April 2002, pages 116-117 The national homelessness charity Shelter has issued a stark warning that thousands of children in the UK are at risk of ill-health, accident and even death as a result of poor housing conditions. Tracey Khanna reports

Last month saw the release of two significant reports tackling the thorny issue of homelessness and the badly housed. In More than a roof - a report by the Department for Transport Local Government and the Regions (DTLR) into tackling homelessness - the Government pledges measures to end the "inappropriate use of bed and breakfast hotels for homeless families with children".¹ The report, which recognises that living in poor quality accommodation is detrimental to health and wellbeing, calls for changes in the way that mainstream health care is delivered to disadvantaged groups.

During the same week, Shelter released its report Home Sick - a joint campaign between Shelter and Bradford & Bingley for healthy homes.² The homelessness charity claims that thousands of children living in run-down housing are "suffering from serious and prolonged illnesses exacerbated by the appalling conditions in which they live". The report draws attention to the health problems faced by vulnerable groups living in a range of accommodation - local authority housing, privately rented housing and temporary housing, such as bed and breakfast establishments - as well as those living on the streets. Shelter estimates that as many as 100,000 children are made homeless every year. Living conditions are often the worst in temporary accommodation and children suffer the most, at risk from gastroenteritis, skin disorders and chest infections resulting from a lack of suitable washing or cooking facilities, damp and cold dwellings, unsafe housing and indoor pollutants.

The charity states that health problems were mentioned by more people calling its national housing advice line than any other problem, after homelessness and threatened eviction. However, the report does not state whether the health problems reported were all directly linked to poor housing conditions. It has been estimated that around 19.3 per cent of private rented properties are "unfit for human habitation", compared with only 7.3 per cent of local authority housing stock, 5.2 per cent of Housing Association properties and 6 per cent of owner occupied properties.³

According to Shelter's figures, 6,015 people have called Shelterline with health problems since its inception three years ago. Of those callers, 51 per cent had nowhere to stay that night and 48.5 per cent had some form of housing. Around 9 per cent of those callers (526) had children.

Steve Ballinger, the author of the Home Sick report, believes that environmental health departments have a role to play in raising standards in poor housing and improving health in the following ways:

• EHOs, who are in the front line when it comes to poor housing, should become involved in active programmes to identify the extent of poor housing and housing problems in their area that can cause ill health, such as local housing stock surveys. Such surveys should focus on housing stock that is more likely to be of poor quality, such as bed and breakfasts and houses in multiple occupation (HMOs).
• Once the level of unfitness and threat to health has been established, policies and services then need to be developed to tackle problems. Best value asks environmental health departments to do this already. It is critical that local authorities adopt appropriate standards for housing and EHOs can, and should, take the lead on this.
• It is important that standards are not prescriptive and inflexible - assessments should focus on the risks to the people living in the property, rather than on the nature of the property itself. Assessments of fitness need to be carried out with the more people-focussed risk assessment system of the housing health and safety rating system (HHSRS).
• A multi-agency approach is required, with teams comprising EHOs and staff from other departments. For example, if tenants might be evicted as a result of an EHO serving notice on a landlord to improve a property, housing advisers should be available to ensure that people do not become homeless as a result.
• The role of EHOs, particularly when serving notices on landlords, can place them in conflict with landlords in the private rented sector. Local authorities can circumvent this by developing partnerships with reputable landlords to encourage the development of a self-regulatory approach to standards in the private sector, for example using a kitemark system.
• EHOs will need to play a vital role with regard to the education and training of landlords if a self-regulatory scheme is to work.
• The changes to local authorities' grant-awarding powers when EHOs have served notice on a landlord, which should come into force in May, will give far greater discretion to how local authorities spend their money. It is important that proper priority is given in spending targets to improving private rented properties that endanger tenants' health.

It is widely acknowledged that currently, for many homeless, badly housed and vulnerable people, health issues only become a priority at a time of crisis. Thus, the DTLR has called for a partnership approach between GPs, primary care trusts, local authorities and local service providers to ensure that vulnerable people do not fall between the gaps in health and housing service provision.

However, Home Sick has gone even further, urging local authorities to promote accreditation schemes for good quality landlords, coupled with financial incentives to improve properties. Finally, in a step that mirrors the CIEH's housing policy, Shelter has renewed its plea for the Government to honour its manifesto commitment to licence HMOs to improve standards across the sector. It remains to be seen whether the Government's announcement on 13 March that councils are to get an extra £10m funding to provide self-contained temporary housing as an alternative to bed and breakfast will be successful. But it is surely a step in the right direction.

For further information contact Steve Ballinger at Shelter on tel: 020 7505 2051.

References

1. DTLR (2002) More than a roof: A report into tackling homelessness, London, March 2002.
2. Ballinger, S (2002) Home sick: Shelter and Bradford & Bingley's campaign for healthy homes. Shelter, London, March 2002.
3. DETR (1996 & 1998) English House Condition Survey, 1996 & 1998, London.