Hazards that cause people to fall in England’s poor homes are costing the NHS £401mn per yea

The NHS is facing a cost of £401mn per year to treat people who are impacted by hazards which cause falls
Unsafe staircases and external steps the biggest risk in 1mn of England’s poorest quality homes
Under £500 average cost of mitigating these hazards – with a relatively quick payback to the NHS

New analysis by the Building Research Establishment (BRE) reveals that hazards which cause occupants to fall and injure themselves in the poorest quality homes in England are costing the National Health Service (NHS) £401mn a year.
Given that older people are most at risk from serious harm from a fall on staircases or steps, poor housing due to unsafe stairs is of particular concern for our ageing society. The average age of a homeowner is 58, with a third 65 years or over1, while over half (54%) of social renters have one or more household members with a long-term illness or disability. Falls prevention is therefore critical to deliver safer housing as well as reduce the cost burden to the NHS.

BRE’s analysis found that most of these hazards are relatively inexpensive to fix and could provide a quick payback to the NHS if investment was made now to rectify them across substandard housing.

This additional analysis comes from BRE’s recent report The Cost of Poor Housing by tenure in England, which for the first time provides a breakdown of the impact of poor housing2 on the NHS between the owner occupied, privately rented, and socially rented sectors.

Falls on stairs were the most common Category 1 hazard3 across the different tenures which BRE explored as part of its analysis.

Staircases and unsafe external steps in just over 1mn properties posed a risk to occupants, with these being more prevalent than falls on the level and falls between levels. Over 680,000 owner occupied homes had a Category 1 hazard which could cause people to fall on their staircase, while the same is true of around 251,000 private rented and 80,000 social rented properties.

Gillian Charlesworth, CEO, BRE, commented: “Our analysis shows just how acute hazards in the home are, particularly those that cause people to fall and injure themselves – yet falls are often an overlooked cause of injury. While many will not result in a serious injury, falls can be particularly dangerous for older people. If their homes aren’t safe, then it can take a long time for them to be discharged from hospital.”

BRE’s research shows that simple safety measures such as installing handrails on dangerous stairs are relatively inexpensive but very cost effective. For example, over half of falls on stairs hazards in owner occupied homes could be mitigated for less than £500. Overall, rectifying these types of hazards in all tenures would cost almost £2bn.

Gillian Charlesworth added: “Hazards that cause falls can be easily mitigated to improve the safety of homes and reduce the cost burden to the NHS over a relatively quick period.

“I would encourage everyone who regularly visits older relatives and friends to check that there is a secure handrail on the staircase and any external steps. We would also welcome greater financial support from national and local government to ensure that older people can safely stay in their own homes.”

Following its latest report, BRE will be publishing a 30-year cost benefit analysis on the cost of all poor housing to the NHS and wider society later this year.

Notes to Editors
For all press enquiries, please contact brepress@pagefield.co.uk
1 EHS 2019 to 2020 Headline report, https://www.gov.uk/government/statistics/english-housing-survey-2019-to-2020-headline-report, Section 1, household tables, Annex Table 1.4.
2 For the purposes of BRE’s report, ‘poor housing’ is defined as ‘a dwelling that fails to meet the statutory minimum standard of housing in England’, i.e., a dwelling that contains one or more Category 1 Housing Health and Safety Rating System (HHSRS) hazards.
3 The Housing Health and Safety Rating System (HHSRS) assesses 29 housing hazards and the effect that each may have on the health and safety of current or future occupants of the property. The HHSRS provides a way that hazards can be assessed and the best way of dealing with them identified. If a hazard is a serious and immediate risk to a person’s health and safety, this is known as a Category 1 hazard. If a hazard is less serious or less urgent, this is known as a Category 2 hazard.
BRE’s full report – The Cost of Poor Housing by tenure in England – can be found here: https://bregroup.com/news-insights/the-cost-of-poor-housing-to-the-nhs/
Methodology
In 2021 BRE published ‘The cost of poor housing in England’ briefing paper to update its earlier 2016 research on ‘The Full Cost of Poor Housing to the NHS’.
The cost of poor housing by tenure replicates the methodology used in our previous research. We have applied this methodology to owner occupied, private rented and social rented homes using the latest publicly available English Housing Survey (EHS) data (2019) on health and safety hazards in the home and costs to mitigate them. In addition, NHS treatment cost data has been updated to 2019 prices.
For each tenure the BRE calculation model uses the following data:
1. The number of homes with each type of Category 1 hazard and the total number of homes with at least one of these hazards
2. The average and total repair cost of making these homes acceptable (so that the risk of harm is no higher than average), modelled using EHS data
3. The costs to the NHS of leaving the hazards un-mitigated
4. The NHS pay-back period of mitigating the hazards now
To estimate the cost of poor housing to the NHS, the research uses data from publicly available NHS treatment cost data, predominantly the National Schedule of Reference Costs for 2017-18 (NHS Trusts and NHS Foundation Trusts) which have been inflated to 2019 prices.