The Guardian carried an article by the Smith Institute’s Director, Paul Hackett, arguing that an increasingly strained relationship with government has left social housing landlords considering withdrawing from work with other public services.
The health and social care systems are stretched to the limit and the funding gap gets wider by the day. While the political spotlight is on extra funding for the NHS, part of the solution lies as much outside the health service as within it.
Housing costs the NHS more than £600m a year alone in avoidable diseases and injuries from damp and overcrowded homes. However, housing providers (especially housing associations) are struggling to balance their social purposes in a time that requires more commercial activity than ever to balance the books.
Decades of improvements to social housing have already saved the NHS a small fortune. However severe cuts to housing grants and an ageing housing stock mean that most housing providers (and especially councils) are now running to stand still in order to keep their stock in reasonable condition. The squeeze on social housing and the continuing fall in home ownership will make this even harder.
Housing conditions have improved in the fast-growing private rented sector, but it still lags well behind both social and owner-occupied housing. The worry is that a failure to improve conditions in the private rented sector, as it houses more low-income and vulnerable households, will lead to a rise in health costs. The problem for healthcare agencies is how to engage thousands of small landlords.
One of the major barriers preventing greater integration between the social housing sector and health is the lack of aligned financial incentives. Acute hospitals, for example, are paid on a per-patient basis which means they need to make sure beds are filled. If the beds are empty they still incur basic costs, but without income. Even if a housing association can provide step-down care at half the cost of the local hospital there is little incentive to change. The same is often true with surplus NHS land, which could be used to build supported housing or provide affordable housing for healthcare staff. However, the advantage to a cash-strapped NHS trust of selling the land to the highest bidder (with no social benefits) far outweighs the costs.
Similarly, housing associations and councils are offered few incentives to work closely with healthcare providers even though they are dealing with the same people. The government hopes that devolving healthcare budgets to combined authorities will overcome some of these problems. It will certainly create an opportunity to do things differently, although housing associations have so far struggled to play a meaningful role in the local decision-making process for planning health and social care.
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