Housing (health and wellbeing needs in South Tyneside)

It has been well recognised that decent and appropriate housing has an essential role to play in good health and well-being. Non-decent homes can have a detrimental impact on residents' health, including both physical health and mental wellbeing. Despite the continued improvements in construction standards the home remains a major cause of ill health for many. Poor housing can increase the risk of injury, cause or exacerbate respiratory and cardiovascular diseases and cause illness or even death from temperature extremes.

It is important that these risks are minimised and prevented, through ensuring residents are within suitable housing that meets their needs. Ensuring that households have decent homes, particularly those residents who may be more vulnerable to ill health, for example older households, is essential to creating a healthier community.

There is increasing evidence that highlights housing and supportive housing care can make a significant financial contribution to NHS and social care budgets due to prevention agenda. It is said that poor housing costs the NHS at least £600 million per year in England alone. Given this and the current economic challenges, it is important that partners work together to deliver efficiencies and bring about positive change. We recognise that in order to do this we must develop strong links between health and housing.

• Over the last 5 financial years (2011 / 12 - 2015 / 16) there has been an average of 274 households who have been accepted as homeless and in priority need, which is an average of 4 households per 1,000. This level of acceptances is significantly higher than the regional and national rates. Notwithstanding this, there is a very low number of households that are placed in temporary accommodation; with a rate of 0.096 per 1,000 households over this period is significantly lower than the national average. Households being placed in temporary accommodation for long periods of time can have a detrimental impact on residents' health, especially more vulnerable households.
• South Tyneside, along with the other Local Authorities of the North East, undertook a health audit with homeless households. These results will inform the service provision that may be required for these households for future. This audit highlighted some noteworthy results, with respondents being less likely to have visited their GP in the last six months, but significantly more individuals have accessed A&E services (44%) or have been admitted to hospital (24%).
• Those who answered the questions in the health audit were much more likely to smoke (84%), and suffer from stress, feeling anxious and feeling depressed. The vast majority (93%) stated that they had a formal diagnosis for depression. In additional, there were 43% of these people who also stated that they have received a dual diagnosis, including mental health and drug or alcohol issues. Over half of respondents stated that they self-medicate to help address their mental health issues.
• These individuals were significantly less likely to have received vaccinations, screening or accessing any other prevention services. 

Key priorities for the borough have been identified as:

1. Prevention of homelessness through comprehensive engagement with the private rented sector landlords and development of pre-eviction protocol.
2. Provide additional and appropriate older persons specialist accommodation which is care ready and meets the needs of future ageing population.
3. Improve the quality of the private rented sector and target support following an update of the Stock Condition Survey.
4. Look to provide suitable housing options and advice for young single households, particularly those who have been impacted on by welfare reform.
5. Development of housing that meets the needs of the entire population and is affordable.
6. Address the fuel efficiency of properties throughout the borough through a fuel poverty strategy.
7. Ensuring council housing meets the Decent Homes Standard and is maintained to a good standard.
8. Investigate the need for community housing for specific vulnerable groups.
9. Specialist development or adaptation of properties to meet the increasing need for disabled children or families that have specific housing needs.
10. Improve hospital discharge and prison release protocol to avoid crisis situations.
11. Develop an outreach service to support those most excluded groups who are at risk of rough sleeping

Households currently living in Housing Need

• The residential survey that was undertaken within 2013 is the most up to date source of information the council has on the improvements that may be required to accommodation, as there has not been a stock condition survey undertaken since 2003. Notwithstanding this, the data from this survey is self-complete and not a technical assessment. The results from the survey have been weighted based on locality and tenure and then grossed to represent the entire housing stock of the borough, and to address the issue of an under-representation from the private rented sector.
• This household survey highlights the need for serious improvements in some homes within the borough, and the need for additional homes that are suitable for those with mobility problems or other needs for adaptations.
• Housing condition and the level of housing need varies considerably throughout the borough, pockets of poor housing can be found mainly within the urban locations of the borough. The latest Strategic Housing Market Assessment update (2015), which included a household survey from 2013 and an update of secondary sources, highlights that there are currently 2,774 households living in housing need; this equates to 4.1% of households across the borough. The main reasons for households living in need are due to major disrepair or unfitness of the property, households living in overcrowded situation and households containing people with mobility impairment or special needs living in unsuitable accommodation, although again this varies considerably throughout the borough.
• Properties that have been identified has having repair problems are more likely to be found within Simonside and Rekendyke, Primrose and Bede wards. There is a greater concentration of properties in disrepair within the private rented sector, but issues can also be seen within owner-occupied and social rented sectors.
• The main reasons for disrepair are centred around windows needing replaced and dampness/mould growth; obviously both of these issues can have a direct impact on residents' health and wellbeing. 40% of those residents who highlighted repair problems could not afford to undertake the repairs.

Source: Strategic Housing Market Assessment Residential Survey 2013

Affordability ratios

• Data released from DCLG highlights the ratio of median house prices to median earnings within the borough has increased from 2.48 in 2001 to 4.56 in 2014, although it remains lower than its high of 5.85 in 2007. Figures indicate the significantly lower affordability ratios compared to the national average of 6.72 and marginally lower than the Tyne and Wear average of 4.96. There is a slightly higher ratio of lower quartile house prices to lower quartile income levels of 4.76; which is the opposite to the national and regional ratio which have lower ratios.
• These figures demonstrate that for those on average incomes in the borough affording to purchase their own home is not a serious problem; notwithstanding this, South Tyneside has a number of households on very low incomes and therefore affordability for these households is a concern. Affordability for those on low incomes entering the housing market within South Tyneside is a greater issue than those on average incomes purchasing median priced accommodation.
• One of the greatest influences on this relatively low ratio is the high earners for the borough, with higher mean and median earnings than the Tyne and Wear average. Further analysis indicates that households that have two incomes would have few financial barriers to entering the housing ladder, but households who only have one income, very low incomes or are reliant on benefits are likely to need assistance to meeting their housing needs.
• Over the last six years there has been a 6.06% increase the number of housing benefit claimants within South Tyneside, which is a lower level of increase than the national (13.56%) and regional (11.57%) averages.
• Over the last three years there have been a number of significant changes in the benefit system, in preparation of universal credit. There has been a significant decrease in households claiming Job Seekers Allowance (JSA), but this is coupled with the increase in Employment and Support Allowance (ESA). Taking both of these benefits into account the overall number within the borough has remained relatively static, although more in depth analysis indicates that there has been a decrease in the number of younger households claiming benefits in South Tyneside.
• The number of households claiming income support in the borough has decreased by 20% within the last 2 years, which has decreased more dramatically within Beacon and Bents and Hebburn Quay wards. Notwithstanding this, the borough remain to have a high level of benefit claimants and a number of households that are solely reliant on the income from the benefits they receive.
• The level of benefit claimants varies considerably throughout the borough, with significantly higher numbers identified within Rekendyke for both JSA and ESA. There has also been an increase in the borough in benefit sanctions, which again can have significant implications for residents choosing to live a healthy life.
• This would have a direct impact on the ably for a households to afford their housing costs, and hence the most appropriate housing to meet their needs. Therefore there is likely to remain a need for affordable housing for a number of households in the borough.
• From the household survey that was conducted in 2013 there are a number of households who are struggling to meet their housing costs; there are 1.2% of the households (846 households) in the borough who are currently in housing need as they cannot afford their housing costs. There is significantly higher proportion of the privately rented tenants that cannot afford their housing costs and are finding themselves in housing need; many of these highlight that they are at risk of losing their home or are in currently arrears.

Households living in overcrowded accommodation

There have been 760 households identified as living in overcrowding housing within the borough. These are more likely to be currently living within social rented housing and be households that contain adult children, or a concealed household. Almost half of those currently living in overcrowded situation would need assistance to find suitable accommodation and would not be able to afford to off-set their housing need themselves. Notwithstanding this, over half of these households feel their home is the current size and are satisfied with their home, despite being overcrowded.

Older Persons Housing

• South Tyneside has an estimated population of 148,127 (Census 2011), which is projected to rise to 163,800 by 2031; despite this, the borough's population has been decreasing for several decades, with a 3.1% decrease since 2001. South Tyneside is made up of approximately 70,000 households, which indicates a 7.7% increase in the last 20 years, with a further projected increase of 14.3% by 2033. The greatest increase can be seen from the older cohorts, with a projected 20% increase in over 65 years over next 10 years and a 39.5% increase of those aged over 85 within the same period. This would result in 22.5% of the borough's population being of pensionable age. This dramatic shift within the population results in the need for consideration for future accommodation and services, this is one of the greatest challenges that the council face.
• The largest concentration of older people can be identified within the urban fringe, including Cleadon, Boldon and Whitburn; with lowest numbers living within Inner South Shields. From the households survey we can identify that the majority of older households live within the owner-occupied sector, although there is approximately one-third of older households live within the social sector.
• Encouragingly there are a lower proportion of older households that are currently living in housing need, or living within homes in disrepair. Notwithstanding this, there are a number of households that are living in multiple housing needs, as their current accommodation does not meet their needs. Not surprisingly the main reason is due to home being unsuitable due to mobility or special needs. The highest concentration of older households who are living in need live within South Shields Inner, with lowest levels within Hebburn.
• The highest percentage of older people living in housing need are within the private rented sector, with a number of older households having complex and multiple needs living within the private rented sector. On the other side of there are very few households who are currently living within social rented housing that need to move to off-set their needs as their current home meets their needs. Therefore, suitable high quality older person's accommodation in the owner-occupier sector in something that needs to be considered for the future.
• There was an identified issue with owner-occupied households finding it difficult to maintain their homes throughout the urban fringe, although a number of these households could afford to offset their need within the open market to move to a more appropriate property. Properties that have serious repair problems can be found within South Shields, but unlike younger households, these are more likely to be owner-occupiers and are unable to afford to undertake the repairs.

Housing Plus schemes

• There are a number of socially provided 'sheltered' schemes throughout South Tyneside; these offer independent living for older people with some security through digitally enabled support. The council have restructured the service and their sheltered schemes are now called the housing plus service; this restructure has had a significant impact on the desirability of the schemes.
• The level of demand for council older person's accommodation, including housing plus schemes, has seen a rise in recent years. Some individual schemes are less popular; this often relates more to location than to the quality of accommodation on offer. Demand for older people's housing is influenced by aspirations, and there is qualitative evidence that many older people in the borough are not looking to the traditional sheltered housing model as a priority choice. Regardless of this there are no long-term voids within any of the council housing plus schemes, with re-let times reduced and number of bids per property increased.
• The decent homes work that has been undertaken in the housing plus schemes has increased the desirability of these homes. This has included visual issues for older people, with contrasting kitchen units and work top surfaces and dementia-friendly design with different coloured doors, walls and carpets with clear signage and easily navigation of schemes. In addition, there has been additional funding given from Homes and Community Agency (HCA), which has looked to give the schemes additional facilities, such as ensuring all schemes are suitable for assistive technology equipment, connectivity through wi-fi and generally developing an environment to encourage using life skills where tenants feel safe. Public consultation has highlighted the desire for assistive call systems and social and community activities to assist with independent living.
• South Tyneside has an extremely high number of residents entering residential care, due to a break-down in their carer support; although the council and partners have worked hard to reduce this it remains a priority for the future.
• Through consultation within South Tyneside and further afield, residents wish to remain independent and part of the community as long as possible, rather than entering residential care. The council will work with their partners to ensure that choice is available to older residents and a planned approach to 'last time movers' is undertaken. Residential care has high levels of costs associated with it and research indicates the negative impact it can have on the quality of life for residents entering this sector.

Households with Support Needs

• From the households survey we can identified that 8.3% of properties have been either purpose-built for a person with a long-term illness, health problem or disability or has been adapted to meet their needs. A similar percentage of households stated that they current require care or support to enable them to remain within their current home.
• Adaptations undertaken within the private sector currently need to be means tested in order to gain access to the service, although anything under £1,000 is not means tested. Despite the on-going demand for adaptations within the borough there are trends pointing towards less stairlifts, level access showers and ramps. Improvements to steps and additions of handrails are the most common adaptations to accommodation that assists residents to remain in their own home safer and for longer.
• The funding to undertake adaptations has halved within the last three years, which has had a significant impact on the number of adaptations that can be undertaken.
• There are some properties that are very difficult to adapt, due to size or layout; this can include one-bedroom bungalows and sheltered schemes and flats with concrete floors. There are also problems with newly built three storey town houses. Although it may be best interest of the household to move to alternative accommodation this is often not what they want and therefore their housing aspirations needs to be weighed up against their support and health needs.
• In terms of the current adaptations budget for the borough, which covers all major and minor adaptations that is required to residents' homes, the vast majority of funding is allocated for major disabled facilities grant (93.4% of the budget), with the rest covering minor adaptations, such as handrails. Within the last financial year there were over 100 stairlifts installed.

Households were asked which housing options that they would consider in the future; that they felt would meet their needs. The percentage below highlights that renting in later life in something that some older households would consider. However, it is not known whether this is due to a lack of suitable alternatives to purchase.

Source: Strategic Housing Market Assessment Residential Survey 2013

• This clearly points to demand for renting by older residents, especially those who have support needs. From previous research it is suggested that this is often due to low incomes and the inability to undertake repairs and maintenance to their home; the 'fixed cost' of living in this type of accommodation makes it more attractive to those in this situation. It is also more likely that independent housing with low level support is within the social rented sector rather than there being an option within the private sector to purchase.
• The Housing LIN have produced an analytical tool to estimate the need for older person's housing; this takes into account the current population, population projections and the current supply of accommodation. These projections are split by housing type and tenure.
• A lower percentage of older people could afford to purchase a property in the borough or pay current private rent levels; although this differs considerably between locations and current tenure. Those older households currently living within Hebburn and South Shields Inner have the lowest income levels and are least likely to be able to afford open market housing. Not surprisingly all those living within social rented accommodation are unable to afford an alternative tenure; and those within unfurnished privately rented housing within South Shields Inner are currently struggling to pay their rent.
• Notwithstanding this, many older households were unaware of the value of the property and hence their equity this would have a significant impact on their ability to purchase suitable accommodation. The cost of bungalows on the open market within the borough, are at a premium, making them out of the reach of many of the older households who are currently resident in South Tyneside. The mix of future housing development needs to be considered to meet the changing requirements of residents.

• Again these tables point to the need for more adapted accommodation to meet the changing needs of our residents, the current budget cannot address this level of need. Without these adaptations it is suggested that some households will be living in unsuitable accommodation, which can lead to higher risk factors associated with their health and well-being.

In general some of the greatest issues that the borough faced in terms of unmet housing need are:

• Lack of extra care or specialist older persons accommodation
• Need for increasing number of adapted accommodation, for both aging population and disabled children
• Higher levels of affordable, high quality single persons accommodation
• Need for suitable supported accommodation for those who are unable to access the wider housing market due to their vulnerabilities

Affordable housing

• From analysis of the residential survey, secondary source data, housing market evidence and information from professionals in the field there has been an assessment to the future requirement for housing.
• The assessment identified a need for an additional 60 affordable units per year, to meet the housing needs of current residents unable to meet their housing need through the open market; these could include social and affordable rent or intermediate tenure. This would represent just less than 20% of all identified future housing development.
• The need for additional affordable housing is for one and two bedroom homes, throughout most areas of the borough but particularly Hebburn and Jarrow. Data suggests that those in need of affordable accommodation are mainly going to require social rented accommodation (57.3%), with almost one-third being able to access intermediate tenures.
• Additional affordable accommodation should be developed for different household types, dependant on the location the development takes place. Within Hebburn there is the need for additional older persons affordable housing, compared to Jarrow and Boldon were there is a need for affordable single persons housing and family homes within West Shields, Cleadon and East Boldon.

Open market housing

• There is also the need for additional open market accommodation within South Tyneside, to meet the increasing population and number of households. The residential survey points to the requirement for an additional 254 open market homes per year. This level of development is based on current residential levels and previous trends in household formation and inward migration; if the council made the decision to go for growth and actively increase the borough's population then this level of development may increase.
• From the current analysis it is suggested that open market accommodation be mainly medium sized homes, with the need for some two-bed housing for older persons and newly forming households.
• Specific demand can be seen within Hebburn and Inner South Shields, although the demand in these areas varies considerably. Demand within South Shields is likely to be for smaller two bedroom homes whereas Hebburn has demand for more medium and large family accommodation.

Institutional bedspaces

• There is no identified need for additional institutional bedspaces for students within the borough, with the majority of students opting for privately renting housing. The only requirement for institutional bedspaces is for the growing aging population. Data points to the need for extra care, residential care and nursing care provision within the borough; many of these extra care units should be provided for rent.

Aging Population

• The increasing aging population , and in particular the over 85 years cohort who have specific health needs, will have a significant impact on the level and type of accommodation that is required in the borough over the next 20 years. This will be addressed to a certain extend through the council's Local Plan which is due for publication in 2018.

The Housing LIN have undertaken some analysis on the level and type of older persons accommodation that may be required in South Tyneside to meet changing gp population. 2030 projections suggest:

No. Of units within South Tyneside by 2030:

• Older Persons Housing
• The current housing market within South Tyneside provides a higher than average level of affordable housing, with approximately one-quarter of houses in the borough being socially rented. The greatest proportion of these homes are council housing, which is currently managed by South Tyneside Homes. The social rented homes across the borough provide accommodation for a range of households, from families to older people.
• There is currently 33 Housing Plus accommodation within the borough, which provides 1,190 units of affordable specialist accommodation and low level support for older people through the council. These schemes include telecare alarms to offer security for older residents in an emergency. There is also four extra care accommodation provided through a range of service providers; Hagan Hall and Clasper Court, which are owned by the council, Campbell Court provided by Places for People and Hanover court is managed by Hanover.
• There is also higher level support accommodation provided in the borough through a number of residential and care homes. There is a wide range of residential and care provision throughout the borough, although the spread is not evenly distributed. A number of the dementia and nursing care provision is managed by the private sector, with the greatest concentration located within South Shields town centre.
• The quality of residential housing and nursing care homes within South Tyneside is generally high, with all of the council's care homes reaching all standards set by the Care Quality Commission. The cost of private residential homes is of concern to many households on lower incomes.

Carers in South Tyneside

• There is not a significant difference in the percentage of carers between the locations across the borough, but it can be seen that South Shields East, South Shields West and Jarrow have a the largest concentration and South Shields Inner and Urban Fringe have the lowest. The greatest concentrated of full-time carers within South Tyneside can be found within social rented accommodation, with 4.1% of council tenants and 4.4% of RP homes containing a full-time carer. There are much lower percentages within owner-occupier and privately rented sectors.
• The majority of these households live within family accommodation and very few have specialist housing; notwithstanding this, there are over three-quarters which have adaptations to their home. There are significantly lower satisfaction levels with current accommodation and significantly higher percentage of households highlighting that their current accommodation is too small for their needs.
• The Carers Association in South Tyneside (CAST) provides individual support, information, advocacy and respite services for family and unpaid carers from the age of 5.

Other Resources

South Tyneside Carers

Mental Health Concern: Carer Support, Carer Support - Mental Health Concern has a dedicated service to support carers of people with mental health difficulties.

KEY Project, KEY Project help young people in South Tyneside who are in danger of becoming or have been homeless.

Wellbeing info: Places for People: South Tyneside Women's Aid, Places for People South Tyneside Women's Aid provides safe, temporary accommodation for women and their children who have been a victim of domestic violence.

Further details can be found at Wellbeing info.

During the development of the borough-wide integrated housing strategy in 2014 the council undertook some public consultation. Although these results are not statistically valid they do give an indication of views on older person housing and supported and specialist accommodation.

We also undertook some focus group work with older people and these are the issues that they raised for housing in the borough. There was a mixture of council tenants, tenants renting from RPs, private tenants and owner-occupiers. These are the main issues raised within the focus groups:

• Security of tenure was very important, it was felt that when living in private rented or on a short-term tenancy this can cause high levels of stress and property does not feel like their 'home'
• There was also mention of secure for younger families that may lose their jobs and be unable to meet their housing costs due to changes in the benefit system
• Improving accessibility of areas could improve desirability of different property types - i.e. a shuttle bus around sheltered/older persons housing areas
• There needs to be amenities close by, including shops, doctors - within walking distance or accessible for bus service
• Issues with lack of car parking facilities
• Design of some older persons housing needs to be looked at as a number of properties are very small or built a long time ago. Suggestion of knocking two bungalows or flats into one for better quality accommodation
• Discussion around the mismatch between supply and demand, for example high demand for two bedroom bungalows and very few available
• Remodelling of sheltered schemes, the current dated format is more like a hotel reducing the feeling of independence
• There was a suggestion that older people find social renting desirable as they don't want the responsibility and stress for doing own repairs and there is a security of tenure
• Hard for people to downsize if they want to (discussed in terms of understanding allocations policy and none IT access to bid)
• Also difficult to downsize as there is a lack of suitable sized properties
• Needs to be mixed communities and not just older person housing and the area get stigmatised
• Some older properties have issues with maintenance and cost of heating etc.
• Was some appreciation (from some) that bungalows are limited and will stay that way
• Felt some property types i.e. large maisonettes were unsuitable for older people
• Lack of knowledge of help and advice out there relating to housing - pamphlet detailing housing options, adaptations, maintenance etc.
• Take the development hit on some sites where older persons housing would be ideal
• People want to remain in their own home, how can this be achieved
• Issue with properties in conservation areas, not allowed to make any changes to the external therefore if required ramp or wider doors would need to move
• There needs to be the development of terraced bungalows
• No need for large gardens for older people but could offer a handyman service
• There is an issue with stock lost to Right To Buy and an issue in Buy To Let being an issue in private rented accommodation

• One of the greatest challenges with assessing the current level of housing need and the requirement for future accommodation is the lack of an up to date private housing stock condition survey. This would enable an understanding on the quality of the housing within the private sector, identification of the SAP ratings to assist with fuel poverty and an assessment of the work that is required within the private sector.
• Regular monitoring of homeless figures and the health needs of this cohort of residents is essential to shape suitable services for this group and reduce the pressure on emergency services used by homeless individuals, through more effective prevention services.

Last updated: October 2016