Memorandum by Shelter (WP 82)
Shelter is the UK's largest provider of independent
housing advice, helping over 100,000 homeless or badly housed
people every year.
INTRODUCTION
Shelter welcomes the Government's White Paper
Choosing Health and the commitment it makes to helping
people make healthier choices for themselves. We particularly
welcome the continuing commitment it sets out to tackling health
inequalities and the recognition that the Government needs to
ensure that people living in disadvantaged areas have the opportunity
to live healthier lives.
Florence Nightingale once said: "The connections
between the health of the nation and the dwellings of the population
is one of the most important that exists." Well over 100
years later, the British Medical Association stated that "Multiple
housing deprivation appears to pose a health risk that is of the
same magnitude as smoking and, on average, greater than that posed
by excessive alcohol consumption."[144]
In 1999, the Government's White Paper Saving
Lives: Our Healthier Nation suggested that at least 70% of
determinants of health are outside the health sector and recognised
that bad housing and homelessness are among the most important
of these. There is a wealth of evidence linking bad housing, and
in particular overcrowding, to ill health. For example, research
has shown that children living in poor housing experience disturbed
sleep, poor diet, hyperactivity, bedwetting and soiling, aggression
and higher rates of accidents and infectious disease. We therefore
believe that decent homes are central to improving Britain's public
health.
This evidence focuses on the particular impact
on health of living in temporary accommodation and is based on
specific research we have recently carried out into this issue.
BACKGROUND
The number of homeless households living in
temporary accommodation has increased by 140% since 1997 and now
stands at a record high of 100,810. 66,120 of these households
are families with dependent children or households which include
expectant mothers. This includes over 116,000 children.
Although not literally on the streets, people
living in temporary accommodation are homeless in every sense
of the word—they have lost their home, often in very traumatic
circumstances; have been "officially" recognised as
homeless by their local authority; and are forced to live in insecure
and often inappropriate housing until a settled home can be found.
The average length of time spent in temporary accommodation has
almost trebled since 1997 to 267 days and in some areas, stays
of two or three years are not uncommon. During this time, they
may be moved several times, causing severe disruption in terms
of changing schools, access to the labour market and the loss
of social and support networks. The insecurity and uncertainty
this causes compounds the impact of homelessness to make living
in temporary accommodation such a damaging experience.
Research has consistently shown that homeless
people are more likely to suffer from poor physical, mental and
emotional health than the rest of the population. Homeless families
in temporary accommodation report high incidences of infectious
respiratory and gastrointestinal diseases, are at greater risk
of being malnourished and having babies with a low birth weight
and are more likely to suffer from poor diet and nutrition.
SICK AND
TIRED
In 2004, Shelter produced two reports which
examined the effects on homeless households of living in temporary
accommodation. Living in limbo145 was based on a survey
of more than 400 homeless households in this situation. It provided
strong evidence of the negative impact this has on people's health:
— Overall, 78% of households reported
at least one specific health problem.[145]
— 49% of respondents said that their
health or their family's health had suffered as a result of living
in temporary accommodation.
— 38% of households reported more frequent
visits to their doctor or hospital.
These findings were explored further in our
report Sick and tired[146]
which was based on more detailed work on a sample of 194 families
from the original survey with specific health problems. The report
provides further evidence of the damaging impact on health of
living in temporary accommodation:
— The number of households reporting
that their health had suffered as a result of living in temporary
accommodation increased to 58% in this sample.
— Almost all of the households felt
that their children's health had suffered through living in temporary
accommodation.
— 63% of people suffering from depression
said this had become worse since they had moved into temporary
accommodation.
— 40% of those with asthma or other
chest and breathing problems said their condition had deteriorated.
DELIVERY
The White Paper gives strong recognition to
the links between bad housing and health. For example, page 87
of the report notes that ". . . poor-quality housing has
been clearly shown to have detrimental health impacts." Page
82 states "Poor health is often compounded by other problems
such as poor housing, poor quality street environments and inadequate
transport and leisure provision. Living in a safer environment
extends opportunities for people to be physically active and develop
social networks . . . We will publish revised guidance on health
and neighbourhood renewal, early in 2005, to support local action
to address health inequalities and deliver neighbourhood renewal."
The Government's cross-cutting review of health
inequalities in 2002 identified homeless people as a key group
to target to improve health outcomes. In July 2003, the Department
of Health published Tackling health inequalities: A programme
for action which set out the Government's strategy for tackling
the wider causes of health inequalities including poor housing
and homelessness. It included the number of homeless families
with children in temporary accommodation as one of the 12 key
national headline indicators for monitoring progress in addressing
health inequalities. This was followed by a joint ODPM/Department
of Health good practice guidance note Achieving positive outcomes
in health and homelessness.
There is evidence that these initiatives are
encouraging joint working at a local level. In Camden, for example,
health check ups are being piloted for homeless children and all
children under the age of six in temporary accommodation are put
in contact with a health visitor. However, independent research
published recently by ODPM found that joint working between local
housing authorities and primary care trusts is still patchy and
that the majority of local homelessness strategies paid little
attention to the health of homeless people.[147]
A recent report by the ODPM Select Committee endorsed this and
recommended that all NHS Trusts should be required to draw up
strategies for dealing with the health needs of homeless people.[148]
The ODPM's Five Year Plan[149]
includes a target to halve the number of homeless households of
living in temporary accommodation by 2010. This is very welcome.
However, it is important to note that achieving this target would
still leave more households in this situation—approximately
50,000—than in 1997. For those who are, and will continue
live in temporary accommodation, it is vital that their health
needs are addressed. This is also essential if the Government
is to deliver on its health inequalities and public health agendas.
Joint working between housing and health bodies at the local level
must therefore improve.
The White Paper proposes to deliver many of
its objectives via schools and schemes such as Sure Start. However,
Living in limbo found that only 20% of households with eligible
children were accessing Sure Start and that children had missed
an average of 55 school days due to the disruption of moves into
and between temporary accommodation. We are therefore concerned
about the extent to which these delivery mechanisms will be successful
in reaching homeless households. Plans to extend health provision
via community based initiatives, such as children's centres and
school nurses also risk not reaching homeless people in temporary
accommodation.
RECOMMENDATIONS
— Primary Care Trusts, Health Trusts
and other strategic health bodies should work more closely with
local housing authorities to develop a more effective approach
to addressing the health needs of homeless people at the local
level.
— As key agents in delivering the public
health agenda, Sure Start services and the new children's centres
should be more accessible for homeless families in temporary accommodation.
— Tenancy support teams and other services
working with homeless households should work closely with health
professionals to ensure that their health needs are addressed.
— Departments across Whitehall should
work together with ODPM as it develops its strategy for meeting
its 2010 target to halve the number of households in temporary
accommodation to develop a comprehensive package of support for
meeting the health and other support needs of homeless households
in temporary accommodation.
— The forthcoming five year Supporting
People strategies must be co-ordinated with local homelessness
strategies and give priority to services providing support to
households living in temporary accommodation.
February 2005
144 Housing and health: Building for the future;
BMA 2003. Back
145
Living in limbo: Mitchell, F; Neuburger, J; Radebe, D
and Rayne, A; Shelter; June 2004. Back
146
Sick and tired: Credland, S and Lewis, H; Shelter; December
2004. Back
147
Local authorities homelessness strategies: Evaluation and
good practice guide; Housing Quality Network Services; ODPM;
November 2004. Back
148
ODPM: Housing, Planning, Local Government and the Regions Committee;
Homelessness; Third report of session 2004-05; HC 61-I. Back
149
Sustainable communities: Homes for all; ODPM; January
2005. Back
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