Firm foundations part two: the crippling cost of the crisis

In the second of our series on the UK housing crisis, Simon Jackson examines two key symptoms – the impact on health and homelessness

In her award-winning book Tenants, Vicky Spratt writes: “In the early twentieth century, those in charge … slowly accepted that housing was a public health matter.” She argues that policymakers “came to believe that poor housing impacted the health not only of its citizens but of the country as a whole.” As a result, good-quality social housing became a major policy priority.

According to Spratt, at some point since then, this attitude “has been buried under arguments about free markets and the importance of mortgage finance to the economy.

“Even the Conservative-friendly argument … that bad housing is damaging the economy because it keeps people sick and economically inactive – seems to fall on deaf ears.”

Now, after decades of ignoring the public health and social implications of poor housing, the resulting financial burden on public services is crippling. Billions of pounds are being spent every single year not to solve the housing crisis, but just to treat its symptoms.

Unhealthy living 

A 2023 Resolution Foundation report, Trying Times, found that people living in poor-quality housing are twice as likely to report poor general health compared to those who don’t (22% compared to 11%).

Poor quality can mean houses which are, among other things, excessively cold, damp, poorly maintained, or overcrowded.

In 2021, the Building Research Establishment (BRE) estimated that poor-quality housing costs the NHS £1.4 billion annually in first-year treatment alone. When factoring in ongoing treatment and societal costs – such as lost productivity – this figure rises to £18.5 billion per year.

UNISON research echoes this, demonstrating that poor-quality housing contributes to increased stress-related absence, exacerbating staff shortages in sectors like healthcare and education.

According to the BRE research, the housing related ‘hazard’ causing the biggest cost to the NHS is excessively cold homes. It costs an estimated £857m each year.

“We had a period where we had no heating and no hot water for almost a month. My housemate got really ill, as a result, they were admitted to hospital with a severe chest infection and were trying to recover in a house where you can’t bathe.”

– Ben

The triple threat of poor insulation, rising energy costs and increasing poverty has left many unable to afford heating and having to live in the cold. These living conditions can cause and worsen asthma or other respiratory illnesses, and raise the risk of heart disease.

Another common problem is damp and mould, again a cause of respiratory illness. According to a 2023 House of Commons report, around 904,000 homes in England had problems with damp in 2021.

This is particularly an issue in the private rental sector, where around 11% of homes are affected. The issue hit headlines after the death of two-year-old Awaab Ishak in December 2020, who died from a severe respiratory infection caused by prolonged exposure to damp and mould in his home.

Damp can be classified as a ‘category one hazard’ (the most serious) and both private and social landlords are legally obligated to ensure properties are safe and free from hazards.

“Every time you call private landlords to come and review the mould problem we have in the house, they always say, ‘Leave your door open, leave your windows open,’ and the weather is cold.”

– Margaret

However, many renters don’t know their rights and, of those who do, many are unwilling to push the issue for fear of being evicted under a Section 21 no-fault eviction notice.

“Often what happens is, when the tenant raises the issues, the landlord is more likely to issue a Section 21 eviction notice, put some paint on it, and then get new tenants that don’t realise there’s a problem.”

– Harry

Mental wellbeing 

Beyond physical health, poor-quality housing takes a major toll on mental health, particularly, again, for tenants in the ‘insecure’ private rental sector.

A 2024 Generation Rent survey revealed that nine out of 10 renters felt that private renting negatively impacted their mental health. Additionally, over four in five renters were worried about being evicted, and 88% felt stressed when reporting issues to landlords or letting agents.

The report concluded: “Having a safe place to call home and a community to put down roots are core to a person’s mental wellbeing.”

Why is there so much poor-quality housing?  

One reason is the UK’s aging housing stock. As of 2023, the Home Builders Federation reported that the UK has the oldest housing stock in Europe.

Nearly four in five UK homes (78%) were built before 1980, compared to an EU average of 61%. The UK also has double the EU average of homes built before 1946 (38% compared to 18%).

As of 2020, 15% of UK homes failed to meet the Decent Homes Standard – once again, the highest proportion in Europe. Older homes are not inherently poor in quality, but without significant investment or a new generation of homes the overall quality of the UK’s housing stock will only continue to worsen.

Four ways to fix health outcomes

  • Set higher insulation standards for new homes as part of their EPC assessments. Existing homes should be included in a nationwide street-by-street insulation retrofitting operation.
  • Empower local authorities, through adequate funding, to address the immediate issues of an aging housing stock, and to invest in technical and professional housing and planning staff.
  • Adopt the principles in the Town and Country Planning Association’s proposed Healthy Homes legislation.
  • Redress the imbalance of power between landlords and tenants in the private rental sector to push up standards and hold landlords to account. Abolishing Section 21 no-fault eviction notices, strengthening landlord enforcement duties, and extending Awaab’s Law and the Decent Homes Standard to the private rented sector are all essential measures*.

Homelessness 

As housing becomes increasingly unaffordable, and social housing increasingly rare, it’s hardly a surprise that homelessness has risen sharply. And while rough sleeping is the most visible face of homelessness, it is by no means the whole story.

According to Crisis, the homelessness charity, as of March 2024 a record 117,450 households were being forced to live in temporary accommodation, a 12% increase on the previous year.

This comes at huge cost. Between April 2023 and March 2024, local authorities spent £2.29bn on temporary accommodation, 29% more than the year before.

The Homelessness Reduction Act 2017 places a duty on local authorities to prevent and relieve homelessness. So, if a local authority is satisfied that someone is ‘threatened with homelessness’ it has a duty to prevent it from happening. This can involve taking steps to ensure their current accommodation remains liveable but, if that is not possible, the duty extends to securing other accommodation for the applicant.

With social housing waiting lists at record levels, this now usually means the provision of temporary accommodation. This reliance on temporary accommodation has devastating consequences, as individuals experiencing homelessness often face poor living conditions that significantly impact their physical and mental health.

“I’ve spoken to a lot of people in temporary accommodation, and it is a terrifying situation for them to be in. It’s usually terrible quality housing, it’s usually very removed from the vital services that people in temporary accommodation need, whether that’s employment services, whether that’s health care, whether that’s just basic public services, like being able to get a bus.”

– Ben

The duty to prevent homelessness respects the idea that housing is a basic human right, but it is vastly underfunded and is placing a crippling financial burden on local authorities.

What should be a duty which catches those who fall through the cracks, before helping them return to their feet, has turned into a £2bn-a-year plug to fill the gaping affordability hole in the housing market.

Three ways to address homelessness 

  • Break the cycle of over-reliance on expensive temporary accommodation by adopting a long-term strategy with significant funding for social housing building and maintenance.
  • Redefine the term ‘affordable housing’. Currently, affordable housing is defined as rents set at up to 80% of market rates, which is beyond the means of people on lower incomes. This definition should be revised to link rents to the household incomes of people in the lowest earning quartile.
  • Prioritise the Affordable Housing Programme in the next spending review. This should deliver a new generation of high-quality, truly affordable social rented housing which meets the highest energy efficiency standards.

Quotes in boxes are from ‘Voices from the frontline’, a 2024 Generation rent and UNISON report based on a roundtable with 17 UNISON members detailing their private rental experiences.

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