Tackling cold homes would save the NHS £540mn per year, new BRE research reveals

Tackling cold homes would save the NHS £540mn per year, new BRE research reveals

New analysis of the latest English Housing Survey data by the Building Research Establishment (BRE) finds that excessively cold homes in England could be costing the NHS £540mn a year in preventable costs.

BRE’s latest analysis quantifies the cost to the NHS of poor quality homes in England broken down by tenure by the first time:

  • Over 700,000 homes in England are defined as excessively cold

  • The NHS spends over £540mn a year treating people affected by the worst properties

  • Investing in repairs and upgrades would pay back within 9 years


Today, BRE publishes The Cost of Poor Housing by tenure in England, which follows its 2021 analysis on the overall cost of substandard housing to the NHS. For the first time, BRE’s research provides a breakdown of the impact of poor housing (1) on the NHS in each of the owner occupied, privately rented, and socially rented sectors.

Of the 2.4mn homes in England which BRE identified as having a Category 1 hazard (2), there are 700,000 homes that are officially assessed as excessively cold.

This means that millions of people across the country could be at risk of ill health as a result of poorly insulated and inadequately heated properties. Excess cold is most prevalent among properties that are owner occupied or privately rented – homes which are more likely to have the lowest energy efficiency ratings (a band F or G). Over half a million owner occupied properties and 200,000 privately rented homes fall into this category.

Because of the long-running Decent Homes Standard regulations in the social housing sector, a comparatively small number – just over 20,000 – socially rented homes are excessively cold. Those living in owner occupied properties are most at risk of ill health caused by excess cold given their age, an average of 58 (3), and health status.

The NHS bill to treat people impacted by excess cold of £540mn per year could be mitigated if action was taken to improve the efficiency and quality of England’s housing stock, with a pay back of between 8 and 9 years.

Gillian Charlesworth, CEO, BRE, commented: “Today’s analysis reminds us just how much of an impact poorly insulated and inadequately heated homes are having on residents and our public services, particularly in the poorest quality properties. Poorly insulated homes have an immediate impact on the health of the people who live in them, as well as being expensive to heat and a barrier to meeting our net zero ambitions. When local and national government know where the most problematic homes are from data like these, they can design targeted programmes to improve them.

“But these results are the tip of the iceberg. These are only the direct costs to the NHS of treating health problems from the very least energy efficient homes. With the current energy price crisis, families living in a much wider group of homes will be struggling to heat their homes this winter and so even more people are likely to face health problems as a result. This leaves them unable to work, and potentially having to remain in hospital for a long time if their home isn’t safe to return to, meaning that the impact on the wider economy is even greater.”

“Strategic retrofit programmes are critical to improving the energy efficiency and safety of a property. We need to see a continued and targeted effort to improve England’s poorest homes, for the benefit of individuals, society and our public infrastructure” – Gillian Charlesworth CEO of BRE.

BRE’s research shows that if immediate steps were taken to mitigate the impact of excess cold across England’s poorest quality homes – through cost-effective solutions like insulation and heating system improvements – it would cost £5.3bn.

When broken down by tenure, BRE estimates that it would cost, on average, £6,690 to remedy excess cold for an owner-occupied property and £6,835 per property in the private rented sector.

A government policy – Minimum Energy Efficiency Standards – is in place to require landlords to improve excessively cold private rented properties. However, landlords only need to spend a maximum of £3,500 including VAT to improve their property towards the required minimum EPC “E” target.

The new BRE research shows that £3,500 is sufficient to bring only 30-40% of excessively cold private rented homes to an “E” standard.

As individuals and families grapple with the cost of living crisis, these prices will be out of reach for many, and owner occupier households and private landlords may need targeted government support to be able to rectify hazards in their properties.

To this end, BRE continues to call for a strategic retrofit programme that will improve the quality of England’s housing stock and provide the financial incentives needed to drive standards up. That needs to target the very least energy efficient homes directly, and provide wider support for the UK’s transition to warm, well-insulated homes.

Investment now could deliver relatively rapid savings for the NHS, freeing up health funding for desperately needed spending in other areas.

Gillian Charlesworth added: “It’s clear from our research that there are major benefits to be reaped from improving the efficiency of England’s homes, particularly as households grapple with record energy prices and public services face significant pressure. However, while progress is being made in this area with new funding being allocated to home insulation, we still have a long way to go.

“Strategic retrofit programmes are critical to improving the energy efficiency and safety of a property. We need to see a continued and targeted effort to improve England’s poorest homes, for the benefit of individuals, society and our public infrastructure.”

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.

See more research from BRE

Notes to Editors
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1 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.
2 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. See more here:
3 EHS 2019 to 2020 Headline report, Section 1, household tables, Annex Table 1.4.

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.