A Report from the College of Occupational Therapists (RCOT) has highlighted the foundational links between health and housing, and advocated for the strategic role occupational therapists can play in easing pressure for both industries.
In the UK, poor housing costs the health and care system £1.5 billion per year, and three quarters of health professionals support people whose housing is harming their health. The report aims to illustrate the depth of the connection between the individuals’ home and their quality of life, and the severe effects of this relationship on the services that support them.
Occupational therapists, as the report states, operate within and witness the intersectionality of these services first hand. Their practice is founded on the dynamic relationship between people, the activities that matter most to them, and the environments where those activities take place. When these factors are in alignment, the individual can live a comfortable and healthy life, and when they fall into conflict with another this relationship creates the barriers that can lead to persistent health issues. These may be physical, cognitive, sensory, psychological, social or cultural and the consequences for independence and wellbeing can be drastic, with barriers operating at individual, community and societal levels.
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The report criticises a similar talking point when housing is placed alongside wellbeing, the siloed nature of the health, housing and social care industries. These siloes separate valuable flows of information, and stands as a key barrier to any of the three industries truly operating in a preventable manner at scale.
The health and housing challenge
The report illustrates the growing complexity and scale of healthcare need in the UK. Almost half of adults in Wales already live with long-term conditions and by 2035, two-thirds of adults in England over 65 will have multiple health conditions. Scotland has the lowest life expectancy in Western Europe, and in Northern Ireland people are living an average of 20 years in poor health. These growing needs react violently with the current housing crisis, which will continue to worsen and exacerbate these needs if not subdued.
The lack of adequate housing is directly tied to these growing support needs across all four nations of the UK. The report states that over 3.5 million homes in England are classed as non-decent, housing 7.5 million people –including 2.3 million aged 55+ and 1.5 million children. Older residents and children are particularly reliant on a suitable and safe home environment, with children in overcrowded homes experiencing poorer health and wellbeing. This reality is particularly stark in the context of the UK’s surge in temporary accommodation, with the number of children living in TA across the country reaching record levels for the past eight years.
Occupational therapists (OTs), the report argues, are perfectly suited to unite the efforts of the health and housing industries and enhance preventative efforts for both sectors. Their expertise in the relationship between people, their environments and their daily activities, enables them to bridge sectors, design inclusive solutions and deliver integrated, person-centred care. The report references a number of care studies where the use of occupational therapists has resulted in both economic and social benefits for residents and the services that support them. Strategic OT interventions in Wiltshire saved £65,000 over the course of three months, and up to £1.4 million saved from adaptation budgets in the London Boroughs of Richmond and Wandsworth.
Conclusions and recommendations
The report is concrete in its conclusion: housing is a fundamental human right and a core social determinant of health. Where homes fail to meet people’s needs, through poor condition, inaccessibility or insecurity of tenure, the consequences ripple outwards – declining health, rising demand for care, deepening inequality and mounting costs for the public purse. This ripple-effect is not inevitable, and the report concludes that the best effort to prevent and counteract it is a joint initiative between the worlds of health, housing and social care.
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The report makes a number of recommendations as to how prevention can become embedded within all three disciplines. One of the concepts key to this is occupational therapy leadership, which involves including senior occupational therapists in decision-making across social care, housing and health, who can act as a strategic voice ensuring that key decisions have prevention at the core, rather than crisis response. This is core for it’s first recommendation, to strengthen system leadership across housing, health and care, and ensure that each service is aware of and addresses how their services overlap and influence the others.
Shifting funding upstream and prioritising prevention and early intervention is another key recommendation from the report. Preventative action delivers better outcomes and avoids higher health, care and housing costs later on, and addressing housing-related risks before people reach crisis point maximises safety and independence. The report suggests how this can be achieved across central government, local authorities and system leaders, including reforming and modernising Disabled Facilities Grants to enable earlier, preventative housing interventions at scale.
Embedding accessibility and adaptability in housing at scale is also a major pathway to saving long-term costs. Drawing on expertise from occupational therapist, the report says local housing, planning and regeneration strategies should place health and adaptability as core strategic priorities. All of these recommendations require investment into workforce capacity and expertise. In order to facilitate positive change and adequate prevention, government should recognise occupational therapy as a critical workforce for prevention and integration across housing, health and social care, and support national workforce approaches that embed housing-related capability.
Breaking the cycle
The reports core message is one that much of the sector is already aware of: prevention must come first. Across housing, health and social care, all three industries are currently trapped in a cycle of meeting steadily increasing demand with tighter and fewer resources. Treating the symptoms of an issue will only yield temporary relief, the core issue must be treated in order to truly solve the problem, the core issue in this case being housing. Fewer and less suitable homes will only breed further and more complex health requirements, placing strain on public services. All three industries mut analyse the current status quo and begin to understand how the cycle can be broken in exchange for a system that prevents problems before they occur, as well as treating them at the crisis point.
