BRE Health – the role of the built environment in social programmes - healthcareAndrew Williams, Director of Innovation, BREDr Ranjit Bassi (bassir@bre.co.uk)Dr Keith Quillin (quillink@bre.co.uk)

The role of the built environment to 2020 and beyond

Winston Churchill

‘we shape our buildings thereafter they shape us’

This is not news; but we are entering a new era where its importance will escalate rapidly

– we must now deliver social equity (social programmes)……. sustainably (in that order!)

The National Academy of Public Administration defines the term as “The fair, just and equitable management of all institutions serving the public directly or by contract; the fair, just and equitable distribution of public services and implementation of public policy; and the commitment to promote fairness, justice, and equity in the formation of public policy.

OECD 63 p.c. scenario breakdown: EXTREME SCENARIO

Scenario 6: Other Spending Growing at trend and Lower GDP Growth (IFS - Assumption) accounting for 2009 GDP reduction                        

Age related Public Expenditure 1999 2000 2009 2010 2011 2012 2025 2026 2027 2028 2029 2030

Education 4.5% 4.5% 6.0% 6.1% 6.1% 6.2% 6.8% 6.8% 6.9% 7.0% 7.0% 7.1%

Pension2 7.3% 7.8% 8.5% 8.6% 8.7% 8.7% 10.3% 10.5% 10.6% 10.8% 11.0% 11.1%

Health 5.3% 5.2% 8.0% 8.1% 8.2% 8.3% 9.9% 10.0% 10.2% 10.3% 10.5% 10.6%

Total Age related spending 17.1% 17.5% 22.5% 22.7% 23.0% 23.2% 27.0% 27.3% 27.7% 28.1% 28.4% 28.8%

Other Spending                        

General Public Services3 4.5% 3.9% 3.9% 3.8% 3.8% 3.7% 3.3% 3.2% 3.2% 3.2% 3.1% 3.1%

Defense 2.7% 2.7% 2.6% 2.6% 2.6% 2.6% 2.5% 2.5% 2.5% 2.5% 2.5% 2.5%

Public Order and Safety 2.0% 1.9% 2.5% 2.6% 2.6% 2.7% 3.7% 3.8% 3.9% 4.0% 4.1% 4.3%

Economic Affairs4 2.2% 2.3% 3.1% 3.3% 3.4% 3.5% 5.9% 6.1% 6.4% 6.6% 6.9% 7.2%

Environmental Protection 0.5% 0.5% 0.8% 0.8% 0.8% 0.9% 1.7% 1.8% 1.9% 2.0% 2.1% 2.2%

Housing and Community Amenities 0.6% 0.5% 1.1% 1.1% 1.2% 1.2% 2.6% 2.8% 3.0% 3.1% 3.3% 3.5%

Recreation, Culture and Religion 0.8% 0.8% 1.0% 1.0% 1.0% 1.0% 1.3% 1.4% 1.4% 1.4% 1.5% 1.5%

Social Protection5 5.6% 5.2% 6.0% 6.1% 6.2% 6.3% 7.2% 7.3% 7.4% 7.5% 7.6% 7.7%

Accounting Adjustments 1.4% 1.2% 1.7% 1.8% 1.8% 1.8% 2.2% 2.3% 2.3% 2.3% 2.4% 2.4%

Total Other Spending 20.4% 19.1% 22.6% 23.0% 23.3% 23.7% 30.5% 31.2% 31.9% 32.7% 33.5% 34.3%

Total Public Expenditure 37.5% 36.6% 45.1% 45.7% 46.3% 46.9% 57.5% 58.6% 59.6% 60.7% 61.9% 63.1%

Just a new way of thinking!

• But as the OECD's Berglind Asgeirsdottir puts it (the burden of ageing population):

"Speaking of the 'burden'... will only be valid if we fail to restructure society and its institutions to reflect these new realities”

The influences on the built environment will be significant

• Buildings should not be passive in how they consume resources or respond to the way we use them

• Significant increase in energy costs (70%) • Potential brown-out in 2018/20• New service models for healthcare, LA services, inclusion, safety

etc• Grid supply energy models will change – more local renewables –

demand management• Communication networks and capabilities will grow• Data liquidity = financial liquidity• New commercial data/energy models with High Street names• As platforms become ubiquitous, ‘consumer electronics’ will hit hard

THE STOCK

Age profile for the projected domestic UK building stock

2010 2015 2020 2025 2030 2035 2040 2045 20500

5000

10000

15000

20000

25000

30000

35000

Pre-1918 1918-38 1939-59 1960-75 1976- New

8

Age profile for the projected non-domestic UK building stock

Analysis1 By 2050, 60% of the building stock will have been built prior to 2010.2 To achieve an 68.4 MtCO reduction in CO2 emissions by 2050, improvements to existing buildings will be required alongside the construction of new zero-carbon buildings.

BRE, 2010 Energy Efficiency in New and Existing

Buildings...

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

2010 2015 2020 2025 2030 2035 2040 2045 2050

Pre-2010 2011-2015 2016-2020 2021-2025 2026-20302031-2035 2036-2040 2041-2045 2046-2050

WHAT ABOUT THE STOCK?IT IS RELATIVELY WELL UNDERSTOOD THANKS TO CLG AND THE ENGLISH HOUSING SURVEY, FOR EXAMPLE

Why the need for a national survey?

• Established link between poor housing and poor health• Housing stock old – difficult to manage and maintain• Difficult to adapt to modern requirements• Difficult to make energy efficient• Many owners don’t have resources for

upkeep/improvement• Limited funds for social housing• Mismatch between housing need and provision.

Physical and social data

• The EHS collects more than just data on the physical building:– age– type of the home– current occupants– household type– income– details of any occupants with disabilities– etc.

Decent homes – the current standard for housing

• Four key components– Housing Health and Safety Rating System (HHSRS)– Thermal Comfort– Disrepair– Modern Amenities

Lets consider one aspect, HHSRS

The HHSRS is based on…

1. Damp and mould growth2. Excess cold3. Excess heat4. Asbestos (and MMF)5. Biocides6. Carbon Monoxide and fuel combustion

products7. Lead8. Radiation9. Uncombusted fuel gas10. Volatile Organic Compounds11. Crowding and space12. Entry by intruders13. Lighting14. Noise15. Domestic hygiene, Pests and Refuse16. Food safety

17. Personal hygiene, Sanitation and Drainage

18. Water supply19. Falls associated with baths etc 20. Falling on level surfaces etc21. Falling on stairs etc 22. Falling between levels23. Electrical hazards24. Fire 25. Flames, hot surfaces etc 26. Collision and entrapment 27. Explosions 28. Position and operability of amenities etc 29. Structural collapse and falling elements

Health Impact Assessment of mitigating falls on stairs hazards for West Lancashire

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25£0

£50,000

£100,000

£150,000

£200,000

£250,000

£300,000

£350,000

£400,000

£450,000

Savings achieved each year and cost of repairs

NHS costs saved this year Cost of repairsYears

BRE HEALTH

UK Population

BRE Health

Digital & smart buildingsBuilding fabric Social & Health

Provision

BRE Health

• To develop a decision support tool and associated consultancy services to enable built environment designers and commissioners to:

• Understand the options available to provide digital health and social care within a range of domestic built environments for whole population groups, and using new build and retrofit programmes (strategic)

• Be able to assess the digital health and social care requirements of specific groups within wider populations and to understand the related domestic built environment options (strategic)

• Be able to design large scale and individual retrofit programmes to maximise the potential for digital inclusion of residents including provision for future digital health and care requirements at minimal up front cost and minimising future costs (practitioner)

• Develop a methodology for assessing the building for delivering, services required, minimum requirements of services and user needs.

BRE Health – proof of concept

• Care homes (developing now)• Gated communities• Residential• Polyclinics/PCTs• Communities

BRE Health

BRE Health in action

BRE Health – a driver for change?

• Help manage and optimise service delivery (with many others)

• Providing system transparency:– Individual– Dwelling/block– Service provider (local, national)– Product supplier/manufacturer

• Stimulate new markets (services and products)• Drive industry change for the better

BRE Health – What next?

• Consultation with key ALIP partners regarding BRE Health and others, eg:– Bournemouth– Willmott Dixon– Cisco

• Identify technical areas that BRE Health needs to cover– Interoperability of tele-care and tele-health services

• BRE Health event at INSITE 2011 in October 2011 at BRE– Funding from BRE to develop methodology and test in 10-15 building– More information on BRE Health

Contact BRE for more details of the programme

• Dr Ranjit Bassi (bassir@bre.co.uk)• Dr Keith Quillin (quillink@bre.co.uk)• Andrew Williams (williamsa@bre.co.uk)