Evidence – bridging the gap

Different approaches to evidence

Supporting the generation of credible evidence

Links to sources of evidence used in this website

Different approaches to evidence

There is a big difference in attitudes to evidence between housing and health professionals and this is stifling innovation in new models of care.

Evidence of success is the primary motivator for most health professionals. It is the first thing they look for and the reason for making decisions about what to do. This is the way they have been trained and rigorous attention to statistical evidence over many decades has been behind many advances in bio-medical science.

In contrast, housing professionals have not been required to generate robust evidence of success in relation to the health and wellbeing work they do, since this is not their core business. Some of the successes are not easily quantifiable and this makes then difficult to measure and to prove so historically, they have relied on what people tell them and their observations about how what they do affects the people they work with.

Some have used Social Return on Investment methodologies to get a more accurate measure of both the financial return on the investment made and the benefits to the individuals and to wider society. However, these methodologies are not traditionally recognised by health partners.

This different approach to evidence does not mean that housing can’t deliver better outcomes for patients at a lower cost. Nor does it mean that health and housing cannot be good partners in health creation. It simply means that ways need to be found to bridge the gap between what is currently available and what is compelling, especially around new ways of delivering care.

More recently, some housing organisations have employed universities to undertake robust evaluations of their housing and health programmes for them, and the evidence is starting to emerge into the public domain. Some use established health measurement systems such as the Warwick Edinburgh Mental Well-Being Scale to demonstrate the impact.

Supporting the generation of credible evidence

There are several ways in which you can support the generation of credible evidence that you have confidence in:

  • Take an interest in the health-related work your housing partners are doing or proposing, even if they only have early indications of what is possible. Don’t let the lack of robust evidence stop you from exploring the possibilities.
  • Pilot new models of care with them in order to generate evidence
  • Advise them on how to construct evaluation frameworks that you will have confidence in
  • Undertake evaluations jointly with them
  • Be prepared to collect new types of data to feed into evaluations
  • Advise them about established health measurement systems such as the Warwick Edinburgh Mental Well-Being Scale, where appropriate.

Links to sources of evidence used in this website

Evidence used to create NICE guidance “Excess winter deaths and morbidity and the health risks associated with cold homes” www.nice.org.uk/guidance/ng6

Healthcare for single homeless people 2010, Department of Health: webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_114369.pdf

Cost of poor housing to the NHS 2015, Building Research Establishment: www.bre.co.uk/filelibrary/pdf/87741-Cost-of-Poor-Housing-Briefing-Paper-v3.pdf

Evidence of the health impacts of loneliness: Campaign to end loneliness, www.campaigntoendloneliness.org/threat-to-health/

NHS Surplus Land for Supported Housing 2014, Smith Institute: smithinstitutethinktank.files.wordpress.com/2014/09/nhs-surplus-land-for-supported-housing.pdf

Inequality in Healthy Life Expectancy at Birth by National Deciles of Area Deprivation: England, 2009-11, Office for National Statistics: www.ons.gov.uk/ons/rel/disability-and-health-measurement/inequality-in-healthy-life-expectancy-at-birth-by-national-deciles-of-area-deprivation–england/2009-11/stb—inequality-in-hle.html

Empowering communities for health: business case and practice framework: www.healthempowerment.co.uk/wp-content/uploads/2012/11/DH_report_Nov_2011.pdf