Why are housing organisations interested in my patients’ health and wellbeing?

There are several motivations for housing organisations getting involved.

1) They have been doing ‘prevention’ for many decades

Until 2009, many housing organisations received a portion of a national budget of £1.6 billion, called Supporting People. This enabled them to provide flexible, personalised, low level ‘housing-related support’ that enabled people with sometimes complex needs to live in their own homes rather than in more care-intensive types of supported accommodation. Un-ring-fencing of this budget in 2009 led to a gradual erosion of these services and has almost certainly contributed to increases in GP and A&E attendances. Rather than waste the skills they have developed, housing organisations want to put them to good use – the NHS prevention agenda is seen by many as the new ‘place’ for these skills and a means of continuing to finance this work. Being flexible organisations, they are prepared to reinvent how they support people to make it more relevant to the NHS. They are looking to deliver wins to the NHS as well as wins for their own organisations and residents/patients.

2) There is a business case for housing

When a resident starts to miss rent payments and rent arrears start to build-up, it can be a sign of other problems in their lives including, sometimes, physical, emotional or mental health problems. Even if arrears are purely a consequence of living on a low income, this in itself can make people anxious and stressed. Increasingly, housing organisations are working with these residents in a person-centred way to resolve matters before arrears rise to high levels in order to avoid having to evict residents, which has a high human cost and significant financial cost to the organisation.

3) Many housing organisations ‘think’ at the community level.

Where they own a lot of the homes in one locality, they are interested in how well that community is functioning as a whole – including those people who own their own home. Communities that function well are healthier and cause fewer management problems, so they are less expensive to manage. Property prices are higher in neighbourhoods where communities function well, so being interested in the ‘social health’ of communities is also a way for housing organisations to protect their housing assets.

4) They will continue to have a ‘presence’ despite budget cuts

While councils are enduring budget cuts that are threatening many community services, such as Sure Start centres and transport provision for older people, housing providers cannot withdraw in the same way, because they own many of the homes. They are looking for ways of mitigating the impact of wider service cuts in a way that doesn’t cost them too much.

5) They care about people and ‘prevention’ makes sense to them

The housing sector is largely values-led and has many people working within it who understand and care about people and who are pragmatic in their approach. Frontline housing staff have significant contact with their residents on a daily basis (two and a half times the number of contacts that GPs have) and they see the negative effect that a lack of appropriate support can have on people’s lives. Also, housing organisations can be fairly flexible in how they respond to people’s needs and aspirations. A more preventative health service makes sense to them, and they can see roles for themselves in helping to bring that about.

6) They are looking to diversify into new areas of business

While housing organisations are not-for-profit and don’t have shareholders, some are nevertheless very business-minded social enterprises. In any case, whether they are councils, housing associations or home improvement agencies, they have a responsibility to their customers to succeed as organisations – and that means being financially sustainable. It is quite normal for housing organisations to have ‘business interests’ that go beyond their role as landlords. For example, some also have significant care businesses and provide care for private residents as well as their own residents. Some providers see the health prevention agenda as an opportunity to diversify their business and in so doing close a gap in provision that they are well-placed to fill. Being not-for-profit means they can reinvest any surpluses they make from contracts into other community services.

A word about ‘who pays?’

Rental income is a key income stream that is common to all housing providers. While there is a certain amount of financial freedom as to how they spend their money (especially for housing associations), there is a limit on the extent to which they can morally justify using their resources (ie. tenants’ rent) on promoting people’s health and wellbeing. They are, therefore, looking to cover some costs from the health budget. They will seek to justify this on the grounds that the preventative actions they take will save the NHS money.