DR Jeremy: [00:00:00] If they're exposed to damp, moldy condition, they get an infection. They have a flare-up of their other symptoms and it just, they come into hospital, and it costs them just a whole lot of work. 

Stories, Labels, Misconceptions NHS remains a blessing Created in 1948 We want it to remain great A podcast where we share our stories Explore solutions in all their glories They say it's broken, but it's not done With your host Val Baron, Dr. Jeremy Anderson

Val: Welcome to Stories, Labels and Misconceptions. Co- hosted by me, Val Barrett. And Dr. Jeremy Anderson. A podcast where we share our [00:01:00] stories, experiences and explore solutions to the issues we face today within the NHS and social care.

Val: This week's episode comes in two parts, and this is part one. Housing and health, the real cost of inadequate homes.

Mhm.

Val: When we talk about housing in general, we all need housing. But when you put the word social in front of that word, all kinds of connotations materialise, and we think something bad is for the poor, the ones in society that need the most help. But yet we all need housing, and say you're offered a flat in a tower block.

Val: The first thing you say is, I don't want to go above a certain floor. 

DR Jeremy: Oh, why is that?

Val: [00:02:00] Because in social housing, the maintenance is bad. The lift breaks down. It's dirty. It's smelly. And he wants to go above, let's say, the fourth floor. 

DR Jeremy: You can expect the lift to break dow,n and you don't want to have to go up seven flights of stairs.

Val: Exactly. And then it takes ages for it to get fixed. And as soon as you see that. You think, how is the property going to look? Is it going to be clean when I go and view it? If it's in a block, what floor is it on? But yet, when you look at High Rise in luxurious Park Lane, everybody wants to aspire to the top because the top has the penthouse suite. And it says wealth.

DR Jeremy: It's the best view. If the lift breaks down, which it probably won't, it'll get picked quickly. 

Val: We know there's two different types. Now let's look at housing estates.

DR Jeremy: Yes. 

Val: Now, when we mention the word [00:03:00] estate by itself, we think of a lord of the manor, a lady of the manor. They have their country estate.

Val: But as soon as you put the word housing in front of that, people think of crime. 

DR Jeremy: High unemployment. 

Val: Yeah. High unemployment. They think of the worst things possible, but the only difference is one word in front of the same word estate. 

DR Jeremy: There's this negative connotation to the term. 

Val: Yeah, because sometimes these homes are inadequate. I really don't think anybody would mind living in a tower block. Here they were kept nice, clean and safe. And the landlord actually looked after the block. Everybody wants to be proud of where they live. Whether you're unemployed, you're employed, you're a carer, it doesn't matter what your background is. Nobody [00:04:00] wants to live in a dirty block. You phone them, you tell them over and over again, they've just broken down. And then you think of people that might get ill. 

DR Jeremy: Yes, people might very well have a source of disability, either because of a mobility problem or respiratory problem. They can't be going up 17 flights of stairs.

Val: Exactly. I know a friend of mine lived on the 14th floor, and their father was ill and the lift was out. Yes. They had to dial 999. Paramedics came and bless the paramedics, they carried him on a stretcher down. I'm not 100 percent sure if there is policy to state that anyone that does have a disability or is elderly or has a vulnerability is housed above a certain floor. Sometimes, it just happens. [00:05:00] We all want a house with a garden, but realistically, that's not going to happen. I think the maintenance, getting repairs done when they are supposed to be done, that would help.

Mhm.

DR Jeremy: Anyone who's exposed to the kind of black mould that grows in damp, mouldy houses can develop a respiratory problem even if you don't already have one. But if you've already got a respiratory condition, it just makes it so much worse. And what I see with my own patients is Because my patients are susceptible to infection, if they're exposed to damp, moldy condition, they get an infection, they have a flare up of their other symptoms, and it just, they come into hospital, and it costs the NHS a whole lot of money. I think this is where we're at, where the housing conditions [00:06:00] can influence our health. 

Val: London Tonight, highlighted. The conditions what some people were living in and that little boy, Awap, died because he was living in a home with mould. This is one of the richest countries in the world. When we look at foreign aid, Britain helping other countries, there's nothing wrong with that. When we look at the situation that we have here at home, people then have a right to look and think you're helping somewhere else. But you're not helping us. You have forgotten us, the voters. In this day and age, no one, not in Britain, should be living. in a state that I saw on London Tonight. That should have embarrassed us. And I hope it went around the [00:07:00] world. That should have embarrassed our government to know that's how they are allowing that citizens to live. For those of you that didn't watch London Tonight and saw the condition of those homes, I will describe a few of them. Full of mould. Blackened walls. Ceilings blackened. Water dripping down the walls. The floor soaked. Some of them had buckets to catch the water. One, he even had some sewage coming in. It was disgusting. And just because you're in social housing, you may be unemployed, single [00:08:00] parent, family, whatever your circumstances are, doesn't give these landlords the right to treat you like you're not human. I couldn't believe what I was actually seeing. These places look like they should have been condemned a long time ago. And to think that people would have complained over many years and felt like they had nowhere else to go and have to go to a TV program and show the country that this is how they were living and talk about the treatment that they were receiving. That must have been so awful for these people to do that. And we have to do better. Yeah. Was an absolute [00:09:00] disgrace. I remember hearing the story of a lady called Sheila Selim Selimane. 58 years old. She was discovered dead in her Peckham flat. They'd even gone in there and turned off the bloody gas. Alarm bells should ring. It's not as if neighbours didn't make phone calls. And you think, if this woman was a good rent payer, why all of a sudden has her rent stopped being paid? There are certain things that the bells should be ringing loud, and you should be hearing that. But you noticed the gas wasn't being paid, and you went in there, you knocked down that door, and you turned off that gas, and you left her there rotting. For two years, she was there. 

DR Jeremy: How does it get like that? Where the housing stock is just so degraded that you've got damp and [00:10:00] mould and all sorts of problems like this. 

Val: Like we talked before about preventative care. It saves you X, Y, Z in the long term. If you have a little mold at first, take care of it 'cause that little mould gonna grow, big mold gonna grow gigantic mold. They don't do it. They just leave it, and it gets worse. And then the cost, I scratch my head. If anybody has, anybody thinks if when a housing officer goes round to look at that flat and those homes, that they think that's okay. That's fine. I don't know if they use that attitude; I don't know, but it's awful. And that impacts on people's health, we know, which then impacts on the NHS. There's a cause and effect. Every bad decision that is made, whether it's in housing, social care, government, there's a cause and effect. And [00:11:00] we are the ones that suffer. At the bottom, not the top, at the bottom. 

DR Jeremy: So maybe in future, we should think about getting a housing officer on the podcast to talk about this. Like the issues with housing. Yeah, of course. Maybe that would be relevant, right? But of course, all of this stuff is relevant to health and social care. 

Val: It's true. We know that one in five dwellings in England do not meet the decent home standard. And a third of these are in the private rental sector, and that is the fastest growing segment of the UK housing market today. And we know there is an unequal distribution of good-quality housing. So those who are elderly or young, those that are isolated without a social support, [00:12:00] adults with disabilities, those are the ones that are more likely to be affected. So it's not surprising that young people are concerned when they spend nearly a quarter of their income just on housing. 

DR Jeremy: Of course. 

Val: So we know that poor conditions can lead to a host of health concerns, respiratory. All these are caused by damp and mold, even tuberculosis and meningitis. And that spreads more easily when it's overcrowded.

DR Jeremy: Yes. If you have an overcrowded. social housing flats, where there's just lots of people in close proximity with damp and mold. Then, if one person gets something, everybody gets it.

Val: Yeah. So it's not just your physical health, your mental health, your [00:13:00] anxious, your mental health is likely to get worse.

DR Jeremy: Obviously, that's going to increase your stress level. And we know that mental health conditions get expressed. According to your stress level, if you're doing really well, then it's much easier to manage a mental health condition. If you're stressed, if you've got a number of different stressors in your life, then it's more and more difficult to deal with your other problems. 

Val: We're a country. we're not poor by no means, we're not. I think it's just the way that the money is redistributed and how the government views priorities. You'd think that housing should be up there. You need to live somewhere. We need a roof. We need shelter. Yes. You look at, , Maslow's Hierarchy of Needs, 

DR Jeremy: Yes, it is. Yes. 

Val: You can't get a job; you can't get employment without housing. That has to be the first rung of the ladder. 

DR Jeremy: Food, clothing, [00:14:00] shelter, safety. Those things. There's no way to meet the needs that are more abstract, so it makes no sense talking about psychological health or emotional wellbeing. Or feelings of achievement, if you're hungry and have nowhere to sleep, I can't remember what social program this was in Canada, where in trying to deal with people's social problems, including things like antisocial lifestyle, crime, drug use, it used to be that you had to fix those problems. There was a drought program that said, let's actually just get, but that was the idea, right? Of bribing people or rewarding them for making progress. But instead, a trial program that works a lot better, that we don't care what you're doing, we're going to give you housing, and then you have a base, then those people, it's easier for them to take steps to fix their [00:15:00] life. So instead of bribing them with a kind of amateur psychologist idea, just give people a house, and then they've got one less thing to worry about, and they've got energy and the capacity to start to tackle their other problems.

Val: But when everything around you is just crap, you've got no housing, no job, no future, no hope. And instead of punishing people that may be living on the streets, that person has a story. There's a reason why they're on the street. There's a reason why. Someone gets addicted to drugs. There's always a story. There is something there. I just don't think we do enough. Whether it's housing or, like we talked before, about social care. [00:16:00] Everything's about social. 

DR Jeremy: Why do you think that is? 

Val: Crap. 

DR Jeremy: Huh? Why do you think we don't do more? Why don't we do more? 

Val: I don't know. 

DR Jeremy: Money? One part of me thinks, 

Val: No, isn't money. Money? I think it's priorities when you look at our leaders, our legislators, and we think these people, they went to the best schools, they went to the best university, they should know better. They're surrounded by the best brains. I just think everything is in the interest of the rich and not the poor. That's what I believe politics is. When you look around, and it's not just housing, it's just the poor in general, all those are just about managing, why do we have food banks? I think we are the sixth richest country in the world.

DR Jeremy: I hear that actually our GDP [00:17:00] is actually a lot lower than that. And we're not really as competitive in producing as much as we should. 

Val: Like I said, I just think you can benefit the well off and the rich better than it benefits the poor, because as soon as something goes wrong, or as soon as. They feel the country's mood first thing they do is look at immigrants and look at people on benefits. Those are the first things that they look at, but that spends money on those at the bottom. If you raise benefits of those at the bottom or those in the middle, the money will come back into the economy. Going to be spent. 

DR Jeremy: I think you and I have talked about this before, about how it seems like the various systems. In our society are [00:18:00] not joined up. So what we talked about with housing, if we spend money on housing, this will help people either not develop conditions in the first place, or if they have long-term conditions, it will help keep them in a hospital. So that will save the NHS money. But I think probably what's happening is the people who are allocating money for housing. They're not looking at the NHS budget as being related to their budget. and NHS, nothing about the housing or social care budget being related to their budget. Everyone's managing their own, but not realizing that if you put more money in one area, it actually helps another. Does that make sense? 

Val: It makes sense to people like us, 

DR Jeremy: Yeah, I have a sense that it's just not being done. Maybe I'm wrong about that, but I really have a sense that these programs- maybe this would be a good time to mention this warm home prescription program that we were discussing earlier, which is a trial program that started in 2022 [00:19:00] and '23. And this was a pilot program, a trial to see if giving people enough money to heat their home via prescription would actually help keep them healthier. So it was what they did was they helped 823 vulnerable and low-income individuals in Aberdeen, Middlesboro, Gloucestershire and London. So they were contacted by the NHS, offered a warm home prescription that would be developed by local energy advisors. They credited their energy account. They could immediately have enough money to keep getting their home, even when it was cold or when they didn't have a lot of money. 79 percent of recipients thought it had a positive impact on their physical health, and 70 percent said it improved their mental health. Not surprisingly, 98 percent of recipients said they wanted to take part in the project again. The healthcare staff thought it was a great idea, thought it would reduce NHS and free up hospital beds. I don't know. Another thing that they cited that I think doesn't get enough attention [00:20:00] is There's something valuable to proactively helping vulnerable people in the winter, even if it doesn't save a lot of money, but being able to reduce financial pressure for people and helping people feel warm and comfortable in their homes is important. And so I think everyone thought it was a really good idea, and people were actually heating their homes more. I think there isn't data that I can find about whether it actually decreased hospital admissions. We're waiting for a final recommendation.

Val: Yeah, but the money's going to be saved somewhere. I was watching a question time. I think it was West Street in that said 40 pounds to see your GP. But if you can't see your GP, 400 pounds in A& E. You think with that kind of figure. You think the government would do more about GPs? [00:21:00] There's always a cost. There's always a saving to be made. And I think sometimes the government have got to stop thinking how much this is going to cost. Start asking the question, how much is this going to save? 

DR Jeremy: Yeah. 

Val: For example, when it comes to investing in the infrastructure of the country, They were all jumping up and down about HS2, going to the north, what's that word, levelling up, and they spent all that money, compulsory orders, people had to sell their homes, and of course, what did they do? It got scrapped. And it makes you wonder if this is how they handled the country's finances, people's [00:22:00] money, people's hard-earned money. They pay their taxes. How the hell do they manage their own household budgets? I know the two may not be the same, but the amount of money that was already spent on this project, for them to scrap it halfway through, says a lot about our government. Our country and how we lack investment in long-term projects. 

Val: you 

Val: Look at short-term fixes and the amount it's going to cost now, instead of thinking, oh, what would it save in 10 years' time or 15 years' time? We are a growing population. I know we started off talking about housing, but when it comes to HS2, our transport system matters.

DR Jeremy: Yes. 

Val: This is what I found on a website. The monetary scale of HS2's [00:23:00] a staggering 92 billion was wasted. And this is your government. But yet, when they say that we're broke, first thing they do, they say, They go straight to the bottom, they look at the sick, they look at the disabled, they look at the poor. How many people question the waste that they make? 92 billion. We have schools crumbling, we have waiting lists, the NHS, they need more staff, we need better social care. But yet, they didn't blink an eye when it came to wasting. Your money, 92 billion pounds of your hard earned [00:24:00] cash. 

DR Jeremy: Yeah, I definitely agree with this idea that prevention is better than cure, right?

Val: Of course it is, but that drug, Ozembic? 

DR Jeremy: Yes. 

Val: Now we know what the drug is initially for.

DR Jeremy: It's diabetes. 

Val: Yeah. Now, this is when those that have get, and those that don't have, don't get. People are able to buy that drug. 

DR Jeremy: Yes. 

Val: Some people, whether they've got diabetes or not, want to get slim. And yet the people that do have diabetes, they're not getting their hands on the drug. Because it's going to a section of society. that have the wealth, that have the means in order to have this, can't. So again, when I talk about everything is in the interest of the rich, [00:25:00] because it comes down to affordability as well. Money gives you access. You have money, you can afford a holiday. You can afford a therapist. You're not waiting for years. On the NHS, you can buy your children better outside school activities. These are the things that money can buy. It buys you a better way of life. Those that have money always say Money doesn't solve your problems. Let me give it a go. I'll let you know from my yacht. 

DR Jeremy: I think with all of these examples, the same applies to housing. If you invest in electric maintenance with housing in the same way you would with your health or crime prevention or vehicle maintenance, you're going to reduce some of your problems down the road.

Val: Yes, build them. But before you start building, look after the ones [00:26:00] you already have. Look after those. Look after the NHS staff. Do they need housing? Do police officers need housing so they can afford to live in the areas that they police in? All these things if you work in London. As a nurse or doctor, whatever or any other part of the NHS. You can't afford to live in London. Expensive, and it's getting worse. Every sector needs fixing. I don't know one sector that's okay, that's doing good, that we can look at and use that as a blueprint for everything else. We need more people in the NHS. We need more people in social care. We need more housing. We need good housing, good jobs. We need to get to a place in this country [00:27:00] where no one has to go to a food bank and ask the formula to feed their baby. That no woman has to go to a food bank to get sanitary towels. We shouldn't have to be doing that. And the government needs to really think of ways how they can save in order to plough money where it's really needed because they've left a lot of places to rot

DR Jeremy: If it was something that happened overnight, if it was good one day, and then all of a sudden something had changed, it got hit by a bomb or something, and it just looked awful. Then we would notice it, and we would demand change. And we'd say, Oh, this isn't the way it's supposed to be. And demand change, but when things are allowed to break down gradually over time, very [00:28:00] slowly, almost imperceptibly day by day, it's harder to notice it.

DR Jeremy: And actually, once you've accepted it's at one level, it's not good, but it's acceptable, and you get used to accepting that it becomes harder and harder to put your foot down and say, no, I won't accept that. 

Val: And people complained over time, which I can imagine that they did 

DR Jeremy: Sure. And when nothing happens, 

Val: Imagine when a person, a housing officer, comes to visit your home.

Val: Sees you catching water in a bucket, sees that the wall, instead of a nice color on the wall, there's black mold on the ceiling, on the wall. It is really, and it probably smells. What do you think could possibly, from a psychologist's point of view, 00:29:00 be going through that person's mind? I don't know. I look at it, and I think, how could they be still living there?

Val: Why weren't they put in emergency accommodation to get away from all of this until they decided how they were going to deal with that problem? That's the part I don't get. 

DR Jeremy: The key word is emergency. Yeah, if you don't perceive it as an emergency, it doesn't trigger that in your head. You don't think they need emergency housing.

DR Jeremy: You don't if you don't think that's an emergency, if that's just the norm where it's bad. But there's a lot of people dealing with this kinda stuff, and it's not so much different than everyone else. It doesn't. at that point, it doesn't count as an e. That's what I'm saying. When these things creep up gradually, it's harder to notice. It's pretty hard to walk away from housing, right? You need a place to live. If you've got little kids, you can't just say, okay, this isn't good enough. I'll go to the next [00:30:00] place. If there isn't a next place, if your choice is this place that kind of sucks. I'd rather not be homeless. Yeah. You're in a tough situation. Yeah. 

Val: But money plays a part because if you look at the demographic of the people that are in this situation. , 

DR Jeremy: low socioeconomic status. Yeah. The people who don't really have much choice. 

Val: Exactly. They don't have any choices. Whether if you are a person where you do have access to money for number one, you might not even be living there, but let's say you work. And you do have a really good job. You then have the access and you have choices. Yeah, and that's what it comes down to: better choices, a variety of choices.

Val: And then you've got people that may have no family, no, no friends, but it's your home. And these people could have been [00:31:00] living there for years and years. It is their home. And I think for somebody to think they're not fixing it for me to run away. Where am I going to go? Even though I, when I was watching the program, a lot of them were in absolute despair, breaking down, which you would, because you go through different ranges of emotion, anger, frustration.

Val: Despair. What are the other ones that you might be going through?

DR Jeremy: Like the stages of grief, you mean? 

Val: Yeah. Yeah. 

DR Jeremy: So it's, it starts with denial, anger. Yeah. Bargaining despair or depression. Yeah. Finally comes around at some point to acceptance. 

Val: But in the meantime, you're still phoning, you're still complaining.

Val: So how might that feel when, as an adult presenting your [00:32:00] situation to another adult and you feel you're being ignored, that you don't matter, how might that person be feeling? 

DR Jeremy: Helpless. Yeah. Have you heard about learned helplessness? 

Val: No, I haven't. 

DR Jeremy: So I think that is a relevant psychology. There's a psychologist named Seligman, and they did research with rats, basically, where they would, I won't go through the whole procedure, but basically they would submit these rats to electric shocks. And in some conditions, the rats could get away. Yeah, in which case, if the rat had a way of getting away, then when it could tell the shark was coming, it would move to the other side of the cage.

DR Jeremy: So it wouldn't get shocked. 

Val: Okay. 

DR Jeremy: So the rat knows it can do something. It does something about it. But for the [00:33:00] rats that are trapped, they couldn't get away from the shark. Yeah. At some point, they just lie down and accept the shark. Yeah. The tricky thing is, even when you open the door so that they could escape, they don't; they've learned that they can't escape, and they just lie down and they just take it.

Val: They're conditioned now. 

DR Jeremy: They're conditioned to think this bad thing is coming. There's nothing I can do about it. I'm just going to lie down here and conserve my energy and just take it. 

Val: Isn't that quite similar to Stockholm syndrome? I don't know. Yeah. There's definitely some connection. Yeah. Yeah.

DR Jeremy: It's a different phenomenon, but yeah, but it is the idea of like, how do I survive? I'm in this bad situation. What do I do to survive? 

DR Jeremy: Yeah. Yeah. And I think if you've learned that you're in this bad situation, there's nothing you can do about it. You just find a way to keep on living as best you can. [00:34:00] So that's, I think, the psychological phenomena that that goes on when people, like I say, when these limits gradually get pushed and there's nothing people can do about it, they feel helpless.

DR Jeremy: And even when there is something they can do about it. Yeah. They've learned that they can't do it. And what we're really talking about here is the whole idea of liberty and freedom, right? Just philosophically, what makes you free? There's a concept of what's called negative liberty. That's the government getting out of your way, right?

DR Jeremy: Someone not holding you back, the less sort of interference in your life, the more free you are, right? Yeah. But there's also this notion of positive liberty, that there's things that the government could do. To make your life better, right? There are certain people who are suffering more than others, that even if no one's in their way, they've still got lots of barriers in their way.

DR Jeremy: There's things that can be done to make them more free. And when you have those capabilities, now you [00:35:00] have more freedom than you had before. And I think if we want to live in a society where people have as much liberty as is feasible, then we need to think about both the, both kinds of liberty both.

DR Jeremy: So both getting out of people's way and also giving them just improving their life to the extent that they can be more free.

Mhm. 

DR Jeremy: Okay, Val, so for this episode, what's your story label in Misconception?

Val: My story is about Sheila. The lady that was found dead in a Peckham flat. She was there for years. We don't have to rehash that, but yeah, my label is, I believe that social housing is a label in itself because when I'm in the earlier episode, when we [00:36:00] talked about housing is a good thing. It's a positive thing, but as soon as you put that word social in front of the word housing, suddenly, a negative happens.

Val: So I believe. That in itself becomes the label, that word.

DR Jeremy: The term that comes with a lot of baggage, right? 

Val: Yes, it does. Anyway, my misconceptions are.

Val: Is that a lot of people probably think that when we look at bad housing, that it only happens in social housing, there's a lot of problems in the private rental sector as well, , they're not at the moment covered by the decent home standard, whereas social housing [00:37:00] is, so when you're in. private rental, they have a problem where if they keep complaining, the landlord then finds a way to get rid of them. So, Jeremy, tell me what your story label and misconceptions are for this episode. 

DR Jeremy: Yeah, for this episode, I think the whole idea of the home heating prescription is an important story and the label there. Really, I guess there's really two labels, and one is heating and one is health.

Val: Because we know that when som is cold. It impacts on the NHS, it cause and effect

DR Jeremy: Exactly, so the label we use is essentially arbitrary.

Val: So, what's the misconception? 

DR Jeremy: The misconception is that those two things are different. Money for heating is different from money for health. 

Val: You always managed to do that. Your [00:38:00] story, your label, your misconception is like the same story. Yeah. I'm able in that story, that misconception where I don't do that, but it's all good. It's all good. 

Val: Yeah. 

Val: Yeah. 

Val: It's all good.  

Val: Brilliant, thank you. I enjoyed our episode. Yeah, it's been fun. And it'd be nice to know if you agree with either Jeremy or myself about our choice of stories, labels, or misconceptions, or do you have your own when it comes to this episode? 

Val: We've come to the end of another great episode, and we hope to see you soon. See you next time. Bye-bye. Don't forget to 00:39:00 subscribe wherever you get your podcasts.