You are viewing 1 of your 1 free articles
How a Walsall social landlord is fast-tracking damp repairs for children with asthma
For children with asthma, living in a mouldy or damp home could put their health at serious risk. Peter Apps visits a landlord that has partnered with the NHS on an innovative project to ensure repairs are carried out. Photography by David Griffiths
In November 2022, as national newspapers were covered with the image of a two-year-old boy who died from prolonged exposure to mould in his social home, housing association boards around the country wanted a question answered: “What is the risk of that happening here?”
For one housing association, WHG in Walsall, answering this question was easier than for most. “I already knew the location of every child with serious asthma in our housing stock, and I could say with confidence that they weren’t living in a home with mould,” says Connie Jennings, director of stronger communities at the 21,000-home landlord.
This is because of a programme that had begun two years previously, in partnership with Walsall Healthcare Trust via the regional Integrated Care Board (ICB), to reach out to households with children who had serious asthma, offer them support and ensure their homes were free of anything which could exacerbate the condition.
With the death of Awaab Ishak throwing the acute health risk to young children from damp and mould into the national spotlight, this work has taken on a new significance. Inside Housing visited Walsall to learn more.
Awaab was not diagnosed with asthma. His death seems to have been simply caused by the appalling extent of mould in his family home and a long-term failure to deal with it by the housing association.
Read more
Nonetheless, the link between asthma and an increased risk of death in damp, mouldy homes is beyond doubt. The condition can be caused by prolonged exposure, and it can trigger attacks in those who already have it.
WHG’s work on asthma has its roots in what Ms Jennings describes as the organisation’s ‘USP’ (unique selling point). The association owns a fifth of the homes in the Black Country town – one of the UK’s most deprived, where a healthy life expectancy is just 56.8 years and 30% of children live in poverty.
To build links with the communities it serves, WHG has a long-term policy of recruiting directly from its customer base. More than 46% of the landlord’s health and well-being team are residents, filling the roles of ‘community champions’ and ‘social prescribers’, who work to support their neighbours.
“A champion has to live in the area that we want them to work in. They have to have had some lived experience of the issue we’re trying to address, and they have to be able to demonstrate resilience to overcome those issues and have the ability to be an advocate and a role model,” explains Ms Jennings.
These are not token voluntary roles. They all represent paid employment, funded by WHG, and offer a route to further employment at the association.
“I’ve always worked in communities that are described by professionals as disadvantaged, but I prefer to call them underserved,” says Ms Jennings. “Residents that live in those areas are often described as ‘hard to reach’, but they’re not. We have to adapt the way that we try to reach those individuals in order to give them an equitable access to the services that the rest of us take for granted.”
Ms Jennings, who also leads on safeguarding at WHG, was moved to think about what could be done on asthma by a story from April 2022, about a boy from Birmingham who died of an asthma attack after his inhaler was used to smoke drugs by his mother. She was ultimately jailed, and a review found failings by multiple bodies that could and should have stepped in.
Ms Jennings used health data to find the postcodes where there were multiple admissions to hospital of children with asthma. “Asthma is a manageable condition. People can remain well if they have proper access to medication, so if they’ve been hospitalised regularly, something is going wrong,” she says.
She was sure there would be reasons for this. “The people I’ve worked with over the years want the best for their children. And if they’re not doing the best for their children, it isn’t because of their lack of willingness to do it, it’s because they’re dealing with a whole range of other things,” Ms Jennings adds.
WHG asked its trades operatives and housing officers to notify the landlord if they came across a family where a child has asthma. If they did, WHG would contact the family to ask if they needed support.
“The reason trades colleagues are important is because one of the things that I wanted them to tell us is if there were any issues with damp and mould,” Ms Jennings explains.
Now, working with the NHS, there is a direct referral pathway from the local hospital. If a child with asthma attends and the parents are WHG residents, the housing provider is notified and can offer support.
“Our social prescribers will go in and do an assessment, which they’ve been trained in by our health colleagues,” says Ms Jennings. “We’ll also check the home for any signs of damp or mould. If the signs of damp or mould are there, we’ve got a structured process in place where the asset side of the business kicks in.”
In 2022-23, the first full year of the programme’s operation, 93 children received help under the scheme. This resulted in 18 referrals to the damp and mould team for a home survey, 23 parents receiving support and confidence building to help attend their child’s annual asthma review, and two families being provided with an entirely new home better suited to their needs.
Parents were also given help by the social prescribing team to complete an asthma assessment, develop an asthma plan for their child and given advice on using inhalers and spacers correctly. The social prescribers
are all trained as tier-one asthma ambassadors.
“Predominantly, the objective is to get that child into the NHS pathway and to ensure that they then continue to self care because it’s not for us to do it for them,” says Ms Jennings. “But we remove barriers. So if it’s money, transport, competence, language, the social prescriber will work with them on a plan to remove those barriers.”
Asthma and housing
The link between damp and mould and increased asthma risk in children is well established. A 2018 literature review found that “visible mould and mould odour were associated with the development and exacerbations of asthma, providing sufficient evidence of a causal relationship” in children. In adults, the link was less pronounced.
A 2014 study in the Journal of Allergy and Clinical Immunology said that damp and mould in homes “could pose a significant health risk” to people with asthma.
Dr Nick Osborne, the senior research fellow who produced the report, said: “This research has highlighted the need for housing providers, residents and healthcare professionals to work together to assess the impact of housing interventions.”
A free online 45-minute tier-one course run by the NHS is available to train non-clinical staff in signposting and considering impacts, and is appropriate for housing staff.
Breaking barriers and building rapport
Simply helping parents regularly attend appointments is a big bonus. “Identifying these children and the support that you can offer in being able to bring people to appointments – that’s huge,” says Lisa Cummings, senior specialist paediatric asthma practitioner at the Black Country ICB.
“They might not have the confidence, they might not have the money to get there – there are a lot of barriers. So we will ask them, ‘What is stopping you?’ And then we will put something in place to overcome that,” adds Ms Jennings.
Ruth Jones is one of the social prescribers. “When we go out to see them to start with, they’ll often say, ‘No, I don’t want support. I’m fine,’” she explains. “The reason most of the time is because they think we’re social services that have come to take the kids away, or we’re going to knock on the door because they’re in rent arrears and we want the money. We have to break those barriers down and build that rapport little by little.”
Tracey Longdon is a mum of eight, three of whom have asthma. “They did a full check on my house for damp and mould, but it didn’t have any – which was a relief,” she says.
“They also gave me an information pack, which was useful, with extra spacers for the children, and warm winter coats and shoes, which is really helpful for me because we’re a low-income family and it just prevents me from worrying to make sure we’ve got the warm clothes to properly cover their chests.”
Ms Cummings runs the project on the NHS side. “For health care professionals, knowing what to do when patients come in and say, ‘Well, there’s mould in my house,’ is really hard,” she says.
“But now we have this [programme] in place, we can deal with it in a WHG property really quickly. If we had this in other areas, that would be brilliant.
“I went to a home owned by another landlord where the family can’t have the heating on in the winter because they’re so overcrowded that the only way to fit the beds in is to have the beds against the electric heaters.”
The programme may expand beyond Walsall. It has been recognised by a national asthma campaign, Ask About Asthma, as good practice, and Ms Jennings is hopeful it will be taken up by other landlords.
In numbers
93
Children who received help in first year of the scheme
18
Referrals made to the damp and mould team for surveys
2
Families provided with a new home suited to their needs
“We think what we have got here could be easily replicated across the Black Country through the housing sector,” says Ms Jennings. “So we’ve worked with the NHS to create a health and housing partnership manager post, which they fund, which sits in my team.”
Toolkits have been provided to the other landlords that may adopt the approach. And there is no reason why it could not be applied outside the Black Country if housing providers and health trusts are willing.
“I think the biggest thing I really want to get across to other housing organisations who will read this article is that WHG doesn’t just do this because it’s a good thing to do, we do it because it’s a commercial thing to do as well,” says Ms Jennings.
“If you’re a parent with a child who’s constantly ill, this will disrupt your employment and make it much harder to sustain your tenancy. We want our customers to be in good work and be able to manage independently. So anything that stops that from happening, we’ve got an interest in.”
With the tragic case of Awaab demonstrating the serious risks to young children from living in damp and mouldy homes, anything that reaches the most at risk before the next tragedy should at least be explored. Like most health and housing collaborations, it is one where everyone stands to gain.
NHS England and NHS Improvement have developed a new framework offering free training for all those who may encounter a child with asthma. The tier one elearning module is recommended for housing professionals. More information can be found here
This year’s # AskAboutAsthma campaign takes place from 11-17 September 2023. More information is available here
Sign up to our Best of In-Depth newsletter
We have recently relaunched our weekly Long Read newsletter as Best of In-Depth. The idea is to bring you a shorter selection of the very best analysis and comment we are publishing each week.
Already have an account? Click here to manage your newsletters.
Related stories
