Below is the text of the speech made by John Healey to the National Housing Federation on 8th July 2011.
Thank you … I am glad to join you again at a NHF conference.
A couple of years ago I spoke at the Federation’s national conference in Birmingham.
That was almost 9 weeks to the day into my job as Housing Minister; this is now 9 months since I became Labour’s shadow health secretary.
As before, this invitation has been a welcome spur to reflect on how we see and meet important policy challenges.
Then I was able to set out plans for the extra £1.5 billion I’d negotiated for our Labour Housing Pledge to kick start 10 000 new homes on commercial sites stalled in recession and build an extra 20 000 new affordable homes, including the largest council house building programme for two decades.
Now I’m no longer in Government; and no longer in a position to make things happen.
It was Tony Blair who said there’s one essential difference between government and opposition: “In government you wake up each morning and say ‘what can I do today?’ In opposition, you wake up and ask yourself ‘what can I say today?’
But one thing after government in opposition that’s imperative, is to learn the lessons of what worked, what didn’t and why.
You are all housing service and policy experts. More so than I am, or will ever become. So I wanted to contribute to your conference discussion by offering my reflections less on policy debate and more on policy decisions as they are taken in Westminster and Whitehall, as well as reflections on overcoming the flaws.
Health and housing
You’ve brought health and housing together for debate at this conference.
But do you know … in my 10 months as housing minister, I don’t recall a single meeting with health ministers to discuss the essential policy and delivery links.
And in 9 months as shadow health secretary, no doctor, nurse, NHS manager or health policy expert has said to me …’we must do more to get better housing if we want better health’.
It is an evident truth.
You know it as housing experts from the way you run your housing and tenant services. I know it as constituency MP for part of Rotherham and Barnsley.
Poorly heated or insulated homes can lead to hypothermia and preventable deaths.
Overcrowded homes can lead to strains on relationships and infectious diseases spreading more rapidly.
Badly adapted homes can lead to trips, falls, avoidable pain and hospital admissions.
Pressure with rent payments or anti-social behaviour can lead to mental stress and ill health.
So housing does directly affect health. Just as health affects housing.
Addiction or mental health problems can lead to loss or work, financial problems, arrears and eviction.
Physical disability or injury can make an existing home impossible to live in.
The Marmot review into health inequalities, which Labour commissioned and published in government, nailed the problem of separating health and housing policy into the silos of different Whitehall departments: “Many of the difficulties in addressing the issue of cold homes is that the effects of the problem are the responsibility of one government department – the DH – while the responsibility for solutions lies with the CLG and DECC”.
Government has not always been organised or operated like this.
When Bevan led the legislation to set up the NHS through Parliament in 1946, he was secretary of state for health and housing.
When he launched the post-war council house building programme in the same year he said: “We must not only build quickly, we must build well. In the next year or so we will be judged by the number of houses we have put up. But in ten years we will be judged by the quality of those homes.”
The twin responsibilities were separated by the new Conservative Government in 1951 into two different departments. And they’ve remained separated at the national level since then.
Housing and public health remained twin responsibilities of local government, however, until 1974 when public health was taken into the NHS as a national responsibility.
We can see both changes, I think, as part of the process of the British state centralising to expand its domestic role as its foreign responsibilities diminished post-empire.
Flaws in system
This is not just a feature of recent years in Whitehall. It is reflected directly in Westminster and in the way policy debate and scrutiny takes place.
Neither the Commons health select committee nor the CLG committee has done a report on health and housing, though from time to time the essential links are raised with both and referenced in their published evidence.
The Marmot report recommended greater integration of policy and delivery: “An important step in tackling the social determinants of health at a local level would be greater integration of health, planning, transport, environment and housing departments and personnel.”
Even when Parliament legislates for the broader view and delivery links, this is no guarantee that it happens in practice.
Directors of Public Health have a statutory duty to assess the health needs of their area. But the Chief Executive of St Mungo’s – London’s largest provider for homeless people – told me recently in the 30 years he’s worked for the charity, not once has a public health director approached them about the health needs of London’s homeless.
The personal consequences of this mean only 1 in 6 homeless people come away with a treatment plan when they are discharged from hospital.
And even when the financial evidence also underlines the imperative to overcome policy and service separations, this is no guarantee that it happens in practice.
The Audit Commission confirm “Every £1 spent on providing housing support for vulnerable people can save nearly £2 in reduced costs of health services, tenancy failure, crime and residential care”.
The Chartered Institute for Environmental Health report health costs of £600 million a year from poor housing; and health, crime and education costs totalling £1.5 billion.
Reflecting on five years as a minister at the Treasury, and two spending reviews, we tried joint PSA targets and jointly-held dual-key budgets between departments in some policy areas.
These worked only up to a point. Neither were strong enough to overcome the force of the single department culture. And neither were underpinned with strong enough financial metrics to support one department spending money that reduced costs or lifted burdens for another.
The row this week over the Government’s cap on and cuts to housing benefit offers an interesting illustration. In this case the DWP wants to cut the benefit bill and, even though the consequences and costs to local government were serious and obvious, they played no part in the decision to press ahead with the policy.
So the separation of health and housing responsibilities makes sound, sensible policy making much harder.
We took some steps in Government to bridge the gap over the last decade. These were necessary, but not sufficient to overcome the significant policy separation between housing and health.
We started and completed 90% of the massive Decent Homes programme, fitting new boilers, insulation, doors, windows and kitchens for council and housing association tenants in more than 1.4 million homes by last May.
We introduced the supporting people grant specifically to help people stay in their own homes; people who are vulnerable and with complex needs for housing support.
And we encouraged closer local working between housing and health providers. The recent ‘Healthy Homes’ initiative launched jointly by Liverpool Council and Liverpool PCT is an excellent example of integrated, locality based, whole population commissioning.
It targets assessment of the health and the housing needs of families living in 25,000 homes across the city. Where needed they improve properties, make appropriate health referrals and expect to prevent at least 100 premature deaths a year.
One year on – the balance sheet
One year on – where are we now with the new government?
The Liverpool Healthy Homes programme is exactly the type of integrated long-term commissioning at risk in the huge NHS reorganisation.
They – like almost everyone else – are beset by uncertainty, confusion and extra cost as more bodies and bureaucracy are being created by the upheaval in the health service.
Within the Government’s NHS legislation however, the move to return public health to local authorities is sound in principle, although there are important unanswered questions in practice about the powers and funding that councils will have to do the job; about the retention of skilled public health staff; and about the continuing commitment of the NHS to work on public health improvements.
But it is impossible to ignore the scale of the Government’s cuts, which have gone too far, too fast.
I have mentioned housing benefit already. Age UK report average cuts this year of 8% – with councils reducing care hours and raising eligibility thresholds for help.
These are short-term, budget driven cuts which will have longer-term consequences for many people’s health and welfare, and will inevitably lead to greater cost in other parts of the system, especially for the NHS.
There are still 400,000 non-decent homes left, and the Government will not provide the funding to finish the programme. The benefits go wider even than health – for every one million pounds of public investment in housing refurbishment, 17 jobs are created and the Labour shadow housing team has calculated that completing the programme would support 54,000 jobs.
Finally, the supporting people grant is being squeezed and is set of a 12% real terms cut over the course of the Parliament.
The recommendations by Andrew Dilnot on the funding of social are provide an opportunity to reverse this trend of damaging policies. I have called for, and Ed Miliband has called for, cross-party talks at the highest levels to discuss and agree a new system of funding social care, and how to pay for it.
Opposition and alternatives – proposals
One of the very few advantages of Opposition that you are freer from the Departmental constraints of Government, and free to think more broadly.
So I want to use this period in opposition to look for solutions to the systematic separation of housing and health, solutions that we can push through from the word go when we are in Government.
And today I want to open up this work to you and the NHF.
I would like to invite you and your colleagues in the housing and health fields to let me know:
– First, what are the best examples of work being done on health and housing together. I mentioned Liverpool – tell me more.
– Second, where are the problems? Where do Government departments or the policy silos of health and housing get in the way of improving people’s health and their homes?
– Third, if there are the problems, what are the solutions?
You can help shape this work which I will do alongside my colleagues Caroline Flint and Alison Seabeck in the autumn. We have a firm commitment to finding the housing and health policies that we can put in place once we’re in Government, and to give them the weight they will need to have a real impact to improve people’s health, housing and lives.
I wrote Labour’s housing manifesto for last year’s election. It was the first of the specialist policy manifestos we published.
The first line was: “Labour believes that everyone has the right to a secure, decent and affordable home in a safe community.”
There’s a strong social, moral and economic case for this commitment. What I didn’t properly appreciate then, but I do now, is that there is also a strong health case for that commitment too.