CPD module: Healthcare and social housing – how to reduce the risks of poor indoor air quality

What are the key steps in setting up an effective collaboration with health services?

People who live in social housing are among those most impacted by health inequalities. This means that housing providers are well-positioned to reduce them. They cannot do this alone, so they must work in collaboration with health services.

People understandably look to health services to deliver health outcomes. But we know that only 20% of health outcomes are delivered by clinical interventions. The other 80% comes from factors like social networks, housing, local environment and employment.

Successful collaborations between healthcare and housing start with a recognition that housing and health services are very different, although often they are supporting the same people.

The second crucial step is understanding how both housing and health services operate. The NHS is a very large and complex system of thousands of providers working across the country, all doing different things, with different responsibilities and priorities. In a similar way, social housing is made up of hundreds of organisations, all providing a differing range of services. A successful collaboration requires a deep understanding on each side of the equation. Each party should have a clear understanding of what the other party does and what they can bring to the table to form a successful collaboration.

This educational activity requires a space where people from the different professions can meet and share their intelligence and insights about the people they serve. This will lead to a greater understanding of what both parties are trying to achieve and how they can work together to solve issues that they haven’t been able to solve alone.

Collaborations often require a broker. Finding the right person to talk to in health services can be challenging. Housing is also often poorly understood by health colleagues and housing providers often don’t understand the difference between the different parts
of the health service. Local authority public health services can fulfil this broker’s role as they have a good understanding of both healthcare and the role of housing providers.

It is critical to start small. You shouldn’t expect to change the world from day one. The most successful housing and health collaborations involved working together for a long time before seeing results. Collaborations also require commitment because both housing and healthcare professionals can be pulled away at any time to focus on other areas of their work.

Another critical element to getting an effective collaboration off the ground is the development of shared common ground, a common language and shared goals. While housing and health both serve the same customers, they use different language and jargon.

Housing uses terms such as community, neighbourhoods and customers. Our health colleagues refer to place and person-centred care. Health services are also more focused on outcomes than housing organisations. So, it is important to find the right language to align those focuses.

Following Amplius’ involvement in a collaboration with health services, we started using the phrase “place-based, person-centred” to describe our work in our neighbourhoods. It has made us consider how we can better understand our customers as people and design services around them.

How can a housing and health collaboration reduce health risks to tenants?

Collaborations can play an important role in raising awareness of health risks and improving access to health services. Housing associations spend time building trusted relationships with our tenants and interact with them regularly. 

But we can easily miss opportunities to make the most of the conversations we have. Amplius is working alongside fellow housing associations Peabody and BPHA in a housing partnership with public health. All three of us emphasise to our staff that they should never waste an opportunity to have a conversation about health with a tenant.

This doesn’t mean training our frontline teams to be experts in weight management, quitting smoking or gambling addiction. But we do train them to have the confidence to have conversations about these issues, and to be aware of the pathways agreed with health colleagues through which we can refer them to services.

Across the partnership we have trained hundreds of housing officers and payment support advisors to connect our tenants with health services. These kinds of conversations are also helpful when the health issue turns out to be linked to the condition of a property.

Housing and health collaborations can also improve access to and the targeting of resources. Each organisation has their own set of resources and their own relationships with other community services. For example, housing and health services will have their own routes into accessing social care support, but each one will be using slightly different levers to do so. Similarly, healthcare is often more likely to have access to social prescribing services than the housing sector.

Collaborations can therefore help housing providers to develop routes into health services. A child or adult with respiratory difficulties can benefit from a combined, single pathway that deals with both their home and their medication rather than multiple separate interventions.

Collaborations can also map how housing management issues, such as anti-social behaviour and debt in particular neighbourhoods, might be connected with health inequalities, and can allow us to tackle these inequalities more effectively.

These kinds of mapping exercises may identify neighbourhoods where people have poorer health outcomes and so are in need of focused work. For Amplius and its partners, this work led us to develop an approach to working at place, a public health term which involves identifying and doing targeted work in areas with shared health characteristics. This led us to develop the Story of ADaM, a project to tackle respiratory issues in children, after discovering a higher proportion of these issues in some of our localities. 

What helpful data and insights can be shared between the two sectors?

Data-sharing between the NHS and housing organisations can be very challenging. It is completely appropriate that there are strong information governance controls in place in the NHS and the public health sector, as well as in housing, since both sectors hold very personal data about individuals. However, housing and health collaborations can develop approaches to share insights more freely.

If data is the facts which housing providers hold about a tenant or household, information is an ordered set of data. Insights are in turn generated by an analysis of that information.

Housing providers should always be focused on good-quality data which is easily stored and retrievable. Robust information helps develop insight which is actionable and can inform collaborations between housing and the healthcare sector. Housing associations should have good insights at a household and community level from data, as well as from their interactions with tenants. Housing providers can share these insights with healthcare professionals, and can say “these are the issues that our customers and tenants are experiencing”.

The health service in turn has lots of access to population-based data, including about health inequalities. It is worth bearing in mind that most information housing providers hold will be on lead tenants rather than whole households. Efforts can therefore be made to address this gap in intelligence.

Housing providers’ insights about their homes, their tenants and the wider household can be overlain with population health and health inequality data. This might then identify areas with higher levels of respiratory illnesses such as COPD (chronic obstructive pulmonary disease) or asthma.

For respiratory health, housing providers can provide insight into the condition of their homes and the people who live in them. This kind of insight can prompt a further set of questions and can be helpful in building referral pathways. They can also help target investment or set up a focused piece of work.

Housing providers should avoid letting the challenges of data-sharing hold up collaborations with health organisations. They should focus on developing jointly the mechanisms which allow them to improve people’s access to their respective services. Once these are established, any relevant information can flow through them with the individual being helped.

While data-sharing about specific tenants is more complicated, it is not impossible. Amplius has worked with health colleagues to get protocols in place when we need permission to share data on an individual as part of an agreed process. For example, we get explicit consent from a customer to share their data with a social prescriber when a referral is made.

How to measure success

The measures of success for a housing and health collaboration must be framed by both parties. 

They should consider what success looks like for the tenants, customers and patients. Measures of success could include hard data, such as whether collaborations lead to reductions in acute presentations for respiratory health, how many people are accessing services and how quickly they are doing so. Through the Health and Housing Partnership, we were able to directly engage with several thousand residents and generate hundreds of referrals into a variety of health services, such as smoking cessation, weight management, drugs and alcohol, and mental health.

A number of outcomes were then shared with our health partners. These included the number of people we have interacted with as a result of the collaboration as well as case studies and shared learning. We also measure success with traditional metrics such as reductions in anti-social behaviour, in housing officer time and in voids and arrears.

However, it can be difficult to draw a golden thread between these traditional measures of success and what is happening in the collaboration. This is always going to be the case with organisations coming together if those organisations can’t share data easily.

To alleviate these issues, success can also be measured by looking at the extent to which issues identified by the collaboration have been resolved, or if activities developed through collaboration have been adopted in the long term. Another measure of success is if the flow of resources into communities that might not otherwise have received those resources has improved.

Evidence gathered through collaborations can help housing and health providers to attract and target resources into communities in a more effective way.

How can collaborations set up to reduce respiratory health risks be extended to other health hazards?

Collaborations can work for a range of health issues once relationships have become established. They are about services coming together to resolve issues they cannot resolve on their own. They can help develop pathways of support for people when they need it. These goals can be applied to a range of health risks, such as trips and falls, which are issues for children as well as older people, because very few health issues exist in total isolation.

At Amplius, the focus for our initial collaboration was the most vulnerable residents and residents who also suffer from respiratory diseases. That was not just because of the impending rollout of Awaab’s Law. It was also because that was what the data was telling us to do.

Data should drive any collaborations because it gives us an understanding of where the greatest need is. Otherwise, there is a danger that you try to do too much and have very little impact because you are not focusing on the right things.

Start with your understanding of the data, your customers and your neighbourhoods, rather than assuming that what is needed in one area is also necessarily required in another.

There is also the potential for preventative collaborations. At Amplius, we use electronic sensors to pick up underheating and high humidity levels and share this data with our tenants on an easy-to-use app they can download on their phone.

If it could also be shared with our health colleagues, it could help flag potential health problems before they occur, prompting early intervention.

Areas to reflect on

• How much do I know about the health of my tenants?
• Which health organisations could I collaborate with?
• How would I start a collaboration with these services?
• What insights about tenants’ health could I share with health services?
• How would I measure the success of a collaboration with health services?

Summary

Housing providers will play an increasing role in reducing health risks to their tenants, especially in relation to respiratory illnesses. 

Commissioners of NHS healthcare have been compelled to work with housing associations and local authorities to improve the outcomes of people who suffer with asthma at least since 2021.

Collaborations with the healthcare sector offer a useful means of protecting tenants from health risks in their homes. They should start small and require a good understanding of how your collaborator operates. They may also require a broker with good knowledge of both the housing and healthcare sectors, such as a local authority public health service.

Collaborations should establish early on their common ground, common language and shared goals. They can reduce health risks by increasing awareness of health problems and improving access to health services among tenants. They can also help housing providers to develop new routes into health services and help health practitioners to understand and access housing services.

The sharing of data on individuals can be challenging. However, if this is done correctly, housing and health providers can share high-level insights about health issues in their communities and develop joint interventions. These insights can be mapped onto each other to pinpoint areas of health deprivation which may require targeted interventions.

The measures of success for collaboration should be framed by both parties. These measures could include hard data, as well as the impact of collaboration on housing management processes. Collaborations can open up access to resources to tenants which might not otherwise have been available.

Collaborations set up to improve tenants’ respiratory health can in principle be extended to other health hazards. However, any extension must be driven by specific data instead of assuming that what is needed in one area is required elsewhere.

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References and further reading

• The Story of ADaM: A process review of the collaboration between housing and health in the East of England around Asthma, Damp, and Mould (ADaM), HACT
• How to develop quality housing and health partnerships, Chartered Institute of Housing, 
• Health and Housing Insights Bank, Chartered Institute of Housing

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