Mainstreaming integration: findings from the Health & Housing Impact Network

A group of field trip participants stand outside in a public square. They are chatting and looking at their surroundings

For health and housing to be integrated and meet shared objectives, the conversation needs to happen in the context of  Integrated Care System (ICS) structures and, specifically at ICB (Integrated Care Board) level. Our communities benefit when it does! Here’s what we learned from year one of the Health and Housing Impact Network where our focus has been housing and integrated care.

Housing and Integrated Care Systems

Integrated care systems (ICS) are the current NHS structure for place-based decision making for public health and service planning. Content from our Health and Housing Impact Network has already highlighted the widespread appreciation of the link between housing supply, condition and stability on health outcomes. In planning our programme, we spoke to representatives from ICBs and carried out a desk-based review of their strategies. It’s clear that housing is deemed a priority. But our interviewees  said they’re still working out how to deliver on this, beyond the issue of hospital discharge (important thought that is) or to use housing as a lever to achieve health outcomes.

From a year of highlighting best practice, a site visit and workshops to uncover opportunities, we’ve found there are opportunities and appetite to make health and housing initiatives more than the sum of their parts.

“The role of the ICS is still developing in terms of housing…we’ve got a conversation happening, but how do we make it more proactive? So instead of just thinking about housing when people are being discharged, we think about it as a means to stop people going into hospital in the first place.”

Nicola Kay, Director of Partnerships, Population Health Management and Reducing Inequalities, NHS North West London

Drawn from our events and research, here are our cross-cutting findings about how to make successful housing and health collaborations the norm.

Cross-cutting findings at a glance

  • Personal relationships matter – Structures change but people are constant. Keep these connections going!
  • Understand who your allies are – Find people with complementary skills, capabilities and networks to make things happen, holistically.
  • Messaging matters – To influence decision makers, present solutions not problems.
  • Timing collaboration – Integration is the buzzword, but the magic happens through collaboration in the right place at the right time.

Making integration mainstream: Findings in detail

Personal relationships matter

With the right connections in place, it’s easier to take action on areas of common interest – such as a specific health issue, place or part of the population.

  • We heard how a member of Southwark’s Environmental Health team joined the South East London Children and Young People’s Asthma Forum to find ways to collaborate with NHS colleagues on an issue of high local importance. This has led to a productive working relationship with Evelina children’s hospital, tackling housing problems for children and young people with asthma. Case study here.
  • In the West Midlands, Walsall Housing Group have fostered relationships with clinical leaders over the years. As a result, services to address housing and social issues are an integrated part of healthcare pathways. Video here

Understand who your allies are 

No one discipline can address London’s complex public health and housing challenges. It’s crucial to draw on the respective strengths of different sectors. For example, public health teams are expert at analysing and communicating health inequalities and can act as an essential link between the NHS and ICB. Council Cabinet leads can champion cross-cutting solutions. Clinicians can spot the patterns in patients’ health affected by their housing.

  • Redbridge Director of Public Health and Association of Directors of Public Health-London Housing lead Gladys Xavier facilitated joint work resulting in the London Damp and Mould Checklist. This is a practical, evidence-based approach to identifying and acting on damp and mould-related health issues. This can be used by health and social care professionals, GPs, nurses, police, social prescribers, and anyone offering frontline help and support in communities across London.
  • In Tottenham, Cllr Das Neves, Haringey’s Cabinet Member for Health, Social Care & Wellbeing and Chair of the Health and Wellbeing Board (HWB) has provided strategic leadership for joint initiatives. She highlighted the opportunity represented by the HWB, which is cross-sector, to showcase and build on joint approaches to areas of shared concern.
  • In Southwark and in Greater Manchester, we heard from frontline clinicians who identified trends in their patients’ health directly linked to their housing. In both places, they were able to make a compelling case for action based on evidence. This led to impact such as providing cots for children in temporary accommodation and rehousing of families of asthmatic children.

“With an integrated approach between teams, something special happens” Cllr Das Neves, Cabinet Member for Health, Social Care & Wellbeing

Messaging matters 

Negative stories can catalyse action, but they need to be complemented with what can be done. Focus on what is in people’s power to change and find the right hooks for your target audience.

  • Camden Council and their research partners engaged residents in a behaviour change initiative to improve indoor air quality using monitors. Success came from balancing messages to residents which raised awareness and suggested action they could take, without apportioning blame or causing alarm. Case study here.
  • In a number of examples, local authority colleagues successfully engaged NHS partners by demonstrating the contribution of their work on damp and mould to delivering the National Bundle of Care for Children and Young People with Asthma.

Smart collaboration 

To have an impact , it’s about drawing on the fundamental principles of collaboration and making sure this happens in the right place at the right time to effect change, regardless of formal structures. Involve the right teams early and build the strategic connections to ease the path for projects to get off the ground.

  • The Regeneration lead for Tottenham High Road West involved the public health team in setting the development brief itself so that health became an explicit outcome rather than one of many indicators.
  • In Wakefield, individuals from Wakefield and District Housing Association also sit on the Integrated Care Board and the Health and Wellbeing Board. This strategic commitment to the link between health and housing has built senior and frontline teams’ capacity to act on housing issues that affect health. It’s also paved the way for initiatives like NHS-employed mental health navigators in housing settings which directly improve residents’ health and support tenancy sustainment. Video here.

A screen grab of a zoom breakout group. There are nine participants in different locations.

Activating our findings

The Network has demonstrated there is fantastic work going on between health and housing colleagues throughout London (and beyond). There is clearly appetite for this to be more mainstream, and for ICBs to play a key role promoting best practice across the integrated care system, and making it happen. We’ve taken our findings to the ICB Health Equity Leads group: with their support, we will be looking to facilitate further dissemination, learning and policy influencing via local and pan-London vehicles such as the London Health Board.  

We’re also speaking to two London boroughs about the potential to help them further with integrating their health and housing initiatives.

If you want to influence and get these sort of initiatives happening at a strategic level in your area:

  • Browse our resources and write-ups to provide you with evidence to help make the case.
  • Get in touch with us to see how we can support you to develop and mainstream health and housing integration.
  • Look out for other resources we’ll be publishing soon.

Supported by Impact on Urban Health

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About the year one programme

A mixed group of around 25 field trip participants are standing in a community garden and posing for the camera. It's raining so some are wearing anoraks or using umbrellas

Housing Pathways to Better Health: Learning from elsewhere
7 February 2024
What are the success factors for embedding services in health and care pathways? Find out in the write-up here.

Tottenham Field trip
19 September 2023
Read the write-up of our visit to High Road West in Tottenham where a whole-place approach to health and housing is being taken.

A population health approach to integrating health and housing
20 July 2023
We focused on two case studies which are taking an integrated approach to improving health and housing outcomes for children and young people by focusing in air quality in the home. Read the write up here.

Housing and integrated care: how can we have most impact?
4 May 2023
We believe there will be huge mutual benefits if built environment professionals work effectively with the new integrated care systems (ICSs) in London. At our launch event, health, care and housing colleagues discussed the opportunities and challenges for integrated care.

We collated relevant resources here.

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