Case study

National Conversation on Health Inequalities: Healthy Homes Programme

This example sets out the work done by the National Conversation on Health Inequalities (NCHI) improving homes for better health.


Ann, 62, and her husband Steve, 65, were both ill and finding it difficult to manage at home. Steve had Huntington’s Disease, a degenerative brain disorder and Ann was caring for him.

However, when Ann suffered 2 strokes she needed hospital treatment and there was no one to help Steve. A social worker suggested that Ann arranged respite care for Steve, so that Ann could take a break.

Respite care is short-term accommodation outside the home, where a loved one can be looked after. This provides temporary relief to those caring for family members.

Ann found this very difficult to organise because of her own poor health and negative experiences of respite care for Steve in the past. Ann said:

I couldn’t deal with this because of the state I was in…I had 2 mild strokes, so I was in and out of hospital and worried about who was going to look after Steve. I didn’t want to put him back into respite because I had a really bad experience before…I didn’t think he had been cared for properly, and all I wanted to do was to take him home.

At the time, Steve was confined to the living room at home where he had a hospital bed and a commode because he could not use the stairs safely. Ann said:

Because of his condition, the stairs were no good for him and it was clear we needed to live somewhere more accessible. He ended up falling down the stairs and splitting his head open. When he was released from hospital he had 2 care workers getting him up, washing him, getting him dressed, feeding him and returning him to bed. I would have done it.

Healthy Homes

Ann’s daughter put her in touch with the Liverpool Healthy Homes Programme (HHP), part of Liverpool City Council’s Public Protection Team. HHP operates in areas with the greatest health and housing support needs; places where residents might need to improve their homes.

Since 2009, HHP has:

  • made over 52,200 home visits
  • helped over 43,300 residents
  • made 29,200 referrals to partner agencies for support

Programme staff knock on doors in areas most affected by poor housing and health and, where necessary, carry out a survey of living conditions.

Assessments of residents’ living conditions include:

  • heating and insulation
  • overcrowding
  • security
  • kitchen and bathroom hygiene
  • damp and mould
  • facilities for elderly, disabled or chronically ill residents (eg banisters and stair lifts)
  • social care supervision
  • respite care

The project focuses both on tackling the environmental elements of housing and improving health by connecting residents to a wide range of services.

Case support workers also make referrals to other support services. This includes GPs and professionals who can offer healthier lifestyle and dietary advice. The support workers can also provide help with social issues, such as feeling isolated.

A helping hand

The case support officer at Liverpool Healthy Homes visited Ann and saw that Steve couldn’t get out of his home or use the stairs. The officer found the family an adapted home in the local area.

He then helped the family apply for welfare benefits and a crisis loan so that they could afford the equipment needed to improve Steve’s quality of life at home. This support allowed Steve to live at home longer, before he passed away 2 years later. Ann said:

They helped us to get things organised and moving by making calls on my behalf. I’m absolutely hopeless at filling out forms. The support officer used to come out to the house and help me fill out the Disability Living Allowance and Accessible Housing application form and found us a new care package including respite care. He also helped us into the new housing, which had a lift for Steve. In terms of me and my family, I had Steve for an extra 2 years before he passed away and if it wasn’t for Healthy Homes - I don’t think I would have had him for that long.

Improving health and wellbeing through improving homes

According to a Liverpool Case Support Worker:

People’s lives are unpredictable, and often, they’ll come across a problem that they don’t know how to resolve. Throughout Liverpool, there’s a small army of support workers that are keeping things going; helping with benefits, supplying debt advice, fuel poverty, housing, food banks, etc. It’s the things that really need doing. Public health allows us to solve things with statutory back up.

The programme also aims to improve general housing conditions, health and safety, and promote a healthier living environment for all residents.

Local inspections by environmental health officers have identified over 4,200 category 1 hazards within homes. Private landlords have invested £5.3 million in repairs as a result of the programme.

The programme is being replicated by other councils. It was recognised by the Municipal Journal Award for Public Protection Achievement 2011 and the European Fuel Poverty Award 2011.

It connects residents with physical or mental health issues that are affected by their home environment. Programme officers negotiate or take legal action on behalf of residents to ensure landlords make living conditions acceptable. The programme provides help to relocate residents to more suitable accommodation if this is unsuccessful.

The health promotion team in HHP has made over 900 visits to GP surgeries since March 2012, helping to increase resident referrals.

It also runs two successful annual campaigns:

  • Winter Survival Campaign
  • Child Safety At Home Campaign; targeted at every primary school in Liverpool

The impact of the HHP can be shown through better and safer housing conditions, greater energy efficiency and reduced fuel poverty. The project has helped reduce hospital admissions from accidents, excess cold or respiratory complaints.

Wider society benefits are gained by encouraging people to adopt healthier lifestyles, access entitlements and training or help finding a job. Building Research Establishment (BRE) estimates are that together these activities save £5.5 million each year in NHS, social and wider public sector savings.

For queries relating to this case study and the NCHI, please contact the programme lead: Lina Toleikyte (Health Equity Unit, Public Health England).

Published 15 September 2015