Royal College of Occupational Therapists highlight health implications of poor housing

Analysis in the Building Health into Homes strategic report found that 3.5 million homes in England are classed as non-decent, affecting 7.5 million people, while 87% of homes fail to meet basic accessibility criteria. According to the report, one in five wheelchair user households in Scotland has unmet housing needs and the cost of poor housing to the NHS in England reaches £1.5 billion annually.

For the RCOT, health prevention and system reform can only be delivered once housing needs are met.

It believes that housing is being addressed too late across the system. When people are discharged to homes that do not meet their needs, their health deteriorates and demand on services increases. This means people are not getting the right support at the right time. Poor housing is also driving health inequalities, with people in worse housing more likely to have poorer health. 

This is why RCOT says housing must be central to health and care systems.

The report, which is relevant to the whole of the UK, sets out how housing must be recognised and used as a core part of health and care. It calls on system leaders to act earlier, integrate housing into prevention and care pathways and ensure people get the right support at the right time.

Without action, more people will experience avoidable harm and pressure on health and social care services will continue to grow. The report shows how occupational therapists are already reducing demand and improving outcomes across health and care systems.

When involved early, they prevent hospital admissions and readmissions, reduce falls and deterioration, and support people to live safely and well at home. They also play a critical role in connecting health, housing and social care. This expertise is not being used consistently across the system.

Lauren Walker, professional practice manager at the Royal College of Occupational Therapists and report author, said: “Everyone lives somewhere, but housing is too often treated as an afterthought in health and care, meaning people are reaching the point of crisis before they get support.

“Building Health into Homes sets out a different approach. It shows how the home can be used as a health intervention, not just something to react to later. We’ve developed practical resources for system leaders, services and occupational therapists to support earlier action and better joined-up working across health, housing and social care.

“We need a shift from reacting to need to preventing it. That means recognising the home as central to people’s health and acting earlier to reduce avoidable demand on services.”

The report sets out four recommendations for politicians, policymakers and system leaders, calling on them to: 

1. Strengthen system leadership across housing, health and care by embedding specialist expertise so housing is consistently treated as a core determinant of health. 
2. Shift investment towards prevention and early intervention by acting earlier on housing‑related risks, keeping people safe and avoiding crisis responses, which cost more in the long run. 
3. Build more accessible and adaptable housing and set baseline accessibility standards for all new‑build housing, ensuring homes are designed to support people throughout their lives and don’t need expensive adaptations later. 
4. Build workforce capacity to deliver joined‑up, place‑based solutions by strengthening senior professional leadership and enabling occupational therapy practitioners to work across housing, health and care boundaries, so plans are joined up and delivered effectively.