This country hasn’t just got a housing crisis. It has a health crisis too. And, writes Tony Watts OBE, by addressing one crisis, we could make a massive impact on the other.
This is a blog version of a presentation I made in October to the Housing 21 conference in Birmingham on older people’s housing. While the other speakers gave excellent analyses of some of the technical, financial, planning and political barriers facing the sector, I elected to go down the personal route, to demonstrate the human significance of the current delays in the system
So I stated talking about my mother. We lost mum just over 20 years ago, but her story sums up many of the points I want to make today.
In about 2000, she got on a coach, taking my sister who has learning disabilities, and gone all the way to the south of Spain on a whim – despite the fact that she didn’t like foreign food. Or foreigners.
Despite a litany of serious medical conditions, including being virtually blind and having an aneurism likely to go pop at any time.
And, even though they wouldn’t take her English pounds when she travelled through France… after she’d played her part in liberating Europe … she had the time of her life.
Yet just a year before, she’d been in a nursing home, struggling to get up in the mornings, resenting being amongst “all these old people”. Actively talking about topping herself.
What turned her life around? Being transferred into a rented housing scheme with extra care, then run by Hanover, now Anchor.
We watched her come back to life in a supportive environment where her needs were met, there was lots going on and active-minded neighbours to chat to and, occasionally, argue with. My mum did like to argue. And a supermarket nearby to buy cream cakes. She loved cream cakes.
Those few years in that supported, caring, lively environment were years we never expected to have with her. And for which I will always be grateful.
And I’m sure that there are many, many older people like her who have added years to their life, and life to their years, by moving into the right environment.
What’s more, many, many more would benefit given a choice of more of the right sort of housing, in the right places… housing that would bridge the gap between their own homes and residential care.
A gap which, in truth, is more like a chasm.
And if there’s one message that the housing sector really needs to get across to government, it’s that building more later life housing isn’t just about putting roofs over people’s heads. Or releasing homes for families to move into.
This is about all of us, as a society, living longer, healthier lives. And market forces, on their own, may not be enough to make this happen.
Why should it matter to government? Because this country hasn’t just got a housing crisis. It has a health crisis too. And by addressing one crisis, we could make a massive impact on the other.
But let’s wind back a bit to one of the things we have done right. One of the great social “achievements” of the 20th century was longevity. In 1901, life expectancy at birth was around 45 for men and 49 for women. In 2001 it was around 78 for both.
A lot of that rise was driven by better health care. Not to mention safer working conditions and a cleaner environment.
But huge improvements in housing made a massive difference too. Because poor housing drives poor health – in turn, a drain on our productivity. While good housing is at the heart of good health and a strong economy.
That’s why previous governments cleared slums, and pumped so much public money into building decent, affordable housing. Even, as in the post-war years, when the country was technically broke.
Somehow, that message that good housing equals good health has been lost as a driving force within government.
We’ve stopped building enough new homes to replace the ones that should have been knocked down years ago.
There are currently 3.5 million households in England that fail to meet the Decent Homes Standard. Over a million of these are occupied by people aged 55 and over. Most are privately owned.
2.3 million households have at least one Category 1 hazard. 935,000 are damp.
The connection between unhealthy homes and poor health is proven, and play their part in the most recent statistics.
The latest Marmot Review, for instance shows that:
- Life expectancy has stalled since 2010
- The amount of time people spend in poor health has increased across England since 2010.
- The gradient in healthy life expectancy is steeper than that of life expectancy.
- Socio-economic disparities have widened, so people in more deprived areas spend more of their shorter lives in ill-health than those in less deprived areas
The Marmot report goes on to say that:
- Cuts in public spending have played a key role in these deteriorating statistics
- Inequalities in poor health harm individuals, families, communities and are expensive to the public purse.
It also maintains that changes in government priorities could turn these trends around.
I want to focus for a moment on healthy life expectancy… the number of years an individual can expect to spend in very good or good general health. In England, the figure for a male fell by a year between 2015-17 and 2020-22. For a female it dropped slightly further again.
So, while the gains in increasing our lifespans has stalled, healthy life expectancy… our “healthspans”… are actually going backwards.
A new study from the University of Oxford and University College London, reported upon at the start of this week, showed that Type 2 diabetes, cancer, heart disease and other diseases were all affecting people at younger ages.
It describes a “generational health drift”, with younger generations tending to have worse health than previous generations at the same age.
Their summation: “Increasing demands for health and social care will have huge implications on government spending.”
Sir Michael’s brilliant report, which should be compulsory reading for everyone in local and national government, advocates six policy objectives to address this. But I’m going to focus on the one most salient to this gathering:
For the country to “Create and develop healthy and sustainable places and communities.”
So, exactly what does a “healthy and sustainable place and/or community” look like in relation to older people?
A key reason many older people elect to move into purpose-designed later life housing is to remain living independently for longer, rather than waiting for the choice to be taken out of their hands and making the “ultimate” move into a care setting.
And, to different levels, depending upon the housing provider, this need for a “healthy and sustainable place and/or community” is being met.
Some schemes have on-site health facilities and classes that residents can tap into. Others provide “extra-care”. But many developments really are not much more than a bog-standard product that happens to house people on the basis of their age…
But there are ways in which developers and operators – especially those that currently offer little in the way of “wellbeing” – can increase market penetration sales… improve the lives and wellbeing of the growing number of people in later life… and play an important role in easing the burden on our struggling health and care services.
It’s in their interest to do so, too. It’s worth remembering that planning applications regularly hit the rocks because the sector has yet to win the argument at many planning appeals that retirement developments won’t cause an overload on local GPs or hospitals, but actually assist our overburdened health and care services.
How can they move the dial? By adopting the best current practices of some of our more enlightened developers… and also looking to the future.
Adopting approaches that encourage greater activity and social connectivity and reduce individuals’ need for formal support.
So here are six ideas for starters to maximise residents’ wellbeing.
1 Firstly, don’t wait for the Older People’s Housing Taskforce report.
Implement – as far as you can – the recommendations of the Housing and Ageing Alliance.
2 Consider the benefits of intergenerational housing
I was in Alicante recently looking at a project has brought together older people needing affordable housing with younger graduates – requiring exactly the same.
This is an incredibly vibrant, mutually supportive community. Younger people, for a reduced rent, help keep older residents living independently. During lockdown, not one older person caught Covid. Could it happen here? A small group of people I’m working with in Bristol are looking to replicate their success.
Pepper-potting housing for older people in new mainstream developments can have the same positive impact.
3 Design spaces for social connection
I’m not just taking about a common room with a TV parked in one corner, or even a nice garden. The Alicante project, for example, has wide corridors, open spaces between floors, activity rooms on every level, a roof garden, where people serendipitously meet, chat, connect, eat together… watching out for each other and combating isolation.
Many new developments – to me at least – seem big and blocky with few natural spaces to gather… which is not conducive to socialising.
4 Make developments community hubs
Social prescribing has been hailed as THE great opportunity to improve older people’s health… but is not making the inroads as quickly as it could for one simple reason.
Why? Because social prescribing relies heavily on community groups.
And all over the country, community charities that help older people connect, reduce isolation and prevent loneliness are shutting up shop because funding has been cut back by cash-strapped local councils.
We all know the health hazards of loneliness. These charities just need somewhere warm and free to hold groups where older people can chat, eat a subsidised healthy meal and stay connected. Perhaps learn new skills to keep them mentally or physically engaged.
Retirement developments that take on a responsibility to host these activities wouldn’t just be winning a lot of plaudits in their community. They would also be advertising themselves to future residents.
5 Harness technology
There are plenty of whizzy ways available in which older people’s health and wellbeing can now be monitored – but in reality, we really haven’t scratched the surface in terms of implementing them.
I’ve recently been looking at the latest University research on how we monitor temperature, humidity, movement, even light levels to ensure resident wellbeing.
Another project has an inconspicuous ear bud to monitor vital signs such as residents’ temperature, heart activity, blood oxygen levels and so on. We need to future proof older people’s homes so that the technology can be integrated – and updated – as it evolves.
I’d like to see developers collaborating with researchers working at the sharp end of these technologies: the researchers need funding and a chance to get these new ideas out there in the real world, and retirement housing developers need to show that life in one of their schemes can really promote wellbeing.
AI is already here: I’m part of a small collaborative group behind an AI driven project to not only reduce loneliness among older people…but to enable them to keep older people connected and safe in their own homes for longer. If that idea resonates with you, we are looking for collaborators in the care and housing sectors.
6 Design for a warmer future
Back to the intergenerational development I visited in Alicante. A key architectural feature there was that the apartments were designed not just to be warm in winter… but cool in summer too.
We build homes to keep heat in, not out. Climate change is real. Increasingly we will see sustained periods of hot weather in this country which will disproportionately impact the health of older people.
The 2022 heatwaves were associated with a total of 2,985 excess deaths in England.
If you haven’t already undertaken an audit of how your developments will cope with more extreme weather, then perhaps now might be a good time.
The grand finale…
So how can the people in this room play their part in improving people’s “lifespans”?
And what role does the government need to play in making it happen?
To me, the sector needs to learn from the best examples of developments that “maximise wellbeing potential”.
And government, at both national and local levels, needs to recognise the wider economic benefits of supporting you to build a greater choice of later life housing that maximises wellbeing.
- in making land available at sensible prices
- supporting developments through agencies like Homes England
- and giving greater planning priority to later life developments that will genuinely deliver better health outcomes.
And while my mum won’t be around to thank you for that, my generation, and future generations of older people, will be.
