Housing and neighbourhoods
- Introduction - Dr Fiona Campbell
- Issues of overcrowding
- Mental wellbeing
- External environment
- Maintaining a sense of neighbourhood and partnership working
- Tackling anti-social behaviour head on
- Housing and neighbourhoods case studies
- Links to case studies
- Process for carrying out case studies
Introduction - Dr Fiona Campbell
Many councils now assign responsibility for their housing function to their director of adult social care. To an external observer this might seem a strange combination of responsibilities. However, it is a practical reflection of the needs of the population who now live in social housing.
The extensive privatisation of council housing over the last 30 years has meant that a large proportion of the remaining council and other social housing is now occupied by some of the most vulnerable groups with complex needs.
The case studies in this group on 'health, housing and neighbourhoods' illustrate some of the range of activities undertaken by local authorities and their partners under the housing umbrella. These activities reflect the close links between people's homes, the environment they live in and their health. They also reflect the changing nature of families.
Issues of overcrowding
For example, in the London Borough of Tower Hamlets, overcrowding is the biggest housing issue, with many large families occupying housing units that are too small for them. Overcrowding directly impacts on health - in fact, we should say that crowding has a negative impact, as Tim Madelin, one of our 'hotseat' guests, has pointed out.
The last 10 years or so have seen an increase in tuberculosis in the East End of London. Overcrowded housing, with several adults and children sharing one bedroom, is a contributory factor. This is something many of us thought we would not experience in this country in the 21st century.
Overcrowding and some of the other aspects of poor home environments also contribute to mental stress and to reducing people's general wellbeing - see Cooper et al, 2008. As the case study on its work shows, Tower Hamlets is taking a multi-stranded approach both to reducing overcrowding and, in the absence of enough appropriately-sized housing units, to mitigating its effects. In a bold move, the council is investing heavily in buying back former 'Right-to-buy' houses. Will this be the scenario all over the country as the demand for 'decent' rented housing increases over the next few years?
Of course, our environment outside our homes affects our health and wellbeing also. In the most obvious way, access to health, social care and other social support facilities make a difference. But so also does that most intangible but real of social phenomena - a sense of belonging to a community.
The case study on Leicester shows how the council and its partners on one deprived estate are tackling the inverse care law that decrees access to services is inversely proportional to people's need. At the same time, they are standing back and letting the estate's residents play a genuinely influential part in running it and in building a community there.
This is part of a 'community asset transfer' strategy - a phrase we are likely to hear a lot in the next few years. It will be interesting to see how councils manage the delicate balance between local democratic accountability for their housing stock and the state of their neighbourhoods and the devolution of power over these issues to those with the greatest interest in them.
Maintaining a sense of neighbourhood and partnership working
The most vulnerable people are the most frequent victims of crime and of anti-social behaviour (ASB). This can quickly destroy a sense of community and turn a neighbourhood into a threat instead of a haven. Rochdale Council, together with its partner Shelter, is working intensively with the perpetrators of ASB. This is on the grounds that moving perpetrators on without any intervention in their families only shifts the problem somewhere else. The importance of partnership to this assertive engagement with perpetrators and their families is illustrated in the essential multi-agency approach coordinated by Shelter's key workers with a small number of the most offending families.
Tackling anti-social behaviour head on
We know of the stress and health impact that ASB causes to its victims, but the work in Rochdale and elsewhere is beginning to uncover a host of unaddressed mental health issues among perpetrators and their families. This is “a social phenomenon that has never been mapped”, as the project manager says, and in response to which Rochdale has committed to developing new Family Intervention Tenancies.
It is examples like these that should make us, as a society, realise that there will always be a place for social housing and a strategic approach to planning as a means to wellbeing and health improvement. The case studies contain references to research on the links between health and housing, but more evidence is needed. Perhaps the proposed move of the public health function to local authorities will provide a new impetus for a systematic approach to gathering such evidence?
ReferencesCooper, R., Boyko, C. and Codinhoto, R. (2008). 'State of science review: the effect of the physical environment on mental wellbeing'. Foresight mental capital and wellbeing: Making the most of ourselves in the 21st century. Government Office for Science, London.
Housing and neighbourhoods case studies
The six case studies that follow demonstrate some of the innovative ways in which local government and its partners are addressing health inequalities and improving health through action on housing and neighbourhoods.
- Tower Hamlets - the council is undertaking an ambitious building and buy-back programme along with a number of innovative measures to mitigate the effects of overcrowding
- Rochdale - Shelter has run a successful project commissioned by Rochdale Council for a number of years, taking a family intervention approach to ASB
- Individual story (alternative case study from Rochdale) - a single mother aged 47 and son aged 17: issues include current risk of eviction, mental health concerns and substance misuse linked to poor health and unmanaged hepatitis C, low educational attainment of son on 'At-risk' register, debt and budgeting concerns.
- Durham - in an effort to avoid the 'revolving door' syndrome of repeated hospital readmissions, St Stephen's provides independent but supported living for people with chronic mental health conditions.
- Manchester City Council - Shore Green extra-care housing scheme provides good examples of how building design and assistive technology can help sufferers of dementia.
- Leicester - the city council and its partners have taken an integrated approach to regenerating housing, neighbourhood and community involvement in the Braunstone Estate.
- South Staffordshire - local authorities and third-sector organisations in South Staffordshire have come together to streamline applications, assessments and provision of aids and adaptations to enable people to live independently in their homes.
Links to case studies
Durham - St Stephen's Close supported living
Leicester City Council - involving local residents
London Borough of Tower Hamlets - overcrowding
Manchester - extra care housing dementia
Rochdale - family intervention case study
Rochdale - reducing the health impact of anti-social behaviour
South Staffordshire - housing aids for independent living
Process for carrying out case studies
These case studies were written by Dr Fiona Campbell and are based on interviews with local authority staff and other project partners. They were selected as representative of the wide range of local authority projects which can be regarded as good practice in health and housing. In presenting their work, interviewees also discuss the lessons learned and the advice they would give to colleagues in local government and the NHS wanting to improve their work in this area.
Principal Consultant - Healthy Communities team
26 October 2010