Unsuitable Homes

Home 5 JSNA 5 Live Well 5 Unsuitable Homes
1. Background

A suitable home contributes to positive physical and mental health and wellbeing and meets basic physiological needs. An unsuitable home does not meet the needs of its household due to size, amenities, location, or for many other reasons. 

Most housing need is met through the open market – general market housing or housing for specific population groups, such as the elderly. Public sector organisations (such as local authorities) can influence the market and improve their local housing offer by shaping planning policies and agreeing housing design standards for new build properties. 

People with a disability, a physical or mental health condition, that have a low income, that have a particularly large family, or are over the age of 65, can find it especially difficult to access suitable housing. Health outcomes are greatly improved when the right home is available, is affordable, accessible, and in the right place.  An ageing UK population means it is becoming increasingly urgent to increases the availability of extra care, of supported housing, and of support for people to adapt their existing homes. Greater availability of supported housing, and support for adaptations, allows people to better plan for their future housing needs, and to continue to live independently for longer, as circumstances change. 

For people with mobility issues, many aspects of life are improved by the provision of accessible homes and related support services. As people age, there is a greater risk of social exclusion, of loneliness and isolation, and mental health problems such as depression. Lack of suitable housing undermines an individual’s wellbeing and contributes to social isolation. For disabled people, and those with chronic illness or injury, lack of accessible housing limits choice and leads to them to reside where suitable accommodation is built, not where it is required – this often means being displaced for an existing social circle. Faced with unaffordable or unsuitable housing options, people are forced to move away from their social networks leading to, or exacerbating, social isolation and loneliness (Source: Scottish Government). 

Provision of suitable homes reduces pressure, and costs, on health and care services by: 

  • Preventing or reducing; hospital admissions, length of stay, delayed discharge, and likelihood of readmission. 
  • Increasing independence for longer; smaller care packages, reduced pressure on informal carers, and less requirement for residential or nursing care placement. 

Digital connectivity, hoarding, and other factors will have to be addressed to ensure a person’s home is and remains suitable for them. Housing is featured in the local NHS long-term plan. Working collaboratively across health, care, and housing services helps authorities meet statutory obligations and reduce costs. 

2. Policy Context
  • TheCare Act 2014 requires greater integration of health and social care services and references housing as a contributor to providing good care. 
  • TheNational Planning Policy Frameworksets out Government planning policies for England.  
  • TheNational Design Guide (2019) covers ten characteristics of well-designed places including; homes that are functional, healthy and sustainable; and Nationally Described Space Standards exist. 
  • NHS guidance Putting Health Into Placewas published following the Healthy New Towns programme that advocates providing suitable homes that are healthy and efficient. 
  • WELL Version 2is a building standard certification scheme from the International WELL Building Institute to implement, validate and measure interventions that support health and wellbeing in homes. 
  • Homes for healthprovides resources for local authorities, health and social care commissioners and decision makers to improve health and wellbeing through the places people live. 
  • The Quick Guide: Health and Housingprovides guidance on the role of housing in improving the health system and improving patient outcomes. 
  • The Housing Grants, Construction and Regeneration Act 1996 sets out the basis for the mandatory Disabled Facilities Grant (DFG). 
  • The Regulatory Reform (Housing Assistance) Order 2002 provides local housing authorities the power to award discretionary housing assistance. 
  • The national Memorandum of Understanding (MoU) sets out a shared commitment for joint action across government, health, social care and housing sectors, in England. The Health and Wellbeing Board member organisations have signed The Lincolnshire MoU 
  • Housing is a priority of Lincolnshire’s Joint Health and Wellbeing Strategy. A Housing Health and Care Delivery Group (HHCDG) will implement the Priority Delivery Plan. 
  • Lincolnshire does not have a single countywide housing strategy as individual District Councils produce housing strategies to address housing needs within their local authority area and wider housing market areas. Further information is available from individual district council websites. 
  • The HHCDG published a Lincolnshire Homes for Independence blueprint, outlining how local partnerships will assist people with care and support needs to live independently. 
  • The Ideas for Change 2017: Extra Care Housing in Lincolnshire  report captures innovative solutions for Extra Care Housing to deliver the County Council’s strategy. 
  • The Transforming Care Planlooks at how Lincolnshire provides care and support to individuals with a range of conditions such as learning disabilities.  
3. Local Picture

As the population changes, demands for different housing types changes too. An ageing population now presents the greatest challenge. People aged 65 and over, with a long-term illness, or whose activity is limited, is already high and is likely to continue to increase. This will require the provision of a range of accommodation and support solutions to mitigate predicted increased demand for health and social care. 

Many older people remain resident in their family home which often becomes larger than required and difficult to maintain. Others live with family members that might become unable to accommodate them as circumstances change. For many, options are limited to their existing home or a care home, which may not be suitable or desirable, and so the offer needs to be broadened. Professionals and public must understand new options being delivered, and these must be promoted appropriately, allowing everyone to determine suitability and encourage uptake. 

Adapting an existing home to meet personal needs can present challenges, particularly in the private rented sector, due to short term tenancy agreements, poor conditions, and overcrowding. Park Homes and caravans, predominantly found along Lincolnshire’s east coast, are particularly difficult to adapt. Roughly half of Lincolnshire’s residential properties may not be adaptable, meaning moving house is the only viable option for some. 

The number of overcrowded households in Lincolnshire is less than the national average but there is geographical variation, with Boston, Lincoln and South Holland having the highest number (Source: OHID). Living in overcrowded housing contributes to the following health inequalities: 

  • Children are up to 10 times more likely to contract meningitis, and 3 times more likely to have respiratory problems. 
  • Childrenare more likely to: encounter stress, anxiety and depression; have poorer physical health, slow growth; and display lower attainment at school due to missing school more frequently through illness and infection. 
  • All ages are at increased risk of accidents, respiratory and infectious diseases, such as tuberculosis and Covid 19. 
  • Irregular or disturbed sleep. 
  • People in overcrowded households are more likely to indicate psychological distress. 

    (Sources: The Health Foundation and Shelter) 

    4. Local Response

    Three partnerships are working on addressing existing unsuitable homes:

    • Lincolnshire Healthy and Accessible Homes Group (equipment, aids, and adaptations) 
    • Lincolnshire Housing Standards Group (overcrowding) 
    • Specialist Adults Accommodation Sourcing Subgroup (people with mental health conditions, learning disabilities, and autism) 

    The housing Infrastructure Subgroup oversees newbuild housing provision, and infrastructure needed for growth. 

    District councils (DCs) are Lincolnshire’s local housing authorities with statutory duties and discretionary roles relating to housing advice, allocation policies, planning, and new housing provision in their area. To understand the current housing situation, DCs refer to: 

    • Local Strategic Housing Market Assessments: Assesses and analyses local housing need based on projections of the households and the national population.  
    • Housing stock condition surveys or modelling: Provides a profile of the current housing stock, and can include an assessment of overcrowding, demand for adaptations, and other factors such as broadband speed. 

    These assessments identify a shortage of homes. Greater Lincolnshire’s local authorities aspire to deliver 100,000 new homes by 2031, as outlined within their Local Plans. A mix of appropriately located, sized, priced, and accessible homes will give the population suitable choices. Lincolnshire County Council (LCC) supports the planning and commissioning of new housing for specific service user groups (e.g. care leavers, working age adults with specific needs, and older adults).  

    DCs administer the Disabled Facilities Grant (DFG) that supports homeowners or private sector tenants to repair, improve or adapt their home with, for example, stair lifts, level access showers, door widening and ramps. DFGs are means-tested and require a Social Care occupational therapy assessment to confirm the adaptation is necessary and appropriate. DFGs are funded from allocations of the Better Care Fund. 

    LCC and the Centre for Ageing Better have formed a rural strategic partnership. The partnership supports the homes and housing agenda, through the HHCDG, to give people greater choice about how and where they live as they age. HHCDG is implementing some recommendations of the Ageing Better, Good Home Inquiry. The work was commissioned to develop a model for a Good Home Agency or Alliance to support people to repair, improve or move home. 

    The Wellbeing Service is available to Lincolnshire residents, aged 18 years and over. The service encourages independent living by delivering community-based support and facilitation within housing, health, and care settings. Housing Hospital Link Workers support discharge teams at Lincoln County Hospital and Pilgrim Hospital, to address housing issues at the earliest opportunity, preventing unnecessary delayed transfer of care (DToC). The service also supports access to equipment and adaptations to maximise independence. 

    Hoarding is an issue in Lincolnshire. A joint agency Hoarding Protocol has been adopted. 

    5. Community & Stakeholder Views

    District councils report that Environment Agency rules relating to flood risk are a significant factor in determining where housing can be provided and may create a discrepancy between where housing is most needed and where housing is provided. 

    The Mental Health, Learning Disability and Autism (MHLDA) Partnership Board has identified that: 

    • There is not enough choice of housing for people with learning disabilities in some parts of the county.
    • Accessing online housing lists is a problem for some people.
    • People need more help to find out about the different sorts of housing available.
    • Getting housing can be complicated – fitting everything together requires support.
    • Housing should be planned around easy access to shops and provision of day support.
    • Housing and support are separate but not considering the two together results in housing that does not work for some people with LD.
    • Planning support takes time; Support does not end for family, even when a housing package is in place.

    The Good Home Alliance project team has collated responses to public and staff surveys, workshops, and interviews to develop a housing service model. A report on this can be found alongside this factsheet. 

    6. Gaps and Unmet Needs

    There are differences in the available assistance across the county. DCs are preparing a common Discretionary Housing Assistance Policy that will cover discretionary adaptations or aids, and assistance above mandatory DFG limits, or to meet financial contributions assessed through the prescribed means test. These actions should help people with disability and health needs to remain in their existing home, or move to a more suitable home. The Lincolnshire Healthy and Accessible Homes Group plans to embed DFGs within the wider health and care system, using funding streams more efficiently and join with equipment services and digital technologies. 

    The services and sources of funding across the county can be confusing to find and to navigate for residents and professionals. The HHCDG hopes to develop a Good Home Alliance to act as a ‘one stop shop’ allowing access to services, advice, and support more easily from across all sectors. 

    There is a gap in data regarding the supported housing needs for older people, people with mental health conditions, learning disabilities, and autism. 

    7. Next Steps

    Next steps are outlined in the Joint Health and Wellbeing Strategy and in the delivery plans of Growth Vision for Greater Lincolnshire. The following aspirations are to be delivered by housing partnerships: 

    • Inclusion of housing in the prevention chapter of the local NHS Long Term Plan permits a deeper, co-ordinated, and mutual understanding between NHS and local authorities. This will ease development of coordinated strategies and pathways to identifying accommodation needs. There will be a priority focus on supporting those with mental health conditions and on improving hospital discharges. 
    • Identify further opportunities to improve hospital discharge rates, minimising delayed transfer of care caused by housing issues. 
    • Integrate housing advice to; in-house services, commissioned services, in social prescribing, and throughout the voluntary and community sector to create an holistic housing advice service. 

    The HHCDG will implement the Lincolnshire Homes for Independence blueprint by: 

    • Expanding the evidence base and developing the case for investment in people’s individual homes, thus, restricting demand for more, residential and nursing care rooms. 
    • Helping people to adapt, improve, and so remain living in their current home. 
    • Ensuring provision of alternative, suitable homes – and supporting people to move to them. 
    Lincolnshire JSNA People