Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant

Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
Housing and Health: energy
John Riley, Director rileyjm@bre.co.uk
Ian Watson, Principal Consultant watsoni@bre.co.uk

Part of the BRE Trust
Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
About BRE

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                                     In 2011/12 BRE Trust expenditure
                                     on research was £3.17 million,
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Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
Coverage of this presentation
1. English Housing Survey

2. Fuel poverty

3. Tackling fuel poverty

4. The costs and benefits of dealing with poor housing in England

5. BRE tools using this methodology - HHCC and HIA

6. Liverpool case study
Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
English Housing Survey
Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
The English Housing Survey

– Why we collect housing data
– The EHS and the English housing
– Monitoring the energy efficiency
– Monitoring fuel poverty
Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
The English housing stock

Why we collect the energy data

 Key indicators
 – Energy efficiency –
     • SAP / BREDEM/ RdSAP / EPCs
  – Fuel Poverty
  – CO2 / energy use

  Other data
– Stock condition, repair costs and EE improvement costs
– Age, type, tenure, size, storeys, material, construction
– Household characteristics – income and composition
– Amenities and services
– Health, safety and security
– Property value, equity and local environment
Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
UK Carbon Emissions
   Domestic,            Agriculture etc.
     27%                      1%
    (UK wide)
                                                             Emissions from the use of
 Lighting, appliances
     and cooking
                                                             electricity and heating fuels
                                                             by households account for
                                                             27% of the UK’s total,
                                                             making 148.5 MtCO2

                                                         • 73% of household emissions
     Space and
                                                           arise from space and water
    water heating                                          heating, and 27% from
                                                           lighting, appliances and
       Source: www.occ.gov.uk
Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
The English Housing Survey (EHS)

– Longest running national housing survey (since 1967)
– Owned by DCLG, delivered by BRE, NatCen and MMBL
– BRE provides: methodology; survey tools; training;
  complex data modelling and analysis; reporting; policy
  support to Government.
– NatCen provides 13,300 household interviews pa.
– MMBL provide 6,200 physical inspections pa.

– Key results published annually (DCLG web site)
– Dataset used within and outside government.
– BRE provides similar support to Scottish, Welsh and
  Northern Ireland surveys.

– Purpose: EHS provides the Government with information
  for the development of housing policies directed at the
  repair, improvement, and energy efficiency of the housing
  stock of all tenures.
Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
The English housing stock

– 22 million homes
– 52 million people
– 50%+ of homes over 50 years old, 22%
  over 100 years old
– 100,000 new homes provided each year,
  just 20,000 demolished.
– Homes will have to last 1,000 years at
  current rates of clearance.
– 99.9% are around from one year to the

Housing and Health: energy poverty - John Riley, Director Ian Watson, Principal Consultant
5 million pre 1919 homes in England (22% of stock)

– There are 750,000 historic (pre 1850)
  homes in England

– Another 2.2 million Victorian homes

– Another 2.0 million Edwardian homes
Typical semi’ – the house of the future?
Victorian terraced housing
English housing stock: changing standards over time
DCLG English House Condition Survey 2007




      % of housing stock







                                1971      1976       1981         1986   1991     1996        2001       2006
                                  lacking basic amenities                       unfit (1985 Act)
                                  unfit (1989 Act)                              non-decent (2001 orig def)
                                  non-decent (2006 updated def)                 HHSRS (2006)
                                  HHSRS excess cold (2006)
Collecting energy efficiency data for housing

– Data on the building structure, building characteristics, heating
  systems, insulation levels, lighting, etc…
– Calculating energy efficiency. SAP is the Government’s Standard
  Assessment Procedure for the energy rating of dwellings
– SAP operates on a scale of 1 (very inefficient) to 100 (very efficient)
– A measure of the notional cost to heat and light each square meter
  of the dwelling
– Uses standard assumptions for occupancy, climate and fuel prices.
– Developed as a compliance tool and allows comparison of housing
  across the country
– Basis for EPC’s in the UK
Improving energy efficiency: progress to-date
SAP by Dwelling Age


SAP by Dwelling Type
Progress to-date
Fuel poverty
Fuel Poverty Components

– Fuel poverty is caused by a combination of factors

  – poor energy efficiency

  – high fuel prices

  – low incomes
Fuel Poverty Targets

– The current fuel poverty target for England sets an
  ambition that as many fuel poor homes as reasonably
  practicable achieve a Band C energy efficiency standard
  by 2030. This became law in December 2014.
– The interim objectives in the new fuel poverty strategy
  – 1. as many fuel poor homes in England as is
    reasonably practicable to Band E by 2020
  – 2. as many fuel poor homes in England as is
    reasonably practicable to Band D by 2025
Fuel poverty
– A measure of ability to pay fuel bills – in particular inability

– Previous definition (10%):
  – If a household spends more than 10% of its income on all household fuel use in
    order to meet a specified heating regime then it is considered to be fuel poor.

   Fuel Poverty                Fuel Price        ×          Fuel Consumption
Fuel poverty

Current (New) definition (Hill’s Low Income High Cost):
   A household is considered to be fuel poor where:
  – It has required fuel costs that are above average; and
  – Its income is below the average poverty line (once housing and
    fuel costs have been taken into account).
    Also defines a fuel poverty ‘gap’:
  – The difference between a household’s required fuel costs and
    what these costs would need to be for it not to be in fuel poverty

Lots of complex definitional aspects, particularly around
how to make households and dwelling comparable on a
like for like basis.
Fuel poverty
 Government has a package of measures
.across the three main components of
 fuel poverty

Efficiency: building regulations, Green Deal,
PRS regulation, heat strategy

Prices: helping customers to switch to a
better deal, smart meters, Warm Home

Incomes: Universal Credit, WFP, CWP


Basic principles

                                                    Roof loss
              Other gains

                                            Total space
      Solar gain                            heating load

                               Cooker                               Windows

Fuel supply                          Appliances                     Walls

      Flue losses

                                      Waste water      Floor loss

– BREDEM is the BRE Domestic Energy Model for the calculation of
  energy consumption in buildings
– Data on the building structure, building characteristics, heating
  systems, insulation levels, lighting, cooking, occupants, etc…
– An indication of the actual fuel cost to heat, light and power the
  entire house
– Uses actual information for occupancy, climate and fuel prices
– Allows an estimate for fuel affordability to be derived
Fuel poverty fuel consumption
   Under the fuel poverty definition, the energy required to heat and
   power a home includes energy for:

1. Space heating - ES (GJ).
2. Water heating - EW (GJ).
3. Lights and appliances - EL & A (GJ).
4. Cooking - EC (GJ).
The BREDEM model is used to predict the energy use of a

Total household fuel consumption = ES + EW + EL & A + EC.
Heating regime
– There are four designated heating regimes
  – Full
  – Standard
  – Partial full
  – Partial standard

– Setting of times and temperatures for heating based on dwelling
  and occupancy characteristics.

– Heating regime is set based on:
    • Floor area of property to assess underoccupancy
      – Bedroom Standard & Parker Morris Standard
    • Household reported patterns
      – Is someone at home on weekdays

Calculating household income

Data Sources

– Information from the EHS Interview Survey
  – HRP and Partner individually
    • amount earned from self-employment, regular
      employment, government schemes, other work,
      occupational and private pensions, other sources
  – HRP plus Partner combined
    • amount received from state benefits (including state
  – Amount of savings or money invested
  – Other Benefit Units
    • which state benefits are received, total gross earnings
      for each benefit unit
  – Rent and housing benefit
  – Mortgage payments, support for mortgage interest
    and mortgage payment protection
Income definitions

– Fuel Poverty Full Income
  “Net income of the whole household, including income
    related directly to housing (i.e. Housing Benefit,
    ISMI, MPPI, Council Tax and Council Tax Benefit)”

– Low Income, High Costs (LIHC) definition
  – Net income of the whole household as in full income
    but with the subtraction of gross rent and mortgage
    payments to give “net income after housing costs”
Fuel Poverty time series
Fuel Poverty time series
Identifying fuel poor

Household characteristics       Composition
                                Age of the main reference person
                                Employment status
                                Fuel method of payment

Dwelling characteristics    –   Dwelling Age
                            –   Dwelling Type
                            –   Insulation
                            –   Floor Space
                            –   Boiler
                            –   Age of heating system
                            –   Tenure
                            –   etc.
Post improvement performance
DCLG English House Condition Survey 2007

   Distribution of homes by EER Bands, 1996, 2006 and post-improvement scenario




                   0%           20%          40%             60%            80%       100%

     B                  C              D              E                F          G
The scale of the task for England
Reaching the 80% target by 2050

Need to include:

  – Stock condition

  – Decarbonisation of the power supply

  – Low carbon heat

  – Advances in technology

  – Changes in occupant behaviour
Retrofitting Challenges

  – Drivers

  – Scale and time presents capacity issues - Can the industry

  – Technical

  – Financial

  – Occupant
Tackling fuel poverty
Tackling fuel poverty

“It is estimated that poor insulation results in £1 in every
£3 currently spent heating UK homes being wasted”

Therefore majority of fuel poverty addressed through
improving energy efficiency. Approaches are both
national and local
Decent Homes
To be classed as ‘Decent’, a home must meet all four of the
criteria below:
1. meet the statutory minimum standard for housing –
   HHSRS (Housing Health and Safety Rating System);
2. be in a reasonable state of repair;
3. have reasonably modern facilities and services; and
4. provides a reasonable degree of thermal comfort.

• 888,000 homes made
  decent 2001 to 2010
• Estimated cost £37
Previous energy efficiency schemes

CESP (Community Energy Saving Programme)
– designed to promote a 'whole house'
  approach and treat as many properties
  as possible in defined geographical
  areas selected using the Income
  Domain of the Indices of Multiple
  Deprivation (IMD)
– 293.000 measures installed to 154,000
  dwellings (75k external insulation)
CERT (Carbon Emissions Reduction Target)
– required certain gas and electricity
  suppliers to achieve targets for
  reducing carbon emissions within
  domestic properties
– 297Mt CO2 of carbon saving, 41%
  saving to priority group
Current energy efficiency schemes

Green Deal
– enable homeowners and businesses to
  implement energy efficiency improvements at
  little or no upfront cost with payment recouped
  through customers’ energy bills

ECO (Energy Company Obligation)

1. Carbon Emissions Reduction Obligation
2. Carbon Saving Community Obligation
3. Home Heating Cost Reduction Obligation
Local energy efficiency schemes

Different areas, different priorities
e.g. the owners of older properties in rural areas who are most likely to be
fuel poor; in others, it may be families with young children living in private
rented accommodation.

1. Collective switching
2. Energy Efficiency Schemes
3. Local energy generation
4. Ensuring the energy efficiency of new build
5. Public health
The costs and benefits of dealing
with poor housing in England
The Real Cost of Poor Housing 2010

– Poor housing was costing the NHS in
  England some £600m in first year
  treatment costs alone

– Well received and the subject of
  much debate

– Led to a number of follow-up
  publications applying the same
  methodology to different housing
Purpose of Research

–   To quantify poor housing and estimate how much money could be
    saved by tackling the worst housing conditions in England

–   To provide a tool for policy makers/deliverers to explore the impact
    of targeting improvements at different types of properties and
    different types of people

    Funded by BRE Trust and carried out by BRE in partnership with
    the Universities of Warwick and Brighton
Linking Housing and Health
Excess winter deaths (England and Wales)

An estimated 31,100 excess winter deaths
occurred in England and Wales in 2012/13
Accidents - breakdown of injuries by location

                   Transport, 299,174

          Workplace, 154,430

                                          Home, 2,701,326

   Leisure, 2,876,294
The English housing stock

– 22.7 million homes
– 52 million people
– 50%+ of homes over 50 years old
– 20% over 100 years old
– 100,000 new homes provided each year
– Only 20,000 demolished
– Homes will have to last 1,000 years
    • at current rates of clearance
– 99.9% remain from one year to the next

   We are stuck with the housing stock we have got so we had
                   better make the best of it!
Housing Health and Safety Rating System (HHSRS)
Category 1 hazard = ‘Poor Housing’
     Physiological Requirements           Protection Against Infection
  Damp and mould growth etc.           Domestic hygiene, pests and refuse
  Excessive cold                       Food safety
  Excessive heat                       Personal hygiene, sanitation and drainage
  Asbestos etc.                        Water supply
  CO and fuel combustion productions
                                         Protection Against Accidents
  Radiation                            Falls associated with baths etc.
  Un-combusted fuel gas                Falling on level surfaces
  Volatile organic compounds           Falling on stairs etc.
                                       Falling between levels
                                       Electrical hazards
    Psychological Requirements         Fire
  Crowding and Space                   Flames, hot surfaces etc.
  Entry by intruders                   Collision and entrapment
  Lighting                             Explosions
  Noise                                Position and operability of amenities etc.
                                       Structural collapse and falling elements
1. How likely a hazard is to effect a vulnerable person over the course
   of 12 months: 1 in:

2. What is the most probable spread of harm outcome taking into
   account the of 4 classes of harm:
                                                        Extreme -    10,000

                                                        Severe -      1000

                                                        Serious -     300

                                                        Moderate -    10

Applying the formula gives a numerical hazard rating
Falls between levels

Same likelihood of suffering ill health,
but harm outcomes very different
HHSRS Category 1 hazards (EHS 2011)
3.4 million (15%) of English homes have a Category 1 HHSRS hazard
                falls on stairs                                                                                           1,352,837
                  cold homes                                                                                             1,325,088
            falls on the level                                               543,848
        falls between levels                                239,930
                            fire                  128,590
                           lead                  112,051
                         radon                   107,603
                 hot surfaces                   107,168
falls associated with baths                   78,132
 collision and entrapment                     74,054
           damp and mould                   53,349
          entry by intruders               47,284
                    sanitation            35,222
                  food safety             32,283
           domestic hygiene               28,355
               overcrowding              23,871
          structural collapse           15,394
           carbon monoxide              15,336
         electrical problems            9,204
                  ergonomics           8,201
     uncombusted fuel gas              7,545
                          noise        6,161
                       lighting        5,453
                water supply           4,894
                  excess heat          1,369
                                   0            200,000           400,000   600,000    800,000   1,000,000   1,200,000   1,400,000
Estimates of costs of remedial work (2011 EHCS)
       Hazard                      Number of Category Average repair        Total cost to repair
                                      1 Hazards       cost per dwelling
                  Excess cold                 1,325,088        £    4,574         £ 6,061,192,123
                Falls on stairs               1,352,837        £      857         £ 1,159,516,031
             Falls on the level                 543,848        £      780         £   424,061,206
         Falls between levels                   239,930        £      927         £   222,382,484
                            Fire                128,590        £    3,632         £   466,975,191
    Collision and entrapment                     74,054        £      692         £    51,274,568
                  Falls - baths                  78,132        £      521         £    40,679,153
                    Dampness                     53,349        £    7,382         £   393,817,237
                 Hot surfaces                   107,168        £    2,436         £   261,065,812
                           Lead                 112,051        £    1,661         £   186,099,748
            Entry by intruders                   47,284        £    1,063         £    50,244,016
                         Radon                  107,603        £    1,126         £   121,124,474
Sanitation (Personal hygiene)                   35,222         £    1,154         £    40,639,168
                 Food safety                     32,283        £    2,461         £     79,460,523
   Pests (Domestic hygiene)                      28,355        £    1,921         £     54,481,109
              Overcrowding                       23,871        £   16,100         £    384,325,757
                        Noise                     6,161        £    1,411         £      8,691,034
           Carbon monoxide                       15,336        £      506         £      7,753,023
          Structural collapse                    15,394        £      812         £     12,507,557
         Electrical problems                      9,204        £    2,360         £     21,722,172
                 Ergonomics                       8,201        £      483         £      3,963,825
     Un-combusted fuel gas                        7,545        £      489         £      3,688,692
                     Lighting                     5,453        £    1,947         £     10,619,508
         Any                                  3,472,765        £    2,875         £ 10,072,810,155
The cost of making poor housing acceptable

– Low cost work includes:
  – Re-locate cooker (£157)
  – Install 2 wired smoke detectors (£194)
 –– Install handrail to staircase (£295)
  Medium cost work includes:          90%
  – Replace lead piping (£1,890)      80%
  – Rewire house (£3,657)             70%

  – Redesign staircase (£4,325)       60%          £1,195
  High cost work includes:            30%
  – Re-fit kitchen (£7,000)
  – Damp remedial works (£10,940)     10%
  – Solid wall insulation (£20,000)    0%
                                             £-              £10,000       £20,000   £30,000   £40,000   £50,000       £60,000

  Total cost of making all HHSRS Cat 1 hazards acceptable = £10bn
  Average cost = £2,875
Typical HHSRS outcomes and 1st year treatment

                                                                 HHSRS Outcome
Hazard                     Class 1                     Class 2                 Class 3                 Class 4

Damp and mould             Not applicable              Type 1 allergy          Severe asthma           Mild asthma
growth                     -                           (£2,034)                (£1,027)                (£242)
Excess cold                Heart attack, care, death   Heart attack            Respiratory condition   Mild pneumonia
                           (£19,851)                   (£22,295)*              (£519)                  (£84)

Radon (radiation)          Lung cancer, then death     Lung cancer, survival   Not applicable          Not applicable
                           (£13,247)                   (£13,247)*              -                       -
Falls on the level         Quadraplegic                Femur fracture          Wrist fracture          Treated cut or bruise
                           (£92,490)*                  (£39,906)*              (£1,545)                (£115)
Falls on stairs and        Quadraplegic                Femur fracture          Wrist fracture          Treated cut or bruise
steps                      (£92,490)*                  (£39,906)*              (£1,545)                (£115)
Falls between levels       Quadraplegic                Head injury             Serious hand wound      Treated cut or bruise
                           (£92,490)*                  (£6,464)*               (£2,476)                (£115)
Fire                       Burn ,smoke, care, death    Burn, smoke, Care       Serious burn to hand    Burn to hand
                           (£14,662)*                  (£7,435)*               (£1,879)                (£123)
Hot surfaces and           Not applicable              Serious burns           Minor burn              Treated very minor
materials                  -                           (£7,378)                (£1,822)                burn
Collision and              Not applicable              Punctured lung          Loss of finger          Treated cut or bruise
entrapment                 -                           £5,152                  £1,698                  £115
Representative cost        £90,000                     £30,000                 £1,800                  £120

Not applicable = HHSRS class very rare or non existent
* = Costs after 1 year are likely to occur, these are not modelled
NHS first year treatment costs 2011

                                         £207 M

                                                                the level
                                                                 £128 M
               £848 M
                                                               £84 M

            surfaces                                  £25 M
             £15 M
                       Damp    Falls -    Collision
                       £16 M   baths       £16 M
                               £16 M
Comparative cost burden to the NHS

         Risk Factor          Total cost burden to the NHS

       Physical inactivity       £0.9 billion – £1.0 billion

     Overweight and obesity      £5.1 billion – £5.2 billion

           Smoking               £2.3 billion – £3.3 billion

         Alcohol intake          £3.2 billion – £3.2 billion

         Poor housing            £1.0 billion – £1.4 billion
Including all sub-standard housing

– 2010 report: Total cost of poor housing = £600m
– 2014 report: Total cost of poor housing (HHSRS Cat 1) = £1.4bn
– 2014: Add HHSRS Cat 2 housing = + £428m
– 2014: Add all sub-standard housing = + £160m

– The full cost (in terms of NHS first year treatment costs) of
  sub-standard housing = £2.0bn
Costs to society of living with HHSRS hazards

Residents costs                           External costs
Annual loss of asset value if owned (H)   Annual loss of asset value if rented (H)

Poor physical health (H)                  Higher health service treatment cost (H)

Poor mental health (M)                    Higher health service treatment cost (H)

Social isolation (NQ)                     Higher care service treatment cost (M)

Higher home fuel bills (H)                Higher building heating costs (H)

Higher insurance premiums (H)             Higher external insurance premiums (NQ)

Uninsured content losses (M)              Uninsured external losses (M)

Under achievement at school (NQ)          Extra school costs/homework classes (H)

Loss of future earnings (M)               Loss of talents to society (NQ)

Personal insecurity (NQ)                  High policing cost (H)

More accidents (M)                        High emergency service costs (H)

Poor hygienic conditions (NQ)             High environmental health costs (H)

Costs of moving (M)                       Disruption to service providers (M)

Adopting self-harming habits (M)          Special health care responses (H)

                                          Government and EU programmes (H)
Cost benefit tool
  – We cannot find £10bn and go out and fix every HHSRS
    Category 1 hazard in the home and save the NHS £1.4bn pa
  – So the cost-benefit tool uses the costs provided through the
    research to apply different scenarios for action.

                    Hazard                     Fall on Stairs                                                                             Number of category 1 hazards in England              1,755,000
                    Scenario                    All up front                         Cost        equal   each year by      1%                              Average Cost to repair £                1,084
                                                                    Potential/Lost Benefit       equal   each year by      1%                       Total cost to repair in England £      1,902,420,000
 Total number of properties to repair
                                                                                                                                          Probability of Category 1 hazardous event                  32
                    Time period for repair                  10 years                                                            Probability of Population Average hazardous event                   245
                      Proportion to repair          All                       1
                                                                                                                                              Average Benefit to NHS by repairing £                 211
                        Time period                1 years
           Annual budget for repair £ 1,902,420,000                                                                                                                 Payback period                    5.1 years
Annual number of properties to repair     1,755,000                                                                                                     Cumulative payback period                       6 years
             Average cost to repair £         1,084                                                                                                     Total All Cost over 25 years £     1,902,420,000
                                                                                                                                                         Total Benefit over 25 years £     9,276,244,453
                                                                                                                   At    7% discount rate:       Period for NPV to become positive                      7 years


                                             Cumulative Benefit
                                             Cumulative cost of repair
                  £8,000,000                 Cumulative cost of Cat 1
                                             Cumulative all costs







                                 1      2      3      4         5      6      7     8        9     10    11   12    13     14      15    16    17     18    19    20    21     22     23    24    25
Payback example: Falls on stairs

– HHSRS Band C (Cat 1 hazard)

– Work = replace balustrades

– Cost of work = £314

– Annual benefit to NHS = £146

– Payback = 2.1 years
Case study: cost-benefit of energy improvements
Before: solid, un-insulated stone walls, After: condensing gas boiler and radiators
partial double glazing, small amount    for space and water heating,
of roof insulation, off-peak storage    top-up loft insulation,
radiators, electric immersion heater.   full double glazing.
– Cost of upgrade = £0                  – Cost of upgrade = £3,528
– SAP = 22                              – SAP = 59
– Annual fuel cost = £965               – Annual fuel cost = £461
– CO2 emissions = 8,972 kg pa           – CO2 emissions = 4,666 kg pa
– HHSRS Band = A (Cat 1 hazard)         – HHSRS Band F (Low hazard)
– Household in fuel poverty             – Household not in fuel poverty

                                        – Cost savings to NHS pa = £528
                                        – Payback to NHS = 5.1 years
                                        WHEN YOU MAKE A HOME MORE
                                        SUSTAINABLE YOU ALSO MAKE
                                        IT MORE HEALTHY!
BRE Tools – HHCC and HIA
Prospective quantitative HIAs for Local Housing
1. Quantifying the number and distribution of poor dwellings in LA
2. Assessing the potential short term effect on health and wellbeing
3. Quantifying the health costs to the NHS and wider society of
   people living in these poor homes
4. Estimate the health cost benefit of interventions to reduce health
   and safety hazards in poor homes
5. Linking and informing the JSNA and Health and Wellbeing
6. Consideration of other data to help develop initiatives designed to
   reduce the inequalities gap
Potential health benefits from improving poor housing

  Housing Hazard type            Number of      Mitigating the          Estimated number of       Cost of repairs
                                  hazards           hazard              medical interventions
       Excess cold                            Improving heating         42, including 13 deaths      £45.4m
                                                  and thermal
                                   8,506     efficiency measures

Damp and mould growth                          Improved heating,                 695                  £11.8m
    Entry by intruders             1,442        Window and door                  436                  £1.5m
                                                   locks, security
                                             lighting and key safes
Falls in baths, on stairs,        14,121              Stair rails,               544                 £13.5m
     trips and slips                            balustrades, grab
                                               rails, repair to paths
   Accidents affecting             4,237       Identifying hazards,              575                  £9.5m
        children                              provide more space,
                                                    education of
(Personal Hygiene, Sanitation                       professionals
and Drainage, Falling between
    levels, Flames and hot
 surfaces, Electrical hazards,
  Collision and entrapment)

           Total                  29,702                                        2,292                £81.7m
Cost benefit analysis

    Hazard              Work           Hazard Mitigated

                                                          Total cost of
                   Cost of work (£)
                                                            work (£)

    Expected annual              Expected annual          Annual saving
     cost to NHS (£)              cost to NHS (£)          to NHS (£)

                                                           period (yrs)
Damp and mould growth

                   Excess cold

          Crowding and space

             Entry by intruders

Falls associated with baths etc

                                                                                       NHS - least expensive 50%
  Falling on level surfaces etc
                                                                                       NHS - least expensive 20%
                                                                                       Society - least expensive 50%
           Falling on stairs etc
                                                                                       Society - least expensive 20%

        Falling between levels


      Flames, hot surfaces etc

     Collision and entrapment

                                   0   2   4    6       8        10     12   14   16
                                               Payback period (years)
Housing Health Cost Calculator (HHCC)
What is the Housing Health Cost Calculator HHCC

– Developed by BRE and administered by RHE
– HHSRS assessments can be added
– HHCC will calculate the score
– Registration and storing data is free!
– HHCC will calculate cost to NHS and to society
– Add a post work assessment to measure savings
– Costs of doing work can also be added, enabling the
  calculator to work out a payback period
– Annual subscriptions allow annual health savings to be
  calculated showing the value of housing intervention
How to add a case

– Cases can be added one
  by one
– You can identify dwellings
  by address, UPRN or both
– HHSRS system uses
  representative scale points
– NHS costs and costs to
  society appear at the
  bottom of the screen
Reviewing your data

– Can order data by rank, hazard, or savings
Case study - Liverpool
Liverpool Healthy Homes Programme
           Ian Watson, Programme Co-ordinator
Liverpool overall context
       Population: 466,000                                       Fuel poverty rates across Liverpool

       148,000 private sector properties:
    -       19,400 present H&S risk (13%) (Excess
            Cold, Falls, Electrical Safety and Fire)
    -       19,000 fail the energy efficiency
            requirements of the DHS (13%)

   Private-rented sector accounts for
    highest rates of hazardous housing
    (18.7%) & highest concentration of
    poorest thermal efficiency
       Among highest mortality rates and
        lowest levels of life expectancy                       Key
                                                               (% all households fuel poor)
       Large health inequalities                                    Above 27%
                                                                     Below 18%

                                                       © Crown copyright and database rights 2012 Ordnance Survey 100018351
Liverpool Life Expectancy
                                                                                                                 Northern Line
                                                                                                                 Bus Route 12
                     County         Croxteth                 Fazakerley                                          City Line
                     76.6           75.3                     77.7

     Kirkdale                         Anfield            Tuebrook             West Derby
     73.8                             74. 7              77. 3                79.6
                                                Kensington                       Old Swan                     Knotty Ash
                                                75.2                             75. 5                        78.4

 Riverside                                              80.7

                St Michaels                                               Childwall              Belle Vale
                                     Mossley Hill
                76.9                                                      82. 7                  77.2
                                     81. 4

                                                                  Church                    Cressington                      Speke
                                                                  82. 6                     79.0                             Garston 74.0
Housing & Health

    Rate of excess winter deaths – 280 per year (NHS health profile 2013)

    For each winter death, there are 8 emergency admissions

   Accidents in the home cause an estimated 70 deaths and 4,000
hospital admissions per year in Liverpool

Poor housing conditions are implicated in 500      deaths and around
5,000 illnesses requiring medical attention each year in Liverpool
(from national BRE estimates)

     Commissioning Drivers

         Tackling health inequalities
         JSNA
         Housing, Health and Safety Rating System
Healthy Homes Programme - objectives
Phase 1
   At scale to make a real population difference
   Identify 25,000 properties in priority neighbourhoods
   Assess the health and housing needs of each occupant
   Engage residents into health and well-being related services
   Carry out full health and safety inspection in worst 4,400
    properties and secure necessary improvements
   Home Safety promotion (particularly under 11’s and over 65’s)

Through the removal of hazard exposure, the programme is
designed to reduce   premature deaths by up to 100
when fully implemented, and reduce GP consultations
and hospital admissions by over 1000 cases
Progress - April 2009 to January 2015

      40,384 initial assessments
      20,934 surveys completed
      28,689 referrals to partners
Referrals to Partner agencies
>2001                                                                                       Dentists

2000                                                             Fuel Debt                     2,869
500-                      Wellbeing
 999                                    1,134                            1,571
                                                                                                                               Food and
Progress – Housing conditions

   5,736 Health & Safety inspections carried out
   4,166 serious housing hazards identified
   £5.2M Private sector investment
   30 construction jobs supported (estimate)
   1,846 referrals to social housing providers for repair issues
Common home hazards to February 2015
Health Promotion
Working with landlords
   Provide information about key contacts
   Ensure annual checks of gas appliances
    carried out. Assisting landlords gain
    access using enforcement powers
   Healthy Homes Property Standard
   Contribute to ‘rogue landlords hit squad’

Housing and health campaigns
   CO Awareness
   Child Accident Safety
   Falls prevention
   Winter Survival
Reaching Out
Healthy Homes on Prescription

   55 practices taken up GP clinical system to identify ‘vulnerable’ patients
   GP ‘alerted’ and prompted to ask vulnerable patient about housing conditions
    during consultation
   Simple referral made from clinical system to Healthy Homes
   Healthy Homes visit and provide feedback

Health Centres
Regularly visit 32
centres to provide
Healthy Homes
Emergency accommodation pilot
    To reduce hospital admissions and delayed discharges
     associated with sub standard housing

                £1750 per            £192 per
                week                 week
Partnership with Dying to Keep Warm charity to
   Provide emergency heating for vulnerable residents
   Install gas isolation valves
   Provide microwaves where dangerous cooking appliances
   Provide and fit CO detectors through Handy Person Scheme
Value for Money?

BRE evaluation of first year’s operation shows:

     861 HHSRS inspections removing 725 Cat1 hazards

    Total project cost £1.07M                (Inspection cost £300K)

     On-going annual NHS savings £440K                                 (£4.4M over 10 years)
        Excess cold hazard alone £341,000                                  (£3.41M over 10 years)

     Wider Society annual savings £1.1M                               (£11M over 10 years)
        Excess cold hazard alone £852,000                                  (£8.52M over 10 years)

Total anticipated savings by HHP:

                                £55 Million
                                             (£42M from excess cold)

(Building Research Establishment Jan 2011)
Cold homes – changing legislation

   Liverpool took action against a landlord who had installed a heating
    system which was too expensive to operate, contending that it was
    unaffordable & unacceptable on grounds of health and safety
   Initial court ruled that affordability of system not relevant to health and
   This was appealed by the Council, and the matter was raised in the
    Houses of Parliament

   A higher court agreed
    that the running costs
    of a heating system
    are a relevant factor
Tackling Fuel Poverty

                               efficiency                              Targeted
                             HHSRS improvements
                             Warm Front                                approach by
                             Efficiency measures
                             Promotion / campaigns                     focusing on
                         •   RSL HHSRS training
                                                                       deprived areas,
                                                                       and inbound
                                                         Fuel cost
  Household                      Fuel
   income                       Poverty
                                              • Winter Fuel Payments
                                              • Fuel Poverty
  • Benefit entitlement checks                • HHSRS – ensuring
  • Next Step job and career opps              affordable systems
  • HHSRS – healthier home,                   • Home Heat Helpline
    healthier workforce?                      • CAB Fuel Poverty
Evaluation (Ongoing, but..)
   Reduction in health deprivation since 2007

   47% reduction in excess winter deaths (36% North West)                  Year    Excess WD
                                                                            11/12   170
   Dental rates increased ‘…the highest NHS dental access rate
     Liverpool PCT has had for over two years…. innovative ways of          10/11   220
     improving dentistry access through the ‘Healthy Homes Dental Scheme’   09/10   300
     NHS Operational Plan 2011/12                                           08/09   320
Remember, it costs to do
    Thank you for listening
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