: This project was funded by the National Institute for Health Research Public Health Research (NIHR PHR) programme (project number 09/3006/02). Visit the PHR programme website for more information. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the PHR programme, NIHR, NHS or the Department of Health

December 2021