TOWARDS SOCIAL HOUSING THAT AFFORDS POSITIVE HEALTHY OUTCOMES FOR AN AGEING POPULATION: A TRANSDISCIPLINARY APPROACH Paull ROBATHAN A thesis submitted in partial fulfilment of the requirements of the University of the West of England, Bristol for the degree of DoCtor of Philosophy Faculty of Environment and TeChnology, University of the West of England, Bristol September 2020 DeClaration This work or any part thereof has not been previously presented in any form to the University or to any other body for the purposes of assessment, publiCation or any other purpose. ExCept for any express acknowledgement, referenCes and/or bibliographies Cited in the work, I Confirm that the intelleCtual Content of the work is the result of my efforts and no other person. The right of David Paull Robathan to be identified as author of this work is asserted in acCordanCe with seCtions 77 and 78 of the Copyright, Design and Patents ACt (1988) at the date speCified beneath. Copyright is owned by the author. Signature: Name: David Paull Robathan Date: 7th September 2020 2 Dedication This work is dediCated to my father, Carlton George Brian Robathan, designer of soCial housing and housing offiCer, and my mother Mary Gasperine Anne Robathan. In the face of adversity, some of it Caused by me, their Clear thinking and human response was always to look forward to the best of future alternatives. We should do the same for everyone we Come into Contact with. I would also like to dediCate the TransdisCiplinary and soCial aspeCts of this work to the memory of Josep BurCet, soCiologist and visionary from BarCelona. BurCet produCed a huge Canon of work in the field of sustainable system thinking for the future of SoCiety. I was very fortunate to be invited by him to work with a number of leading figures from Club of Rome on a study of post-industrial soCiety – it was formative in my appreCiation of the Complex issues involved. This final version of my work was Completed during the Corona Virus Covid-19 period. It is both ironiC and hugely transformative that the teChnology and networks disCussed in this thesis have Come in to their own in a massive way to respond to the forCed distanCing and isolation required to proteCt people from CatastrophiC ConsequenCes. The need for all disCiplines to work together to address the future of Care and wellbeing for everybody, but partiCularly for the older less Capable and more teChnophobiC members of our population is now in sharp foCus. The ConsequenCes of a dramatiC shift to remote CommuniCation in a very short time will be felt long after the Covid-19 epidemiC is behind us. Systems and proCedures that might be considered ill-advised or inseCure have been deployed for inesCapably sound reasons, but how we work together to refine, systematise and embed appropriate new teChnology will be one of the defining legacies of the Covid-19 epidemic. And last, but by no means least a dediCation to Professor John LuCas who sadly passed away in April 2020. Not only was he a giant in the field of polymathy - he wrote on ontology, epistemology, new soCial eConomiCs (quoted herein) and formulated what beCame known as the LuCas Penrose Argument based on Gödel’s theorem that minds Cannot be explained as machines (also referenCed herein). I was fortunate to know John as a near neighbour in his later life. 3 ACknowledgements My wife Margaret has been a patient supporter of my more outlandish pursuits for over 40 years. She has been steadfast in her Commitment to our family over the years, and to my patchy but Continuing engagement with the effort required to Complete this work. Our Children Daniel and Mary have been a delight for us, and now in their adult lives are an inspiration. Our grandChildren are so luCky to have them as their parents. I would like to thank the members of my supervisory team, espeCially Dr Colin Booth, who not only took the risk of acCepting a retired IT Consultant as a graduate student in soCial sCienCes but has been patient and strongly supportive over the long haul. Professor Graham Squires (Massey Business School) offered rigour, energy, pace and strong CritiCal assessment to the early stages of my researCh. Ceri ViCtory-Rowe (Campbell TiCkell) was a member of the team for a short while and brought speCifiC relevant experienCe and knowledge that was Comforting and valuable. Professor JessiCa Lamond (UWE) has a wealth of ability in the struCturing, management and delivery of a sound pieCe of researCh as well as an analytiCal and positively CritiCal approach to supervision that has undoubtedly made this work much better than it would otherwise have been. Others at University of the West of England, espeCially Professor Neil Willey, and Dr Paul SpenCer (now Bristol University) whose tireless efforts on behalf of a whole generation of researChers at UWE have been magnifiCent. Amongst many others who have been inspiring and helpful I would like to mention partiCularly Colin Macdonald, StrategiC Housing offiCer at South Somerset DistriCt Council, Emeritus Professor Peter Malpass, former leader of the UWE postgraduate Housing Course that bred so many exCellent housing professionals and Phil Sweet, of the Chartered Institute of Housing who has given his time to advise and guide my work. Also Professor Mike Parr, world leading dragonfly expert, who as a lifelong academiC and loCal neighbour has been a Constant sourCe of enCouragement and enthusiasm. Finally, and by no means least, I would like to thank Gaz Summer, Managing DireCtor of HousingNet who has made their databases available to me to assist in my researCh and has been a sounding board for some of my ConCeptual Considerations. 4 Abstract This study demonstrates the linkage between design and management of soCial housing and the wellbeing of older residents and Creates a ConCeptual model of the affordanCes offered by housing for their health and wellbeing. The ConCeptual model identifies the interrelationship between the disCiplines of housing, health, wellbeing, design and teChnology and has been validated by referenCe to a panel of experts in the field Evidence drawn from signifiCant longitudinal data Confirms that older residents in soCial housing are in general more at risk from , and less able to respond to, life events suCh as long term mediCal Conditions or disability. Primary data analysis is presented of the strategies being adopted to radiCally re-task health and wellbeing provision and the reasons for ‘Delayed Transfer of Care’. The wide variation of appreCiation across England of the Contribution housing makes to health quality is Clearly identified. This study Contributes to enhanCed knowledge of the interrelationship between soCial housing and the health and wellbeing of older residents. The ConCeptual model presented is a Contribution to knowledge of a meChanism of transdisCiplinary researCh that facilitates Collaborative researCh across diverse disciplines (housing, health, assistive teChnology, oCCupational therapy, well-being, energy efficiency, soCial Care and others) and supports a deeper understanding of the alternative sustainable options for funding and delivering real savings across the whole realm of housing and health through the meChanism of affordanCes. The effeCtive implementation of teChnology to support monitoring of properties would result in lower maintenanCe Costs for housing providers. EnhanCing the CommuniCations Capability for residents for remote health monitoring, teleCare and inter-personal CommuniCation would alleviate loneliness and lack of Community Cohesion while enhanCing acCess to health Care. Crossing the borders between design, housing, teChnology, health and soCial Care would Create a more holistiC and systemiC approach to housing that Can lead to an enhanCed life- Course experienCe as oCCupants age. It is ConCluded that a disproportionate number of older, less well-off, less healthy and less resilient people live in homes managed by LoCal CounCils, Housing AssoCiations and other SoCial Housing providers Compared with all residents in housing of other tenures. Utilising Capital at low Cost of funding due to the prediCtable return on investment houses Can be built with full acCessibility for all potential oCCupiers, sustainable heating and ventilation to minimise mould, airborne partiCulates and Cold and damp that Cause many of the admissions to hospital for oCCupiers. Keywords: age-friendly, healthy homes, affordanCe, acCessibility, ConneCted 5 Table of Contents List of Abbreviations 13 Definitions of Some Key terms enCountered in this Thesis 15 Chapter 1 Introduction 1.1 IntroduCtion 16 1.2 Background and motivation for the researCh 20 1.3 ResearCh Questions 27 1.4 Aims and ObjeCtives of this researCh 28 1.5 StruCture of this thesis 30 1.6 Summary of the Chapter 32 Chapter 2 English Contemporary Social Housing in Context 2.1 IntroduCtion 33 2.2 Housing Provision Compared with other Countries and traditions 39 2.3 Old Age Living 44 2.4 History of soCial housing provision in England 47 2.5 CharacteristiCs of Current Housing Provision 49 2.6 Affordability 58 2.7 English Affordable Housing Market StruCture 63 2.8 Rationale for the ResearCh 66 2.9 Summary 70 6 Chapter 3 Health, Design and Technology 3.1 IntroduCtion 71 3.2 Relationship between Housing, Health and Well-Being 73 3.3 The role of PubliC Health 77 3.4 SystematiC Reviews of ResearCh Literature 79 3.5 Housing as an enabler of Better Health and Well-Being 84 3.6 Design for Healthy Ageing 88 3.7 Interrelationship between home and its surroundings 92 3.8