Investing in warmer housing could save the NHS billions

This article by , Research Officer in Health Economics, , PhD Research Candidate and Research Project Support Officer,  , Professor of Health Economics, all of the  was originally published on . Read the .

British weather isn鈥檛 much to write home about. The temperate maritime climate makes for summers which are relatively warm and winters which are relatively cold. But despite rarely experiencing , the UK has a problem with significantly more people dying during the winter compared to the rest of the year. In fact, have occurred since records began in 1950 鈥� that鈥檚 equivalent to the entire population of Manchester.

Although the government has been collecting data on excess winter deaths 鈥� that is, the difference between the number of deaths that occur from December to March compared to the rest of the year 鈥� for almost 70 years, the annual statistics are still shocking. In the winter of 2014/15, there were a staggering , the highest recorded figure since 1999/2000. In the last 10 years, there has only been one winter where less than 20,000 excess deaths occurred: 2013/14. Although excess winter deaths have been steadily declining since records began, in the winter of 2015/16 there were .

According to , respiratory disease is the underlying cause for over a third of excess winter deaths, predominantly due to pneumonia and influenza. About three-quarters of these excess respiratory deaths occur in people aged 75 or over. Unsurprisingly, cold homes (particularly those below 16掳C) cause a substantially increased risk of respiratory disease and older people are significantly more likely to have difficulty heating their homes.

Health and homes

The UK is currently in the midst of a housing crisis 鈥� and not just due to a lack of homes. According to a , a fifth of all homes in England fail to meet the 鈥� which is aimed at bringing all council and housing association homes up to a minimum level. Despite the explicit guidelines, an astonishing 16% of private rented homes and 12% of housing association homes still have no form of central heating.

Even when people have adequate housing, the cost of energy and fuel can be a major issue. Government schemes, such as the , have been implemented to help low income households increase indoor warmth and energy efficiency. However, approximately (about one in nine) are still in fuel poverty 鈥� struggling to keep their homes adequately warm due to the cost of energy and fuel 鈥� and this figure is rising.

Poor housing costs the NHS a whopping . Reports indicate that the health impact of poor housing is almost on a par with that of . Clearly, significant public health gains could be made through high quality, cost-effective home improvements, particulalrly for social housing. Take insulation, for example: that properly fitted and safe insulation can increase indoor warmth, reduce damp, and improve respiratory health, which in turn reduces work and school absenteeism, and use of health services.

Warmth on prescription

In our , we examined whether warmer social housing could improve population health and reduce use of NHS services in the northeast of England. To do this, we analysed the costs and outcomes associated with retrofitting social housing with new combi-boilers and double glazed windows.

After the housing improvements had been installed, NHS service use costs reduced by 16% per household 鈥� equating to an estimated NHS cost reduction of over 拢20,000 in just six months for the full cohort of 228 households. This reduction was offset by the initial expense of the housing improvements (around 拢3,725 per household), but if these results could be replicated and sustained, the NHS could eventually save millions of pounds over the lifetime of the new boilers and windows.

The benefits were not confined to NHS savings. We also found that the overall health status and financial satisfaction of main tenants significantly improved. Furthermore, over a third of households were no longer exhibiting signs of fuel poverty 鈥� households were subsequently able to heat all rooms in the home, where previously most had left one room unheated due to energy costs.

Perhaps it is time to think beyond medicines and surgery when we consider the remit of the NHS for improving health, and start looking into more projects like this. NHS-provided 鈥溾�� have already been trialled in Sunderland with positive results. This sort of cross-government thinking promotes a nuanced approach to health and social care.

We don鈥檛 need to assume that the NHS should foot the bill entirely for ill health related to housing, for instance the Treasury could establish a cross-government approach by investing in housing to simultaneously save NHS money. A 拢10 billion investment into better housing could through NHS cost savings. With a growing need to prevent ill health and avoidable death, maybe it鈥檚 time for the government to think creatively right across the public sector, and adopt a new slogan: improving health by any means necessary.

Publication date: 5 October 2017