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The importance of good quality housing in addressing health inequalities
Perhaps unsurprisingly, I have never spent as much time in my own house as I have in the last year. My dining room has become an office; trips to the gym have been replaced by PE with Joe in the living room; and having people round to visit in those few brief weeks in the summer typically involved perching on wobbly chairs either end of the garden. Unlike many, I’ve not had the additional challenge of trying to create a classroom environment! The Covid-19 crisis has highlighted a number of inequalities in our society but the impact of housing inequality is one of the most apparent. Indeed, last year, Housing Secretary, Robert Jenrick acknowledged that the pandemic has highlighted “the importance of having somewhere secure and comfortable to live”. Some households have been locked down in homes with room for separate workspace, reliable Wi-Fi, affordable heating and insulation, and gardens. Their experience of lockdown is clearly very different to that of families living in overcrowded, cold or damp homes, with limited or no outdoor space, and no room or capacity for working from home, meaning no choice but to travel to work and risk exposure to the virus. However, housing inequality is nothing new. It is estimated that in 2019, over 4 million homes in England failed to meet the Decent Homes Standard[1] and, whilst this figure has fallen over the last decade, it still amounts to 17% of homes. The situation is particularly acute in the private rented sector, where 23% of homes do not meet the Standard. As such, poor quality housing is a challenge faced by a huge number of families in England. It also has significant economic impacts; research by the Building Research Establishment estimates that treating patients with illnesses or injuries caused by poor housing costs the NHS £1.4 billion a year[2]. Yet, despite its far-reaching impacts, the issue of poor-quality housing and housing inequality seldom receives the attention it deserves. The link between housing and health It has long between accepted that there is a direct link between housing and health. The Healthy Urban Development Unit[3] identify decent and adequate housing as being critically important to health and wellbeing and the NPPF highlights the importance of ensuring safe and healthy living conditions[4]. Having access to good quality, suitable and secure housing has a profound impact on our health and wellbeing and, therefore, our quality of life. As summarised by Public Health England, “the right home environment is critical to our health and wellbeing; good housing helps people stay healthy, and provides a base from which to sustain a job, contribute to the community, and achieve a decent quality of life”[5]. There are myriad direct and indirect impacts that housing quality can have on health. These include, but are not limited to: Affordable housing – a lack of affordable housing may negatively impact lower income families by reducing the amount they can spend addressing other health and wellbeing needs. Conversely, provision of affordable housing as part of a mix of tenures helps to create mixed and balanced communities. Accessible and adaptable homes – most literature shows a preference of older people to remain in their own homes as they age[6]. Provision of accessible and adaptable homes makes this possible for older people and those with disabilities. It also enables them to receive care in the community. As the country’s population ages, provision of this type of housing is likely to become increasingly important. Thermally and energy efficient homes – cold, damp homes can cause and exacerbate many health conditions but particularly respiratory illnesses. It is estimated that excess winter deaths are almost three times higher in the coldest 25% of houses compared to the warmest 25%[7], and with older people being particularly vulnerable. Homes with poor insulation or inefficient heating can also result in fuel poverty[8], causing stress for lower income families who may be unable to afford both fuel and food. Housing design – internal layout and windows can provide good access to daylight which improves quality of life and reduces energy needed for lighting, and ventilation[9]. Sound insulation reduces disturbances from traffic or neighbours which can disrupt sleep and lead to psycho-physiological effects. Good design can mitigate against potentially dangerous design features, such as stairs, uneven levels, or trip hazards. Provision of outdoor space can create room to exercise, play or grow healthy food and provides private amenity. Overcrowding – The extent of overcrowding is often hidden but severe. In 2019/20, there were 829,000 (4%) households in England living in overcrowded conditions[10]. In Scotland, an average of 51,000 (2%) of households were overcrowded[11] and in Wales, it is thought that 6% of working age family units live in overcrowded housing[12]. Overcrowding has particularly negative impacts on children and is associated with increased risks of meningitis, tuberculosis, anxiety and depression, and delayed cognitive development. Overcrowded housing also impacts children’s ability to learn at school and study at home, with research from the US showing that children living in crowded homes, particularly during high school, have lower educational attainment, contributing to inequality later in life[13]. Homelessness – Housing insecurity can lead to homelessness which is closely related to ill health. 73% of people experiencing homelessness report a physical health problem and 80% report mental health issues[14]. In what can be a vicious cycle, ill health is often a trigger for becoming homeless. Cause for optimism The link between housing and health is clear and the importance of considering how development can affect health is becoming more widely acknowledged, with steps being taken to try and improve the quality of housing. For example, last year, MHCLG announced that new homes delivered through Permitted Development Rights will now have to meet space standards, in order to prevent the delivery of small homes without justification and ensure proper living space. Likewise, homes delivered through Permitted Development Rights are now also required to provide adequate natural light. As we await publication of the forthcoming Planning White Paper and planning reforms, it will be interesting to see how much explicit emphasis is placed on what housing quality can do for health in the context of the Government’s increased focus on design and quality. At a local level, there is also reason to be optimistic and the North East has numerous examples of inspiring developments that have set out to address housing quality and creating healthier neighbourhoods. The Green in Hartlepool is an example of the power of regeneration. Awarded the RICS best residential property 2019, the Placefirst scheme involved the transformation of 175 semi-derelict terraced houses into 86 modern, high-quality, 1, 2 and 3 bedroom homes for long term rent. The properties have been made bigger and lighter, larger homes have been created where two houses have been knocked into one and extensions have been added to enable more open-plan, spacious living. Insulation, double glazing, and efficient boilers ensure the homes are warm and dry, crucial to promoting the good health of residents. Placefirst state that the homes cost around 50% less to run than typical terraced properties in the local area, helping to reduce the stress on lower income families. Courtyard gardens provide private outdoor space and selective demolition has cleared space for a communal green, promoting community engagement and creating new spaces for children to play. Similarly, as an area of housing market renewal, The Rise in Scotswood in the West End of Newcastle is unrecognisable from the older terraced houses that dominated the area previously. The £265 million Joint Venture between Barratt, Keepmoat, and Newcastle City Council, who together have formed the New Tyne West Development Company, will eventually comprise 1,800 new energy efficient homes on a site that two decades ago comprised dense terraces of partly derelict, dated, and poorly ventilated houses. A mix of housing types and tenures are provided, including private sale, shared ownership, and affordable rent. The homes make use of green technologies to provide heating and hot water from a district heating system and are designed to the latest space and security standards. In addition to providing quality homes and community infrastructure, the development has created opportunities for employment and training aimed specifically at local people. However, it is not just regeneration schemes that need to consider health. A holistic strategy is needed across the housing sector, ensuring that all housing developments, be that new build homes, conversions, regeneration schemes or empty properties being brought back into use, are of a high quality to mitigate against negative health impacts and maximise positive health outcomes. In doing so, housing can make a hugely significant contribution to reducing health inequalities within our communities. Whilst Covid-19 has highlighted the importance of high-quality housing, including well-designed and useable space within and around new homes, the impact our homes have on our health and wellbeing will remain relevant long after the current pandemic ends.     [1] English Housing Survey[2] BRE. The Cost of Poor Housing to the NHS.[3] Healthy Urban Development Unit, Rapid Health Impact Assessment Tool, 4th Edition[4] NPPF, 2019. Paragraph 117[5] Public Health England, Preventing Homelessness to Improve Health and Wellbeing[6] Mulliner, E., Riley, M. and Maliene, V., 2020. Older People’s Preference for Housing and Environment Characteristics. Sustainability, 12, 5723. doi:10.3390/su12145723[7] The Academic Practioner Partnership, 2016. Good Housing, Better Health.[8] NICE, 2015. Excess Winter Deaths and Illness and the Health Risks Associated with Cold Homes.[9]  The Academic Practioner Partnership, 2016. Good Housing, Better Health.[10] English Housing Survey[11] Scottish Housing Condition Survey: 2019 Key Findings[12] Judge, L. and Pacitti, C. 2020. The Resolution Foundation Housing Outlook.[13] Lopoo, L.M. and London, A.S., 2016. Household Crowding During Childhood and Long-Term Education Outcomes. doi: 10.1007/s13524-016-0467-9.[14] Homeless Link, 2014. The unhealthy state of homelessness  


Round and round in (almost) circles – initial thoughts from the North East on the new new new (!) Standard Method
The issue of housing need and the number of homes being planned for is really important and it’s great to see it getting more airtime and column inches in the mainstream media. But has this led to yet another kneejerk reaction that will result in harmful outcomes for the North East? When reading the news of the Government’s latest proposals for the Standard Method, I was reminded of an episode of The Thick of It where beleaguered MP, Nicola Murray, pleads “That WAS a U-turn! If I do another U-turn it’s an O-turn.” The latest iteration of the Standard Method, which has been causing consternation (albeit for different reasons) amongst planners, developers, MPs and the general public since its proposal in 2017, will largely return to the approach suggested previously, with a single modification that falls considerably short of those which its various critics advocated during the recent consultation. As set out in Lichfields’ recent blog, the Government has now announced that the Standard Method will largely remain that which was first introduced in 2017. The only difference is that an uplift of 35% is applied to the 20 largest cities across England. For the vast majority of LPAs, including 65 of the 72 LPAs in the North, there will be no change in their housing need figure. As a result, it is hard not to feel that a great deal of time and effort has been expended to arrive back at somewhere very close to where we started out over three years ago – and there was broad consensus that that approach wasn’t fit for purpose! How does the Standard Method work and why is this a problem in the North? The formula which underpins the new (SM3 - the third and what now seems likely to be the final) version of the Standard Method uses the 2014-based household projections to identify a demographic baseline for each local authority (LPA), which is then uplifted to address local affordability and is finally capped (if needed) based on the age of the LPA’s Local Plan. The ‘cities and urban centres uplift’ is then applied to this figure. The problems (particularly for the North) with basing the Standard Method on the household projections, has been extensively discussed by Lichfields. The projections are based on historically low population growth which was followed by suppressed household formation rates experienced during the 2008 recession. As a result of the projections being based on past trends, these are perpetuated in future projections. This is acute in the North, where the recession had a particularly significant impact. Given that the newest version of the formula is, for most LPAs, unchanged, it is unsurprising that these issues remain. The increased age of the projections still being used in the SM only compounds these problems. As a result of the artificially and excessively low baseline, the affordability uplift is largely irrelevant for most northern LPAs, where affordability ratios are typically lower than in the South of England. The third stage of capping the resulting Standard Method figure is irrelevant in the North, as the Standard Method outputs are lower than housing requirements set out in Local Plans. An opportunity missed? SM3 results in an overall national figure of 297,600, which is closer to, but still below, the Government’s target of 300,000 new homes each year. It is also significantly less than the figure of 337,300 dwellings per annum generated by the version of the formula consulted on in August 2020 (SM2). The reason why that figure was so high was to ensure that even after some LPAs had justified the use of a housing requirement lower than their SM2 figure, the 300,000 home target could still be achieved. The difference between the two methods is stark in the North; SM3 results in a figure of 47,500 dpa, higher than the figure of 43,300 dpa generated by SM1 (the current version of the Standard Method), but significantly less than the 49,800 dpa identified by SM2. More significantly, and worryingly, the SM3 figure is over 20% less than the average number of homes actually delivered across the North in each of the past three years - 59,600 dpa. Figure 1 Comparison of Standard Method approaches for the North Source: Lichfields In the North East, the discrepancy between SM3 and past delivery levels is even greater; SM3 results in a total of 6,625 dpa, compared to the average delivery levels of 9,815 dpa, a decrease of 32%. Indeed, SM3 exceeds past delivery levels in only two of the 12 North East local authorities (Gateshead and South Tyneside), even with Newcastle’s ‘cities and urban centres’ uplift. Table 1 Comparison between original Standard Method, August and December proposals and past delivery Source: Lichfields (Figures correct as of Dec 2020) SM2 was considered a moderate improvement on the original approach when applied in the North East (although a number of issues remained unaddressed). The major difference was that the revised approach used the higher of the 2018-based projections or 0.5% of existing stock as the baseline. As a result, the proposed figure across the North East was significantly closer to past delivery rates than when projections alone are used (as in SM1 and SM3).  Additionally, a stock-based approach provides a much more stable method to identifying a baseline position, as it is based on the number of existing homes in an area which does not experience the significant fluctuations observed through projections, which are updated every two years. Finally, SM3 reverts to using the 2014-based projections, despite the fact that two sets of projections have been released since. In their rationale for retaining the current (SM1) approach, the Government state that although use of the 2018-based projections has been carefully considered, “due to the substantial change in the distribution of housing need that would arise as a result, in the interests of stability for local planning and for local communities” the 2014-based projections should be used instead[1]. This approach seems counter-intuitive given the importance of using up-to-date evidence, including within the Standard Method itself (affordability ratios) and does not seem like a long-term solution as we move further away from 2014. In the North it causes decline rather than stability. 20’s plenty…or is it? As shown in Table 1, in the North East only Newcastle sees a difference in SM3 when compared with SM1. For every other LPA, the Standard Method is back where it started, with all the associated problems. This is because only Newcastle is within the 20 cities to which the 35% cities uplift is applied. Looking more broadly, seven (Newcastle, Manchester, Liverpool, Leeds, Bradford, Sheffield and Hull) of the 20 cities are found within the North. The uplift is only applied to the LPAs which contain the largest proportion of the population for each of the 20 cities identified (with the exception of London, where an uplift is applied to all Boroughs). This approach is problematic for a number of reasons, as discussed in my colleague Harry’s blog. Specifically in the North East, Newcastle is part of a much larger functional economic and market area that extends into Gateshead, which shares a local plan with Newcastle, and North Tyneside. Both areas play key roles in supporting the wider city. However, under the proposed method, these authorities will receive no uplift to their housing need figure. Although Newcastle appears able to accommodate the entirety of the uplift, concerns have been raised previously about the proportion of housing delivered in Newcastle that is student accommodation and city centre apartments compared to family housing. It is also unclear why the Government has chosen 20 cities and a 35% uplift. At face value, both would seem to be arbitrary figures. Why not apply a lower percentage uplift to a larger number of cities, which would help to ensure figures remained deliverable, whilst maintaining the Government’s aspiration to direct more growth to cities and urban areas? This might have the added benefit of directing a greater proportion of the national housing need to cities in the North, supporting the Government’s levelling up agenda. Finally, the Government’s strategy behind the SM3 is that the urban centres are the most sustainable locations for large amounts of new housing, they have the largest supply of brownfield land and often the most acute affordability problems. That appears laudable in theory but, in reality, there could be problems: Is there enough brownfield land to meet these needs? Is it in the right locations? Is it suitable for the type of housing that is needed? Can it be developed viably? If plenty of suitable, viable and available brownfield land exists, why has it not already been developed? 14 of the 20 cities are constrained by Green Belt[2] or Metropolitan Open Land. Newcastle took the bold decision in their Core Strategy to release land from their Green Belt which has supported their recent healthy supply and balanced the city centre student and apartment accommodation with family housing. Can the physical and social infrastructure cope with this additional concentration of demand? Will there be sufficient supply to address the affordability in other areas? Will there be sufficient supply to address the other reasons why more housing is needed? In the North these are often more significant than affordability.  One size simply doesn’t fit all One of the key criticisms levelled during the consultation on SM2 in August 2020 was that imposing centralised local housing need figures, dictated by national Government, would significantly weaken local democracy by taking decision-making away from local people and Councils. Further criticisms highlighted the apparently arbitrary inputs to the formula. It was also stressed that reliance on a single formula was no substitute for local knowledge and expertise taking into account constraints and opportunities and does little to address the vast range of housing challenges and local strategies in different areas of the country. In the North East, many discussions focused on the continued absence of an economic uplift factor within the formula, reflecting the importance of providing sufficient quality and choice of housing to support the North’s economic aspirations by attracting and retaining young people. SM3 does nothing to address these problems. It still only takes account of a very narrow range of factors (if anything the removal of a stock component is a backwards step for the North East). It focuses solely on affordability, which, though a key factor, is just one of a number of challenges that drive housing need and, particularly in the North, fails to recognise other factors which are at least as important. It applies a one size fits all approach and imposes a housing need figure on local Councils. It uses arbitrary inputs and, indeed, has increased these. Lastly, far from ‘levelling up’, it continues to funnel housing development towards London and the South East, at the expense of the North East. After three attempts, is it time to accept that local housing needs simply cannot be calculated using a simple national formula? A broader debate is needed to consider alternative approaches that recognise the importance of this country’s rich local diversity and actually facilitates ‘levelling up’.    [1] Government response to the local housing need proposals in “Changes to the current planning system”[2] Local authority green belt statistics for England: 2019 to 2020 | #planoraks: Well, now we *really* need to talk about the Green Belt