My Lords, I thank the noble Lord, Lord Howarth of Newport, for his inspiring speech. I declare an interest as a vice-president of the Local Government Association. I also chair the University of Oxford’s Commission on Creating Healthy Cities, which brings together academics, policymakers and practitioners. We hope to support city leaders and their citizens by shedding light on the policy interventions that are most likely to be effective in enhancing the health of their cities.
The Oxford commission is not due to report until later this year, but it is already clear that the two core issues raised by the noble Lord, Lord Howarth, in this group are likely to be central to our conclusions. The first relates to the wider determinants of health creation that take us beyond the integration of health and
social care services towards recognising the relationship of public and personal health to other non-clinical services, including those affecting the built environment. The second issue relates to the value of engaging local and community organisations in a variety of ways in achieving health outcomes.
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Our Oxford commission is learning about the underlying causes of health inequalities, looking at interventions that address healthy lifestyles, such as: combatting poor diet and obesity; the value of social prescribing, which is getting a good airing tonight and will get even more as the Bill progresses; healthy transport, such as encouraging walking and cycling, with linked impacts on air quality; and healthy homes in healthy environments.
It is the last issue, housing and place, that I want to address in the context of, in particular, Amendment 90 in the name of the noble Lord, Lord Howarth of Newport. I hardly need to emphasise the significance of housing as a health issue. Obviously, homelessness causes every manner of physical and mental health problems, and your Lordships’ debate on Tuesday drew attention to the exclusion of homeless people from the healthcare system.
However, housing conditions impact on a vastly larger number of citizens. Overcrowding clearly has serious health impacts, as revealed in the Covid statistics, for example. Cold and damp conditions lead directly to hospital admissions and excess winter deaths. In his analysis of health inequalities, I note that Sir Michael Marmot has given housing a very high priority. For later living, homes that are in bad condition and/or have unmanageable steps and stairs mean not only hospital admissions for older people but serious delays in hospital discharges and swift readmissions. Incapacitating housing drives older people into costly and unpopular residential care. Better housing is key to the health and well-being of our ageing population.
As the All-Party Parliamentary Group for Housing and Care for Older People—and I declare my interest as its co-chair—has long maintained, health, care and housing represent three legs of the same stool. All three components need to be integrated through the new ICBs in a way that health and well-being boards have not be obliged to achieve. Such a duty for ICBs has special resonance in relation to older people for whom getting the right housing is fundamental to health, whether by right-sizing to accessible, manageable, companionable, new accommodation that can also end years of loneliness or by retrofitting unsatisfactory, unhealthy, existing homes.
The health and social care White Paper demonstrated dawning recognition of this housing dimension with a planned boost to grants for home adaptations. Now the Bill before us takes a step in the same direction. The clause to which Amendment 90 draws our attention states that:
“Each integrated care board must exercise its functions with a view to securing that the provision of health services is integrated with the provision of health-related services,”
wherever this would improve the quality or outcomes or reduce health inequalities. It adds that
“the provision of housing accommodation is a health-related service.”
This duty in the promotion of integration seems to me to represent a very welcome breakthrough in the recognition of the health impacts that housing can achieve and demands, at last, the greater integration of health and care and housing which a number of us have sought for so long.
Amendment 90 seeks to extend the inclusion of housing in the duty on ICBs to promote integration to embrace the wider environment. Health is certainly enhanced by access to nature, parks, green spaces and a quality urban environment, as the noble Lord, Lord Howarth, noted so, without wanting in any way to diminish the reference already in the Bill to housing, I certainly support the addition of reference to the wider environment.
The other aspect of the amendments tabled by the noble Lord, Lord Howarth, in this group calls for recognition of the role of
“the voluntary, community and social enterprise sector and creative and cultural bodies.”
These various organisations—perhaps exemplified by the enterprises established by the noble Lord, Lord Mawson, to whom fully justified tributes have been paid this week—can make a fundamental difference not only to the way local needs are recognised and services are provided but to the buy-in, the acceptability, of actions within local communities that are necessary but seldom universally popular.
In keeping with my housing theme, I wish to highlight the voluntary and community bodies that comprise the non-profit social housing sector which, while being regulated but independent of the state, contributes immeasurably to the nation’s health. Today, social housing providers are almost universally present throughout country, working in partnership with local authorities. Many are themselves community-led enterprises doing brilliant work which is improving health and well-being.
Although we need the scale of provision achieved by today’s major housing associations, which have developed over the last 50 years from tiny origins to massive social businesses, some of the most innovative and entrepreneurial social housing bodies are those that remain embedded in their local communities, such as the housing charity Giroscope in Hull, which provides housing, employment and training by renovating derelict and empty properties. It helps ex-offenders, the long-term unemployed, those with mental health problems and those recovering from alcohol and drug misuse. The Leathermarket community-led housing organisation works in partnership with Southwark Council to develop truly affordable homes designed by and for the local community, as witnessed on a recent visit from your Lordships’ Built Environment Select Committee. These community-based housing enterprises are among hundreds of varied initiatives up and down the country that deserve the recognition proposed by these amendments.
In conclusion, I welcome the inclusion of housing in the Bill, as part of the integration of services to achieve health and well-being objectives. I support the amendments in the name of the noble Lord,
Lord Howarth of Newport, in extending this to embrace the wider urban and green environment that impacts health and well-being. I also commend the noble Lord’s amendments that would give prominence in the Bill to the voluntary and community bodies of which, I maintain, those with housing objectives now represent an important part of the country’s social fabric. I support the amendments.