Devolution: A More Holistic Approach to Health and Housing

Posted on the 8th November 2018

The link between the NHS and housing associations is growing evidently clearer as they offer practical and strategic solutions to address the amounted issues experienced by our 70-year-old institution.

The State of the NHS

On the 5th of July the NHS, arguably the UK’s most valued institution turned 70. Since its inception, the NHS has developed a rich history and is the envy of nations throughout the world who suffer the cost of a private healthcare system.

However, what was once a beacon of hope, and a shining example of an institution that provided assistance for all, is now struggling. Indeed, according to the NHS Confederation, the health expenditure per capita was £2,106 per capita in 2016, compared to £1,879 in 2012. The result is that the net deficit experienced by the NHS in 2016 was £1.851 billion, adding extreme pressures that they [the NHS] quite simply cannot afford to address.

However, that is not to say all is bad. Following a review of 10 countries including Germany, Sweden and the Netherlands – all countries we idolised in terms of health systems – the UK came first for ‘safe care’, ‘affordability’ and ‘equity’. Quite an impressive feat given that 1 million patients visit the NHS every 36 hours.

Regardless, it is seemingly evident that the NHS needs help, and following the failings of and political campaigns and ‘resolutions’, it seems that housing associations may indeed be their saving grace.

Two Prominent Issues

At present, the NHS is faced with two significant issues. On the one hand, you have a scenario where there is a backlog of available beds available within hospitals. These beds are priced at £275 per-day themselves, costing around £820 million per annum for treating patients that should have been discharged, but not well enough to live independently at home.

On the other, the second issue is increasing house prices, coupled with the stagnated wages of nurses, social carers and young doctors. This is particularly problematic for NHS workers in London, where the average house price exceeds £500,000, 18 times the salary of a nurse.

These issues, amongst other severe complications, hinder the NHS’s ability to operate effectively and fulfil their initiatives as stipulated in their 2018 Annual Report. In this report, the NHS notes a desire to ‘integrate care locally’ by putting centres and GPs are the ‘heart of the populations they serve.’ However, in order to commit to this mandate, they need to be accessible. Not only for the general population but for the doctors and nurses who serve within the practice – who quite simply can’t afford to live there.

The Proposed Solutions

As articulated in our blog on social housing, we stressed how housing associations are passionate about their social impact, as it is core to their mission statements. From our perspective, it is unsurprising that housing associations have offered to answer the call from the NHS and provide solutions for an institution that offers the ultimate social value: life.

Traditionally, in response to the identified financial pressures, the NHS and their affiliated trusts would sell off large bulks of land to private owners in order to acquire large, but one-off, sums of money. However, these – short-term – solutions were exactly that. They were a quick fix that did not provide the NHS with the salvation that it requires.

Alternatively, the proposal offered by many housing associations is essentially to build on NHS trust land, providing social or affordable housing for NHS staff, in addition to short-term housing for dischargeable patients, and/or the population.


Mould on wall

Solutions in Action

These types solutions are currently being proposed between Oxford Health NHS Trust and Metropolitan Thames Valley, with the intention being to alleviate some internal pressures off of the NHS, allowing staff who have been ostracised due to extortionate rents to be able to live closer to where the work.

Similarly, One Housing and Camden and Islington NHS Foundation Trust have joined into a strategic partnership with a financial and social impact that exemplifies the potential benefits that can be rewarded following a link between the NHS and housing associations. In this instance, these two organisations have collectively:

  • Helped save £900,000 in mental health services since 2012.
  • Freed up multiple NHS beds by reducing the number of mental-health-related admissions.
  • Promoted independence of their tenants, and improved the quality of lives for those living with mental health needs.

Additional advantages: Social Housing – Standard of Living & Care

We believe there to be additionally social advantages that could be realised should we witness more partnerships between housing associations and the NHS.

Beyond the identified financial implications of these partnerships, there are additional savings that could be rewarded following the construction of more social housing. Given that over 30% of housing association residents live with a disability, or are aged 60 and over, it is safe to say that they host some of the more vulnerable within our society. These members of our communities are consequently more susceptible to health issues surrounding accidental falls and cold temperatures, which cost the NHS £435 million and £848 million respectively. What’s more, the cost of poor housing quality on the NHS itself is estimated to be around £1.4 billion. Housing associations can afford to improve the standards of their housing, with the role of technology within social housing playing an important role.

Indeed, social housing can compensate for these extortionate costs, as housing associations have the surplus revenue streams to reinvest back into their property to keep them above standard. Revenue acquired from the tenants can be used for better insulation and better boilers, helping to address issues such as mould and other long-term health implications, all of which have financial implications for our public health system. These quality hygiene standards are exemplified by housing associations in Wales, with which 99% comply with the Welsh Housing Quality Standard (WHQS) compared to 77% of council housings.

The Devolution of NHS Investment & the Role of Measurement

Following these partnerships, and the identified examples of where improvements can be made, there are proposals that suggest greater investment into these housing associations rather than exclusively into the NHS itself. There is the perspective that given the evidence that housing associations can contribute to displacing some costs on health care, housing associations should receive greater investments in order to continue to alleviate the financial burdens undertaken by the NHS. Arguably, it is better to devolve investment in the NHS for example, into social housing that has the foundations in place, and adaptability to more efficaciously cater to the needs of people with mobility issues or acute health requirements.

However, in order to make devolution a reality, evidence-based data needs to be captured to show the true social value that is being created.  Therefore a strong measurement framework is essential. Here at Impact Reporting, we are continually developing our social value reporting tool to enable housing associations to quantify their socially impactful activities and transform them into evidence-based data.

We can identify the community impact, highlighting the social value so that you can – as organisations – leverage more funds, have confidence when presenting data to stakeholders and partners, scale-up projects, and in this case, justify a diversion of NHS investment. Our tool was designed by housing associations for housing associations, so should you wish to learn more about the ways in which we can help track, monitor and report of your impact chat with us here.

About the author:

Lee Smorthit

Marketing and Social Value Executive

Following the completion of his MSc in Digital Marketing Communications, Lee joined the Impact team in 2018 to set a marketing direction for the company, and to apply his research capabilities to further develop the Impact tool, ensuring that our software as a service (SaaS) is client-friendly and accessible.

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