Building Health into Homes: Strategic Report

Housing is a foundation for living well – but too many people live in environments that don’t meet their needs. When homes fail, the consequences are profound for individuals and for the systems that support them.  

When housing is unsafe, insecure or inaccessible, it undermines people’s health and participation in daily life, including their ability to access education and employment.

This makes housing a powerful lever for positive change. We can improve health, reduce inequalities and enable people to live well for longer by shaping homes and communities that are safe, inclusive and supportive. 

Demand for health and social care services is rising, the complexity of people’s needs is increasing, and we’re experiencing a housing crisis that is also a public health crisis. Poor housing accelerates health decline, drives inequality and increases health and care demand. 

At present:

• 3.5 million homes in England are classed as non-decent, housing 7.5 million people
• 87% of homes in England fail to meet basic accessibility criteria
• In Scotland, one in five wheelchair-user households has unmet housing needs

Children in overcrowded homes face poorer health and lower attainment. Adults with unmet accessibility needs are four times more likely to be unemployed.

Policy across all UK nations is shifting towards prevention, community-based services, and population health. Housing must be central to this agenda. Acting early, before poor conditions harm health, saves lives and money. 

On the other hand, if the risks and opportunities created by homes aren’t considered, the shift to community-based prevention is likely to fail.  

Enabling cross-sector collaboration

The health, housing and social care systems operate too often in silos. This means that opportunities to act preventatively and collaboratively are frequently lost.  

Occupational therapists are uniquely placed to drive a shift to more effective collaboration between housing and health. They already work at the intersection of housing, health and social care. Their expertise in the relationship between people, their environments and their daily activities, enables them to bridge sectors, design inclusive solutions and deliver integrated, person-centred care.

The economic case for investment

The report summarises evidence that occupational therapy-led housing interventions can deliver measurable system benefit and return on investment, including avoided costs and improved outcomes. 

For example:

• £65,000 saved in three months through strategic OT interventions in Wiltshire
• up to £1.4 million saved from adaptation budgets in the London Boroughs of Richmond and Wandsworth
• £67,000–£100,000 economic benefit per wheelchair-accessible home over 10 years
• 62p return for every £1 spent on preventative work to reduce falls on stairs.

A unique skillset

Occupational therapists can work at multiple levels simultaneously – supporting individuals with complex needs, shaping resource allocation and service design, and influencing policy and planning at a strategic level. They are well placed to review building proposals early, promote universal design principles, advise on housing allocation, and ensure homes meet real-world needs and not just technical standards.

In some locations, occupational therapists are already increasing their impact through housing interventions:  

• Supporting people experiencing homelessness to access stable housing and improve health.
• Helping neurodivergent individuals create environments that meet their needs.
• Enabling people leaving inpatient mental health services to develop household skills and maintain tenancies.
• Shaping policies for ageing in place and influencing new-build design.
• Advising on housing stock allocation, rehousing decisions and planning and regeneration schemes.

The case for change is clear and the evidence is strong. Housing is a fundamental human right and a core social determinant of health. Where homes fail to meet people’s needs, through poor condition, inaccessibility or insecurity of tenure, the consequences ripple outwards – declining health, rising demand for care, deepening inequality, and mounting costs for the public purse.

These consequences are not inevitable. They are, in large part, avoidable. Acting earlier, designing better, and connecting services more effectively can prevent ill-health, support independence and reduce pressure on overstretched systems. But this cannot be achieved by housing, health or social care working alone. The challenge is inherently cross-sector, and the response must be too.

If more systems invest in the occupational therapy workforce, embedding it in strategic roles, removing structural barriers to cross-sector working, and aligning funding with prevention goals, the benefits for individuals, communities and society will be far-reaching. The potential is there. It needs to be unlocked. 

This isn't a niche customer group that you're being able to support through an OT. It's almost everyone that lives within the services, and that's what the added value can come from. 

Assistant Director, Housing Support Service

Our report sets out four recommendations for politicians, policymakers and system leaders. In summary, we call on decision-makers to:

1. Strengthen system leadership across housing, health and care by embedding specialist expertise that brings a preventative and enabling perspective into policy, governance and commissioning, so housing is consistently treated as a core determinant of health.
2. Shift investment upstream towards prevention and early intervention by acting earlier on housing‑related risks to independence and safety, avoiding the need for crisis responses, and reducing long‑term health, care and housing costs.
3. Deliver accessible and adaptable housing at scale by introducing baseline accessibility standards for all new‑build housing, ensuring homes are designed to support participation across the life course and limit the need for costly future adaptations.

4. Build workforce capacity to deliver joined‑up, place‑based solutions by strengthening senior professional leadership and enabling practitioners to work across housing, health and care boundaries, connecting strategic intent with effective delivery. 

    

When I realised what a benefit it was having [occupational therapists] at the earlier stages of planning… we were able to build something future-proof.

Regional Director, ADASS