POOR housing is driving avoidable pressure across health and social care services and damaging people’s health. Millions of people are living in homes that do not meet their needs, identified in a new report by the Royal College of Occupational Therapists (RCOT).

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
· 87% of homes fail to meet basic accessibility criteria
· One in five wheelchair user households in Scotland has unmet housing needs
· Poor housing costs the NHS in England £1.5 billion annually.

RCOT is calling for the governments of all four nations, local governments, and health, social care and housing systems to work together to address where people live. Health prevention and system reform can only be delivered once housing needs are met.

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.

Martha Hall, who lives with a physical disability and complex mental health challenges, was consulted for the report and toolkits. At one point, she was stuck in hospital over a year longer than needed while she was waiting for suitable accommodation. Repeated gaps in adaptations, accessibility and support harmed her wellbeing and things only started to improve when an occupational therapist assessed her needs in full. She now lives in a home that meets her needs, showing how better, joined‑up housing decisions can transform lives.

Martha said:
‘When I was facing homelessness, I felt like I was begging for the tiniest sliver of dignity throughout that entire process. Later, I was left in an unsafe property due to bureaucracy: Disabled Facilities Grants don’t cover temporary accommodation and no one would fund it. Now, I finally feel lucky to be in a home that meets my needs, as I know many people are inadequately housed. But I shouldn’t have to feel lucky. Accessible housing should be a given. Your home is meant to allow you to live your life to the best that you can, to open up the world to you, not close it down.’

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
· 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.

For more information about Building Health into Homes or to read the full strategic report, visit: rcot.co.uk/health-into-homes