The Housing Health and Safety Rating System

The Healthy Homes Rating System

Interactive tool

• https://drive.google.com/folderview?id=0B8REr4fsWecuRnJBXzYxSzE4cDg&usp=sharing

• Windows only

Aims of the Session

• Learn about the use of the Healthy Homes Rating System in England

• Focus on health impacts from housing and their relevance from an English perspective

• See two software tools– Interactive house– Health Cost Calculator

Aims of the Session

• Learn about the use of the Healthy Homes Rating System in England

• Focus on health impacts from housing and their relevance from an English perspective

• See two software tools– Interactive house– Health Cost Calculator

WHAT IS THE HEALTHY HOMES RATING SYSTEM?

Principle behind rating system

A dwelling, including the structure and associated outbuildings and garden, yard and/or other amenity space, should provide a safe and healthy environment for the occupants and any visitors.

What is it...? • It’s how we evaluate potential risks to

health and safety that may arise from deficiencies in a dwelling

• It looks at:– Likelihood of harm– Probable severity of that harm

• It assesses 29 different hazards• Comfort does not matter!

Categories of hazard

• Physiological requirements – e.g. damp and mould growth, excess cold, excess

heat, carbon monoxide, lead, VOC’s• Psychological requirements

– e.g. entry by intruders, lighting, noise• Protection against infection

– e.g. food safety, sanitation• Protection against accidents

– e.g. falls, fire, structural collapse

All The Hazards 1. Damp and mould growth2. Excess cold3. Excess heat4. Asbestos (and MMF)5. Biocides6. CO and combustion products7. Lead8. Radiation9. Uncombusted fuel gas10. VOCs11. Crowding and space12. Entry by intruders13. Lighting 14. Noise

15. Domestic hygiene, pests and refuse16. Food safety17. Personal hygiene, sanitation and

drainage18. Water supply19. Falls associated with baths20. Falling on level surfaces etc.21. Falling on stairs etc. 22. Falling between levels23. Electrical hazards24. Fire25. Flames, hot surfaces, etc.26. Collision and entrapment27. Explosions28. Position and operability of amenities29. Structural collapse and falling

elements9

Hazard profiles

For each hazard:• Definition is offered• Potential for harm is identified• Vulnerable groups are identified• The ‘ideal’ is identified• Relevant features are described• Guidance is developed

Health outcomes

Four classes of harm identified• Class 1 – extreme• Class 2 – severe• Class 3 – serious• Class 4 - moderate

Class 1

Examples include:• Death from any cause; • Lung cancer; • Mesothelioma and other malignant lung tumours;• Permanent paralysis below the neck; • Regular severe pneumonia; • Permanent loss of• consciousness; • 80% burn injuries.

Class 2• Cardio-respiratory

disease; • Asthma; • Non-malignant

respiratory diseases; • Lead poisoning;• Anaphylactic shock; • Crytosporidiosis; • Legionnaires disease; • Myocardial infarction;

• Mild stroke; • Chronic confusion; • Regular severe fever; • Loss of a hand or

foot; • Serious fractures; • Serious burns;• Loss of

consciousness for days

Class 3 – serious harm outcomes• Eye disorders; • Rhinitis; • Hypertension; • Sleep disturbance; • Neuro-pyschological

impairment; • Sick building syndrome; • Regular and persistent

dermatitis, including contact dermatitis;

• Allergy; • Gastro-enteritis; • Diarrhoea; Vomiting;

• Chronic severe stress; • Mild heart attack; • Malignant but treatable skin

cancer; • Loss of a finger; • Fractured skull and severe

concussion; • Serious puncture wounds to

head or body;• Severe burns to hands;• Serious strain or sprain

injuries; • Regular and severe migraine.

Class 4• Regular serious colds or coughs• Pleural plaques; • Occasional severe discomfort; • Benign tumours; • Occasional mild pneumonia; • Broken finger; • Slight concussion; • Moderate cuts to face or body; • Severe bruising to body; • Regular serious coughs or colds.

Linking deficiencies to hazards

• Once identified, deficiencies must be allocated to a hazard

• A deficiency may contribute to more than one hazard

• Several deficiencies may contribute to one hazard

Deficiencies to Hazards

• It is the cumulative contribution of the deficiencies to the hazard that should be assessed

• It is a whole dwelling assessment for each hazard

• Assumes the ‘at risk group’ inhabit the property

BOX 1

Similar Hazards, with Differing Outcomes

Example –

There is a window with a low internal sill (about 250mm above the floor). A small child could climb onto the sill and open the window relatively easily and could fall out through the open window. The likelihood of this occurring over the next twelve months is judged to be around 1 in 180.

If that window is on the ground floor with grass immediately below, the outcome would be relatively minor – 99% Class IV (bruising) and perhaps 1% Class III (a strain or sprain). This would give a Hazard Score of 7 (Band J).

However, if that same window is on the 2nd floor with a paved area immediately below, the outcome would be major – 10% Class I (paralysis or even death), 80% Class II (serious fractures) and 10% Class III (a strain or sprain). This would give a Hazard Score of 1,016 (Band C).

Although in both cases the likelihood is the same, the Hazard Score reflects the dramatically different outcome.

USE OF THE HEALTHY HOMES RATING SYSTEM IN ENGLAND AND WALES

Housing Act 2004• HHSRS (HHRS) is

enshrined in legislation

• England and Wales assessment system for all housing

• Stock condition surveys

• Decent Homes Standard

Issues with UK housing

1. Excess cold2. Falls on stairs3. Falls on the level4. Falls between levels

5. Fire, damp and mould, hot surfaces, radon, pests

6. Overcrowding, electrical, CO, sanitation, noise

Increasing awareness

• Attitudes• Ignorance• Political will• Prevention vs cure• Old housing• Fuel poverty

Interactive tool

• https://drive.google.com/folderview?id=0B8REr4fsWecuRnJBXzYxSzE4cDg&usp=sharing

• Windows only

Quantifying improvements and justifying your work

• Hard to measure something that has not occurred

• Justify expense of interventions• Interventions can vary in cost

considerably

BRE, 2008

• Quantifies poor housing

• Providing a tool for policy

Funded by BRE Trust and carried out by BRE in partnership with the Universities of Warwick and Brighton

Costs to society of living with HHSRS hazardsIssue Cost

Poor physical/mental health/social isolation Higher healthcare costs

High home fuel bills High building heating costs

Uninsured contents losses Spending on building security/possessions

Living with repairs needed High housing maintenance costs

Under-achievement at school Extra costs on school budgets/tutors

Loss of talents to societyLoss of future earnings

Personal insecurity High policing costs

More accidents High emergency services costs

Poor hygienic conditions High environmental health costs

Costs of moving Disruption to service providers

Adopting self-harming habits Special health-care responses

(adapted from BRE, n.d.)

Typical Healthy Homes Rating System outcomes and 1st year treatment costs (40% of total costs)

Hazard Class 1 Class 2 Class 3 Class 4

Damp and mould N/A Type 1 allergy(£1998/$3342)

Severe asthma (£1120/$2040)

Mild asthma (£180$301)

Excess cold Heart attack, care, death (£19851/$33206)

Heart attack (£22295/$37295)

Respiratory condition (£519/$868)

Mild pneumonia (£84/$140)

Radon Lung cancer, death (£13247/$22159)

Lung cancer survival (£13247/$22159)

N/A N/A

Falls on the level Quadraplegic (£59246/$99106)

Femur fracture (£25424/$25424)

Wrist fracture (£745/$1261)

Treated fro cut/bruise (£67/$112))

Falls on stairs and steps

Quadraplegic (£59246)/$99106

Femur fracture (£25424/$25424)

Wrist fracture (£745/$1261)

Treated fro cut/bruise (£67/$112)

Fire Burn, smoke, care, death (£11754/$19662)

Burn, smoke, care (£7652/$12800)

Serious burn to hand (£2188/$3660)

Burn to hand (£107/$178)

Hot surfaces and materials

N/A Serious burns (£4652/$7781)

Minor burn (£1234/$2064)

Treated very minor burn (£107/$179))

(BRE, n.d.)

Health Cost Calculator• Building Research Establishment & RHE

‘The Trust commissions research into the challenges faced by the built environment and publishes project findings which act as authoritative guidance to the construction industry’

(BRE, 2014)• Uses direct costs of medical treatment and aftercare

(<1yr)– Robust data

• Probably accounts for 40% of total costs

Health Cost Calculator• Uses reduction in probability of category

1 hazardous event and severity of outcomes

• Provides projected savings on healthcare costs based on NPV calculations

• Gives account of costs vs savings– Payback period

• Cumulative record for area based work

Cost of work (£)

Expected Cost to NHS (£)

Expected Cost to NHS (£)

HAZARD Mitigated

How it all works

Work

HAZARD

/

-=

Saving (£)

= Payback period

Example

• Cost to fit banister £400/$669

• Annual savings on healthcare £146/244

• Payback 2.7 years

Area based work (courtesy of Bristol CC)

Savings from five officers working across a 460,000 person city (courtesy of Bristol CC)

Payback period for officers’ work (courtesy of Bristol CC)

• Cases can be added one by one

• You can identify dwellings by address, UPRN or both

• HHRS system uses representative scale points

• NHS costs and costs to society appear at the bottom of the screen

THANK YOU FOR LISTENING

Henry Dawsonhdawson@cardiffmet.ac.uk