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 Housing and housing issues affect all members of the population in Bedford.  In broad terms there are two distinct parts to Housing Places, that is the bricks and mortar that we live in, and Housing Services, that are designed to keep people living independently in their own homes.  Both of these have significant impacts on the health and wellbeing of the population in Bedford. 

There is a strong and enduring link between housing and public health.  This has been acknowledged in many health reports which state;

          ‘Shelter is a pre-requisite for health. However, people who are disadvantaged suffer both from a lack of housing and from poor quality housing’25

          ‘the health inequalities infant mortality review; this work showed that reducing child poverty, improving housing and reducing overcrowding had a direct impact on the infant mortality aspect of the health inequalities target’26        

‘Poor housing conditions have a detrimental impact on health, costing the NHS at least £600 million per year27

The World Health Organisation (WHO) have identified the most significant housing hazards associated with health effects to include poor air quality, hydrothermal conditions (e.g. cold and damp), radon, slips trips and falls, noise, dust mites, tobacco smoke and fires1.  It is therefore widely accepted that poor housing can have a significant influence on physical and mental health with links between:


  • Poor insulation and heating leading to excess winter deaths (excess cold). Excess cold is also associated with dampness / mould and poor respiratory health including asthma6.
  • Disrepair / poor construction leading to accidents in the home including falls resulting in fractures.
  • Overcrowding which can cause poor mental health  and contribute to the spread of airborne infections, for example TB
  • Poor cooking equipment, heating appliances and inadequate ventilation leading to carbon monoxide poisoning.
  • Poor housing areas and the threat of increased crime and anti social behaviour (ASB) leading to mental health problems including depression.


   The Parliamentary Office of Science and Technology published a document on housing and health in January 2011 which found that there can be a negative effect on children’s education because those living in cold, damp homes cannot learn as effectively.


For the foreseeable future the great majority of the population will continue to live in stock that is already built. The evidence available to the JSNA (see the chapter on climate change) and through the Stock Condition Survey is that excess cold, fuel poverty and homes that are not energy efficient are a key issue with regard to the condition of the stock and its impact on health in Bedford Borough.  Research elsewhere supports this view. A World Health Organisation’s World Health Report 2013 noted that:


“….Better home insulation, plus energy-efficient, smoke-free heating and cooking systems and indoor ventilation, can reduce respiratory diseases, including asthma, pneumonia and tuberculosis, as well as reducing vulnerability to extremes of heat and cold. Large savings in health costs from asthma and other respiratory illness were observed in follow-up studies of home insulation in low-income homes in New Zealand. The promise of immediate health gains helped drive large-scale government investments in home improvements in New Zealand. To these short-term gains must be added the economic value of carbon savings that will be realized in future.”3

There is an increasing awareness of the impact that social isolation and tenancy failure has on a person’s health, particularly the health of older people over the age of 75 who are more likely to be living alone.  This results in more frequent access of primary care such as frequent visits to a GP where there is a limited reason for doing so.  Housing services have a significant role to play in tackling issues that arise from social isolation and are uniquely placed to do so with the networks of services available to such ones.


 Affordable housing in Bedford Borough is provided by housing associations with the largest provider being Bedfordshire Pilgrims Housing Association (now known as bpha). Partnership working is essential both across the Local Authority departments, with Registered Providers of Social Housing, with the voluntary sector and with the different organisations within the NHS.  The Council is no longer a stock holding authority but maintains a housing function. In 2013/14 the Council handled more than 17,000 contacts related to housing issues. This figure reflects individual interactions across a range of services the most frequent being with Housing Benefits.


Housing is important to health and well-being in two ways:


  • The supply of housing and its condition is a fundamental wider determinant of health for the whole population. The Council has an important role in relation to the condition of the stock and the supply of new housing. These two elements are fundamental broader determinants of health. The key stock condition issue is hard to heat homes and fuel poverty and this has a direct bearing on health and demands on health and care services. Accessibility and suitability of homes for people whose abilities are limited is also a key issue with service use implications. The provision of new homes is important generally to healthy lifestyles; the provision of affordable housing is particularly important to people with low incomes who generally suffer from health inequalities; the provision of specialist housing is important to older people and many vulnerable groups whose use of health services is substantially affected by their access to specialist accommodation, or lack of it.


  • There are people within the community who need care and support services. For some this is at a particular time in their life, in other cases on a long-term basis. Housing services are well placed to provide prevention and early intervention for people with a range of short term and long term conditions, thereby reducing the demand for more acute services.  All the agencies engaged in responding to these needs have to work together to deliver effective and efficient services.


The primary functions related to housing are listed below:


  • Housing Strategy – development of housing strategy and supporting strategies, support for new supply and affordable housing, empty homes, stock condition surveys and response including the Bedfordshire and Luton Energy Scheme
  • Housing Services – housing options, assessment of housing need, homelessness prevention, temporary accommodation, rehousing, supported housing services including special needs groups, gypsy and traveller management
  • Environmental Health – statutory interventions to address poor housing conditions, houses in multiple occupation licensing, 
  • The Sustainability Team - work to promote energy efficiency and reduce fuel poverty.
  • Home Improvement Team – Disabled Facilities Grants, Home Improvement Loans and grants, Handyperson Services
  • Housing Benefits - Determination of benefit claims from applicants and administration of discretionary housing payments


Other Council departments also have key roles in relation to housing issues. Adult’s and Children’s Services provide a wide range of specialist accommodation and care services.  Planning Services create the planning policy framework for housing development and sustainable communities and determine planning applications


The Care Act 2014 includes housing services amongst those services which should be integrated with health services. While recognising that housing and care are distinct services the Act also recognises that housing can be part of the solution to someone with care and support needs.  This is particularly relevant when considering the wellbeing aspect of an individual’s care needs.


The implementation of the Care Act 2014 is being addressed by Adult Services. Housing Services, which sits within Adult Services, is an integral part of this process. The engagement of the broader housing functions of the Council will be supported by the following steps:


  • providing a broader vision of health and housing within the JSNA
  • recommending an implementation group to follow up on the chapter
  • supporting the development of a Care and Support Accommodation Strategy


What do we know?

Base data on housing in Bedford


There was a population of approximately 161,400 in the Borough in June 2013.  This is forecast to rise to more than 174,000 by 2021.


Private sector housing is housing which is privately owned and is either owner occupied (64.2% of households in England) or rented out to tenants (18.1% in England including those living rent free).  Bedford Borough has higher levels of owner occupied housing than England (66.5%) but lower levels of social rented housing (16.1% compared to 17.7%).   Private rentals (including living rent-free) in the Borough increased from 7,064 in 2001 to 10,958 in 2011, a rise of 55%. 


Nationally the private rented sector has been growing in recent years reversing the long decline over most of the twentieth century. In England it has more than doubled in size since 1991 and at 4.3 million households and is now larger than the social rented sector at 4 million households4.  In Bedford Borough it now approximately equals that of the social rented sector. 


Figure 1: Distribution of occupied dwellings by tenure in 2011






Bedford Borough


East of England






Owns outright





Owns with a mortgage or loan





Shared ownership





Social Rented

Rented from council*





Other social rented





Private Rented


Private landlord or letting agency











Lives rent free












Source: ONS, 2011 Census, Table KS402EW.  © Crown Copyright 2012

* Bedford Borough Council transferred all its social housing to BPHA in the 1990s, so these responses represent a misunderstanding on the part of some housing association tenants.


The Borough has higher proportions of detached, semi-detached and owner-occupied housing than England, and lower proportions of terraced houses, flats and social rental housing.


Average household size declined consistently between 1951 and 2001. However, the 2011 Census indicates that it was largely unchanged between 2001 and 2011. This may be due to a number of factors: younger people staying at home longer, high levels of student debt, high housing costs, restricted mortgage availability, rising birth rates, improvements in male life expectancy, and high international in-migration.5

Severe overcrowding levels (2.1% of households) are below the national average (2.3%) but higher than the Region (1.4%), with the highest levels in Harpur (5.6%), Castle (5.6%) and Queens Park (5.5%) wards.5


 Average house prices in the Borough doubled between 2001 and 2008 from a median price of £92,000 to £180,000. They declined in the second half of 2008 and in 2009, were largely stable in 2010-12, and then rose in 2013 and 2014.  The ratio of median house prices to median earnings rose from under 5x in 2001 to 7.6x at peak in 2008, but has declined slightly to 7.23x in 2013.5


The economic downturn, lower consumer confidence, difficulty in obtaining mortgages, and higher deposit requirements resulted in 2008-2011 sales’ volumes declining to half the peak levels experienced in earlier years when prices were rising strongly.  Volumes and prices did, however, rise in 2013.5  Mortgage Repossessions: In 2013, there were 52 Court Orders issued for mortgage repossession of properties in Bedford Borough.  These orders reached a peak of 195 in 2007.4


The 2014 Annual Survey of Hours and Earnings (ASHE) indicates that full-time workers resident in Bedford earn an average of £27,981 compared to £27,227 in England. ASHE indicates that Bedford Borough residents who are in employment earn more than the people whose workplace is in the Borough. This is a reflection of the large number of Borough residents who commute to areas such as London, Cambridge and Milton Keynes where higher salaries are available.3


Figure 2: Gross Weekly Pay of Full Time Workers (£), 2013











Bedford Borough



Bedford Borough



Bedford Borough

East of England



East of England



East of England









Annual Survey of Hours and Earnings, ONS, 2013


 Within the Borough, there are huge disparities between wards in both income and employment levels.  Average gross weekly household income in 2007/08 (latest available data - an update is expected in 2015) in Bromham ward (£1,110) was more than twice the level in Harpur (£530), Kingsbrook (£540) and Queens Park (£540) wards, and well above the regional level of £700.7    As is the case both nationally and regionally, male workers in the Borough earn more than female.

 In addition to out-of-work benefits, a range of other benefits and tax credits are available and are significant sources of income for many Borough residents:


Income Support: In November 2013 there were 2,180 people aged 16-59 claiming Income Support benefit in Bedford Borough. The more deprived wards in Bedford have the highest levels of Income Support claimants.


Disability Living Allowance:In February 2014 there were 6,670 recipients of Disability Living Allowance (DLA) in the Borough (note that DLA for adults is now being replaced by the Personal Independence Payment).  The main conditions for which payments were made were:

  • Learning Difficulties - 1,210
  • Arthritis - 890
  • Psychosis - 590
  •  Diseases of the Muscles, Bones and Joints - 320
  • Neurological Diseases - 300
  • Psychoneurosis - 300


Housing Benefit / Council Tax Benefit claimant levels in the Borough both exceed the regional average but are significantly below the level in England. 9,880 households were claiming both Housing Benefit and Council Tax Benefit. Of the 11,446 households receiving Housing Benefit in the Borough, 68% were Social Rental and 32% were Private Rental households. The proportion of claimants living in privately rented accommodation has increased from 28.3% in August 2009.  This is in line with the growing share of the private rental market in the Borough's housing tenure mix.6


Figure 3: Households receiving Housing Benefit and Council Tax Benefit, February 2013





East of England



% Households

% Households

% Households






Council Tax






DWP, Single Housing Benefit Abstract, June 2013


Working Tax Credits and Child Tax Credits: In 2012/13, an average of 4,900 families with children in Bedford Borough were receiving both Working Tax Credits and Child Tax Credits. There were 8,800 children in these families.  A further 2,200 families (with 4,600 children) were receiving Child Tax Credits only.  An additional 900 families without children were receiving Working Tax Credits6.


Pension Credit:There were 29,210 pensioners in Bedford Borough in February 2014.  Of these 17,170 (59.0%) were female, and 4,780 (16.4%) were in receipt of Pension Credit, marginally above the regional average of 16.2%, but below the national average of 19.6%.6


Housing conditions


The Decent Homes Standard is a government policy that states that everyone should have the opportunity of living in a decent home which means that four broad criteria have to be satisfied:

  • Above the legal standard for housing and free from category 1 hazards.
  • Being in a reasonable state of repair.
  • Having reasonable modern facilities including kitchens and bathrooms.
  • Having a reasonable degree of thermal comfort (effective insulation and heating)


The highest rates of non-decency are in converted flats at 85% with older properties, pre 1919, having the highest prevalence at 43.1%.  Geographically the inner area of Bedford exhibited the highest rates of failure at 31.4% compared to Bedford North, Kempston and Bedford South and Bedford Rural.  In the centre of Bedford the highest rates of failure were found in Caudwell and Harpur Wards (40%+)8.  


In the UK the Housing Act 2004 (the Act) introduced the Housing Health and Safety Rating System (HHSRS) which defines 29 types of hazard found in dwellings ranging from asbestos through to fire safety.  The hazards are grouped into four categories:


  • Physiological requirements (e.g. damp, mould and excess cold).
  • Psychological requirements (e.g. crowding, space and entry by intruders).
  • Protection against infection (e.g. domestic & personal hygiene and food safety).
  • Protection against accidents (e.g. falls on the level, on the stairs and steps between levels).


The role of fuel poverty

Public Health England has investigated the national pattern of excess winter deaths week-to-week over the winter months10.  Their analysis demonstrates that weekly peaks in excess deaths coincide with cold snaps and high circulating levels of respiratory viruses, i.e. influenza and respiratory syncytial virus. 


The effects of cold temperatures are not felt exclusively by people living in cold homes, but most of the people in the vulnerable groups (over 65s, those living with long-term conditions or disabilities) will spend the majority of their time at home.  The landmark Marmot review “Fair Society Healthy Lives”11  and the more recent King’s Fund report into health inequalities12 both identify warm homes as crucial to reducing the risk of death from cold temperatures, and specifically to reducing the social inequality in risk of death from the cold. The Stock Condition Survey 2011 identified excess cold as the key failing in the condition of the private sector stock in Bedford. This section focusses on excess cold and fuel poverty in relation to the housing stock. Please see the JSNA chapter on excess winter deaths for further information about this issue.


Fuel poverty describes the circumstance of a household having such high heating bills in proportion to its income, in order to keep the indoor temperature at a health-protecting level, that the household is living in poverty as a result.  Statistically it is defined as a household which:


  • has required fuel costs that are above average (the national median level)
  • were they to spend that amount they would be left with a residual income below the official poverty line


This definition is new, and is felt to be more robust that the previous definition, in which a household was in fuel poverty if more than 10% of income needed to be spent on fuel13.  Households can find themselves in fuel poverty because of a low income, poor energy efficiency, high unit energy costs or a combination of the three.  Households at particularly high risk are those living in private rented accommodation and those who are unemployed.


It is important to note that, like the excess winter deaths measure, fuel poverty is estimated rather than counted accurately.  Statistics are published annually and are calculated using a complex model, which is based on survey findings about the size and age structure of households, the type and tenure of their dwellings, average energy prices and self-reported income14


The most recent statistics available at neighbourhood level are from 2012.  Overall, 6,214 households or 9.9% of all households in Bedford Borough were estimated to be in fuel poverty.  The proportion varies substantially between areas, from over one in five households in Bedford town centre to less than one in twenty in the lightest coloured areas.  There are hotspots (or rather ‘coldspots’) in the urban neighbourhoods with high levels of deprivation and in rural areas where the population is quite sparsely spread.


Figure 4: Prevalence of fuel poverty in Bedford Borough by lower super output area, 2011


H1 2015

Bedford Borough has a higher prevalence of fuel poverty than the regional average, but in 2012 has dipped below the national average (figure 4.2).  The decrease follows the national trend and is primarily due to increasing income rather than improvements to housing stock or home energy efficiency14.

Figure 5: Percentage of households in fuel poverty in Bedford Borough 2010-12 with regional and national comparators


H2 2015



The LIHC value is only available at local authority level from 2011 onwards. 

The Bedford Borough figure using the 10% definition is available from 2010, it is presented for completeness.

Source: Department of Energy & Climate Change fuel poverty statistics15


Although fuel poverty is a recognised risk factor for excess winter deaths, comparing the map in figure 4.1 with the distribution of excess winter deaths in figure 3.2 shows that there is a similarity between the two patterns but fuel poverty is not the whole story.  Fuel poverty and other risk factors do not necessarily co-exist (figure 4.3) – the key to preventing excess winter deaths will be to solve fuel poverty first in those households where the risk is greatest.

Figure 6: Conceptualisation of risk factors contributing to prevalence excess winter deaths


H3 2015

The magnitude of risk increases with the number of ovals an individual falls into.  Other risk factors include being in one of the vulnerable groups (see Introduction) and behavioural factors such as wearing inappropriate clothing16 and keeping windows open in the home17.


Social Housing

Social housing received sustained investment to achieve the Decent Homes standard in the first decade of the 21st century. Bpha achieved the decent homes standard for all its properties in 2010. The proportion of social rented dwellings failing to meet the Decent Homes standard in England less than 1% and In Bedford was 0.  In contrast, nearly a quarter of the private rented sector dwellings (24.2% from a total of 13,540 dwellings) failed the decent homes standard. The remainder of this section on housing conditions focusses on conditions in the private sector.


Private sector housing

Category 1 hazards have a major impact on health in Bedford.  The most frequent category 1 hazards are excess cold (59.6% of the total of all category 1 hazards) and falls either on a level or on the stairs. This is different from the national picture where falls on the stairs are higher than excess cold.  The cost to remedy excess cold locally is estimated to be £13.7 million8.


Figure 7: Individual category 1 hazards as a % of all category 1 hazards

H4 2015

(Source: Private Sector House Condition Survey 2011)8


The following table shows a breakdown of non-decent properties by age of head of household.  Category 1 hazards and thermal comfort failure are both highest in the youngest age band (16-24) at 25.4%. The next highest rate of Category 1 hazards is found where household heads were aged 65 and over (16.5%) which also had the highest rate of disrepair (5.7%). 


The following table shows a breakdown of non-decent properties by age of head of household.  Category 1 hazards and thermal comfort failure are both highest in the youngest age band (16-24) at 25.4%. The next highest rate of Category 1 hazards is found where household heads were aged 65 and over (16.5%) which also had the highest rate of disrepair (5.7%). 


Figure 8: Non-decent properties by age of head of household

H5 2015

Category 1 hazards:

There were 66 category 1 and high category 2 hazards found in 2013/14 as part of the Housing and Environmental Health teams inspection work with 50 damp and mould investigations with 174 damp and mould complaints.

Figure 9: Category 1 hazards – actions and outcomes


Housing Action Taken




2013 /14


Category 1 and high category 2 hazards present as part of inspection work – an indicator of the condition and seriousness of housing defects following complaints or routine inspection.




Damp and Mould investigations




143 investigations


50 investigations

174 complaints

Resulting Enforcement Action





Hazard awareness notices served




Informal notices served (this is the first action as part of the staged approach for enforcement).




Outcomes of Enforcement Action





Properties were works/notices are compiled with the hazards removed: Category 1 hazards
























Standard Assessment Procedure (SAP) ratings:      


 SAP ratings measure the energy efficiency of a building and are calculated from 1 (least efficient) to 100 (most efficient) and based on the annual energy costs for space and water heating measured in Kilowatt hours (KWh).  The modelling of excess cold hazards is based on the use of an individual SAP rating for each dwelling which is scaled to give a hazard score.  Where a dwelling has a SAP rating of less than 35, this produces a category 1 hazard score.  The more modern the building the better the SAP rating with the lowest ratings in pre 1919 dwellings (mean SAP rating of 47) with the highest scoring dwellings post 1990 at 678.


The lowest SAP ratings were found in Bedford Rural (Mean SAP 37) and Bedford North Centre (mean SAP of 48)8.

Thermal comfort relates to effective insulation and efficient heating.  The average thermal comfort failure in Bedford relates to the Bedford inner area at nearly a quarter (24.4%).  Under 25s are the social group most likely to suffer from thermal comfort failure8.

3.21 The highest proportionate rate of fuel poverty is found in the private rented sector in Bedford at 12.7% (1500 households) compared to 10.5% (4510 households) in the owner occupied sector.  Highest rates were also found in the Bedford Inner sub-area (13.7%) closely followed by Bedford Rural sub-area (13.6%). 


Complaints: - Environmental Health

Bedford Borough Council, through its Environmental Health and Trading Standards team has the core responsibility to ensure that private rented housing complies with minimum standards for safety under the HHSRS system    

The team investigate all complaints relating to private sector housing conditions including disrepair, overcrowding, dampness and mould.  A risk based inspection programme is also undertaken to tackle the properties which have the poorest standards for fire safety and management.

 In 2013-14 Environmental Health and Trading Standards received approximately 300 complaints about private rented accommodation and in 2013/14 there were 556 complaints and enquiries about HMOs compared to 200 in 2012/13.  This increase was mainly due to the additional licencing scheme where there were 417 enquiries including licence applications.  In the past four years there has been a large increase in complaints about landlords 63 in 2013/14, 61 in 2012/13, 16 in 2011/12 and 36 in 2010/11.  There was also a large increase in disrepair complaints with 218 in 2013/14, 53 in 2012/13, 61 in 2011/12 and 43 in 2010/11.

 The Council have also seen an increase over the past three years in complaints about overcrowding with 143 complaints in 2012/13, 135 in 20/11/12 and 100 in 2010/11.

 The team provide advice leaflets to tenants to help them manage their lifestyles to reduce preventable problems attributable to damp and mould.  They also deal with complaints about overcrowding to enable tenants to potentially increase their priorities for social housing.  However, with serious pressures on the availability of social housing locally due to high demand and a lack of vacancies  there is an increased need to grow and develop the private rented sector and improve the quality of accommodation.

The Council has commenced a Keeping Cosy pilot project where Environmental Health Officers will provide tenants of Houses in Multiple Occupation (HMO) with advice and leaflets to help them to use heating more efficiently and keep affordably warm. Landlords will be provided with advice and leaflets on energy efficiency measures and source of funding.

Houses in Multiple Occupation In May 2013 the council introduced an Additional HMO licensing scheme to improve standards in this particular sector of the private rental market as it was estimated that over 1/3rd did not comply with current fire safety and management standards 3.  The rate of non-decency in these properties was 31.2%, substantially higher than that found in Bedford as a whole. Over the next 5 years it is estimated that there will be approximately 1000 HMOs within the Borough which will need to be licensed.

3.29 A public register is maintained of all of the HMOs in the Borough which have been licensed and regularly updated to ensure that it is accurate.  However, there is a very dynamic housing market in Bedford so intelligence supplied by landlords, letting agents and estate agents is important to keep the information up to date.

3.30  From 160 people surveyed in January 2013, 85% agreed with the Council’s aim to improve safety standards and the management of HMOs in the Borough19.  Tenants also reported concerns with their housing generally and were particularly concerned about damp and mould, poor repair, anti-social behaviour and electrical safety.  Other concerns which tenants mentioned included poor insulation of homes, lack of disabled facilities, uneven flooring resulting in slips and trips and the need for designated smoking areas outside of their property.  43% of tenants, leaseholders and residents were either neutral or had concerns about the way the private rented sector was being managed by landlords with 9% suggesting that there was a very poor element within the market locally.


Estimated Costs to the NHS of key HHSRS Hazards

The Building Research Establishment (BRE) have developed a methodology for evaluating the health impact assessment of housing enforcement interventions to tackle category 1 hazards14.  This includes calculating the cost of removing the category 1 hazard against the cost of health care to the NHS to provide a net present value, cost benefit analysis. Table B provides a breakdown of costs for the key category 1 hazards.

A health impact assessment (HIA) can therefore be used to calculate the potential savings to NHS and society by mitigating the most common category 1 hazards.14

The costs in the table below are based on simple sums and although commonly called cost benefit are properly known as ‘cost off-set’. This is the cost to the NHS and does not include other associated costs – in particular it does not reflect care costs which are potentially very high. There are also costs to the broader economy through time off work, reduced productivity etc.


Figure 10: Typical health outcomes and first year treatment costs for selected HHSRS hazards. 24



Class 1

Class 2

Class 3

Class 4

Damp and mould growth


Type 1 Allergy (£1,998)


Severe Asthma (£1,120)

Mild Asthma (£180)

Excess Cold

Heart Attack, care, death (£19,851)

Heart Attack (£22,295)

Respiratory Condition (£519)

Mild pneumonia (£84)

Falls on the level

Quadraplegic (£59,246)

Femur fracture (£25,424)


Wrist fracture (£745)

Treated cut or bruise (£67)

Falls on stairs and  steps

Quadraplegic (£59,246)

Femur fracture (£25,424)


Wrist fracture (£745)


Falls between levels

Quadraplegic (£59,246)

Head injury (£6,464)


Serious hand wound (£1,693)

Treated cut or bruise (£67)


Burn, smoke, care, death (£11,754)

Burn, smoke, care (£7,878)

Serious burn to hand (£2,188)

Burn to hand (£107)


Current activity & services – Housing Conditions

Home energy efficiency schemes

The Council is seeking to raise awareness and has produced a Safe, Healthy and Well leaflet which brings together information on all the existing services provided by the council and other organisations in the public and voluntary sectors.  Over 1,000 copies were printed which have been distributed at information events and presentations, and via the Council’s Customer Service Centre, libraries, GP practices,  housing associations, and through the community organisations that contributed to the leaflet, and is available to download  from the Council’s website: www.bedford.gov.uk/safehealthywell


The Council works in partnership with Street Energy to deliver insulation to priority groups and in deprived areas. It also has a revolving fund created through the Bedfordshire and Luton Energy Scheme (BALES) for boiler loans. Initially funded through the Regional Housing Pot, 190 boiler loans have been completed in the Borough, helping to reduce the risks of fuel poverty and reducing the health risks associated with excess cold.  The volume of loans and the rate of repayment limit the opportunity to offer new loans. This scheme is managed by the Housing Strategy Team working with the Sustainability Team.


The Council successfully applied to the Department of Health’s Warm Homes, Healthy People Fund in 2011/12 and 2012/13. The aim of the national fund was to support activities which would address the public health consequences of cold housing for the most vulnerable and support the Government’s Cold Weather Plan, ultimately to reduce excess winter deaths.


 The Council’s Adult Services department, along with local charities and voluntary organisations partners were successful with an application to the 2011/12 fund. An additional application by the Housing Strategy Team to extend the BALES programme delivered 35 boiler replacements. The Council’ Adult Services department was also successful in leading a further joint application to the 2012/13 fund but there was not comparable funding available in 2013/14.


 Through the fund, the partners provided keeping warm advice, warm packs (consisting of a fleece blanket or ‘Snuggie’, ‘Thinsulate’ hat and gloves set, packet soup, hot water bottle and cover, a room thermometer and documentation promoting local services and advice on keeping warm) given to vulnerable residents in the Borough, funding for community groups to put together and distribute their own warm packs, energy audits, the installation of small energy efficiency measures, the opening of the Night Café for rough sleepers on additional nights and information on how to access insulation offers and financial assistance to help with energy bills, Those benefiting from the funding were mainly older residents living in private housing who were vulnerable to the cold and were provided with all the help that was available to them through cross-promotion and cross-referrals. Unfortunately the Warm Homes, Healthy People fund was not renewed.


Several voluntary organisations are delivering important services.:


Age UK Bedfordshire provides a wide range of support including information and advice on income maximisation.  For the 2014/15 season they are also offering a handyperson service which has been sponsored by E.ON UK energy company and is expected to help 100 clients.  It will provide advice on how to use heating controls and improve the thermal efficiency of the home, as well as light home improvements.  Age UK Bedfordshire’s services are available to anyone over the age of 55 but the majority of their clients are aged between 75 and 100 years.


Bedford Citizen’s Advice Bureau (CAB) provides face-to-face, telephone or web-based advice on a broad range of issues including income maximisation, debt management, and housing problems.  Unaffordable energy bills are a frequent reason for clients to seek support.  Anecdotally, enquiries are common amongst single men in their 40s and 50s, and particularly from households who pay for their power through pre-payment meters.  The CAB can support clients to switch to cheaper energy tariffs but there are practical barriers to overcome such as the best tariffs only being available to those who are able to pay by monthly direct debit.


Home Improvement Loans and Grants

The Council has a very limited fund for home improvement loans, or exceptionally grants which are available for emergency boiler replacements, critical repairs and bringing empty homes back into use. These funds are managed by the Home Improvement Team which sits within Property services.


Disabled Facilities Grants

The Council provides Disabled Facilities Grants which are subject to a referral from an Occupational Therapist.  In 2013/14, 227 people in Bedford benefitted from this support with the Council spending more than £1.2 million delivering these works.  A budget of £1.4 million was available in 2014/15 to meet the increasing demand for these services.  Currently there is an average waiting time of 12 weeks from the time a referral is made by the Occupational Therapist to the point of the grant approval.  The actual work may then take several weeks more to complete.

The maximum grant available is £30,000 and subject to a means test.  These statutory grants provide for aids and adaptations to be made to an individual’s home to enable them to remain living in it as independently as possible.  Some examples of the types of work which can be undertaken include:


  • Making it easier to get in and out of the dwelling by widening doors, levelling thresholds and installing ramps.
  • Making access to the living room and kitchen easier.
  • Providing or improving access to the bedroom, toilet, washbasin and bath (and/or shower) facilities; for example, by installing a stair lift or providing a downstairs bedroom and bathroom.
  • Improving or providing a heating system in the home that’s suitable for the needs of the disabled person.


3.43  The grant works are vital to enabling people to remain at home rather than move into residential or nursing homes which may not be appropriate to their needs.


Landlords forum & newsletter

A landlords' forum is organised at the Bedford Corn Exchange on a bi annual basis to provide advice and support about the new additional licensing scheme with updates on current issues including how to comply with the law.  It is usually well attended with over 75 landlords and guest speakers are also invited to give specialist talks and advice on current topics for example the Green Deal, a government initiative to encourage new green technologies to be installed and paid for through energy bills.  The fourth forum took place on the 26th November 2014. 


A bi annual newsletter will also be produced with the first issue distributed in December 2013.  The newsletter is intended to sit alongside the forum and keep those landlords who cannot attend updated. http://www.bedford.gov.uk/housing/houses_in_multiple_occupation/additional_licensing_of_hmos/landlords_forum.aspx


Anti-social behaviour (ASB)  forum

The Environmental Health and Trading standards team work closely with the Bedford Anti Social Behaviour Forum, with members from the police and community services, mental health teams and housing associations working together to support vulnerable victims of ASB.  A key role is to work with landlords to manage any problems identified with Tenants causing ASB.


Supply of new housing

The health impacts of under-supply of housing are many and serious:

  • Appropriate housing is unaffordable to many households
  • Household budgets are over-stretched in order to meet housing costs
  • New households that are ready to form are unable to do so
  • People live in overcrowded conditions
  • People remain in unsuitable accommodation when their needs have changed
  • People are forced to move away from their family and support networks


The Local Plan 2002 set out plans for an increase in the housing stock of Bedford by 19,000 dwellings by 2021.   Net completions between 2001 and 2013/14 increased the housing stock by 8,200, to a total of approximately 69,500 dwellings in March 2014. 


 Almost 35% of the dwellings completed since 2001 have been flats.   There is a need as identified in the Strategic Housing Market Assessment (SHMA) for dwellings to accommodate smaller households.  There are increasing numbers of older persons who are under-occupying properties that would be more suitable for larger households.  The older people’s age profile for the area shows that numbers of older people in Bedford are lower than the East of England. However, Bedford does have more 75-89 year olds than comparator authorities (although Aylesbury and Colchester have higher numbers of persons in the age range 60-69 indicating a future challenge as the population ages).


More than 17% of completions were by social landlords, and a further 16% were affordable housing units for sale under assisted ownership schemes. Since it was formed in 1990 bpha has developed both within and beyond Bedford and is now a significant regional housing association. Other housing associations also manage properties in Bedford. The proposed merger of Raglan and Jephson Housing Associations will for the first time create another housing association in Bedford with over 1,000 properties in management.  Whilst there are a number of Registered Providers (RPs) that operate in Bedford Borough there are only three with more than 500 properties.  The following RPs have a housing stock of more than 500 properties in Bedford Borough:


  • Aldwyck - 860
  • Bpha – 8,731
  • Stonewater (formerly Raglan and Jephson) – 1,606


New supply takes three principal forms: Strategic Urban Extensions, developments in the urban area, developments in villages. Planning Policy identifies a growth area and a rural area.


The growth area covers the urban area of Bedford and the Strategic Urban Extensions. These major developments are at Wixams (4500 dwellings of which half are in Bedford and half in Central Bedfordshire with expansion beyond these numbers planned in both areas), Shortstown/Cardington (1020 dwellings), Land West of Kempston and Biddenham Loop (2750 dwellings), Land North of Bromham Road (1300 dwellings), Fields Road, Wootton (1203 dwellings) and Rousbury Road, Stewartby (610 dwellings).


The delivery of new housing in the urban area is limited by the availability of sites and in many cases the complexities of bringing forward brownfield sites.


In the rural area development planning policy delineates Settlement Policy Areas for most villages and development.is limited to schemes that bring forward affordable housing. The new National planning Policy Framework allows some market housing where this helps to bring forward affordable housing.

Current activity & services - Supply


The level of need, the dwelling types required and the tenures that will best meet those needs are considered through the Strategic Housing Market Assessment which provides an evidence base for both Planning Policy and the Housing Strategy. A new Strategic Housing Market Assessment is currently in preparation.


The Housing Strategy Team works closely with developers and Housing Associations to promote the delivery of all forms of new housing and particularly affordable housing. Critical to the delivery of new housing is the relationship with the planning system. The Homes and Communities Agency has reduced funding for social housing and, unlike some local authorities, the Council has very little land available for development. The funds generated by the stock transfer to bpha are no longer available and there is only a small amount of funding available from the Council’s own resources. However, working closely with the planning system, developers and housing associations the Council has achieved significant successes in providing both general needs affordable housing and special needs housing. The Housing Strategy sets a target of 200 affordable homes per year. In the five years following becoming a unitary authority in 2009 the Council delivered 1530 affordable dwellings – an average of 306 per year21.


 The Council has also delivered special needs housing in particular extra care schemes for older people (St Bedes and Gordon Colling House) and gypsy and traveller sites (Kempston Hardwick extension and Willow Drift). Current projects include a Complex Needs Scheme for rough sleepers, further extra care schemes at Wixams, Wootton and Kimbolton Road, and small scale schemes for people with mental health issues. The Housing Strategy Team has worked closely with colleagues across the Council to ensure that schemes do meet the needs that are identified. The Care and Support Accommodation Strategy will be important to ensuring that future provision does reflect needs identified across housing, care and health services.


Empty properties are a waste of resources, they undermine neighbourhoods, they create problems of damp penetration and other problems where they adjoin neighbouring houses and problems of vermin infestation. They also create a risk with opportunities for squatting and vandalism. The Council has committed itself to a major campaign to tackle empty properties and set aside nearly £3m to compulsorily purchase properties which will be resold on condition of being brought back into occupation. Most of the funds will therefore be recovered through sales.


Housing Needs


A significant number of residents approach the Council each year with a specific housing need.  Bedford Borough Council works with BPHA in maintaining a housing register and operates a choice based lettings system for social housing.  There are currently 1037 people on the housing register seeking permanent accommodation.

Some residents require assistance with securing accommodation and approach the Council for help.  The table below shows the number of face to face contacts with the Housing Needs service over the last 4 years.


Figure 11: Housing Options Service Customer Contacts

Housing Options Service Customer Contacts






Total approaches to the Housing Options Service






Source: Bedford Borough Council Housing Needs Service


Of these approaches, many are down to a person being homeless or at risk of homelessness.  The table below shows the number of homelessness decisions made by the Housing Needs service over the past 4 years.


Figure 12: Housing Options Homelessness Decisions


Statutory Homelessness Decisions





- Accepted





- Intentional





- Non priority





- Not homeless or threatened with





- Ineligible










Source: Bedford Borough Council Housing Needs Service

There are a small number of cases where an individual has a health need or children, but they are not owed any housing duty.  The table below gives a breakdown of these cases.


Figure 13: No homelessness duty owed – Children & Health Needs


No homelessness duty owed – Children & Health Needs






Total number of intentionally homeless households 





Applicant (or a member of the household) has health needs





Applicants household includes children






Source: Bedford Borough Council Housing Needs Service

A key function of the Housing Needs Service is to prevent homelessness where possible through the use of spend to save initiatives or assisting individuals to access properties in the private sector.  Below is a table showing the success of this over the last 4 years.


Figure 14: Homelessness Prevention

Homelessness Prevention






Total number of preventions





Able to remain in current home





Assisted to secure alternative accommodation*





*of which were supported into a Rent Deposit Scheme tenancy





Homelessness relieved (following an adverse statutory decision being issued)















Source: Bedford Borough Council Housing Needs Service

 In addition to this the House of Industry (a local charity) funds a court desk to assist with legal cases.  In 2013-14 the Court Desk prevented homelessness for an additional 97 households. 


The Citizens Advice Bureau also assists in the prevention of homelessness.  In 2013-14 the CAB debt advice service dealt with 147 cases where homelessness was threatened.


Rough Sleeping


Rough sleeping refers to people sleeping in the open air, or in buildings or places not designed for habitation.  Using the snapshot date of the 13th of November 2014, Bedford Borough Council conducted its own annual Rough Sleeper Evaluation in partnership with Bedford based agencies and organisations that work locally with socially disadvantaged people.


 The Estimate methodology requires a robust verification process which showed that 25 people were sleeping rough on that night; this compares to previous year’s estimate figures as follows;


Figure 15: Rough sleeper estimate







Estimated Figure






Source: Bedford Borough Housing Needs Service

The reduction of 1 in the number of rough sleepers is the first reduction since rough sleeper evaluation began.  This is the result of the ‘No Second Night Out’ (NSNO) funding arrangements which were implemented in Bedford in May 2013.  The funding secured the Street Outreach Service and Reconnection Service provided by Noah Enterprise.  In total 153 individuals supported into housing as a result of the NSNO initiative.  57 individuals have been identified who do not have a local connection to Bedford of which 35 were reconnected to their home area and others found appropriate housing solutions. 


The funding for the Street Outreach Service comes to an end on 31st December 2014 and the Reconnection Services will end on 31st March 2015. 


Of the 25 identified rough sleepers only 4 of the 25 rough sleepers (16%) were identified in the previous annual estimate in 2012.  This compares to 23% in 2013.  Only 5 people are assessed as being on the streets for a short period with 20 assessed as rough sleeping for months or years rather than just a number of weeks. This compares to 13 out of 26 assessed as long term rough sleepers in 2013 and 14 out of 19 in 2012. 


There was an increase in non-British rough sleepers to 13 from 7 in 2013; within this, 12 of the 13 were from Eastern Europe.  People with no recourse to public funds increased from 3 in 2013 to 8 this year. This is thought to be due in the main to changes in eligibility legislation introduced in April 2014. These changes make it harder for EU nationals to qualify for assistance in the UK leaving those, who cannot secure employment or choose not to be assisted with Reconnection to their home country, destitute.  The work of the ‘No Second Night Out’ initiatives assisted with reconnecting a significant number of Eastern Europeans to their home country during 2014.  


This year’s estimate showed that the current proportion of rough sleepers with multiple needs (on top of their housing need) is in the region of 52%.  This is a decrease from 70% in 2013; further evidence that the NSNO assessment and initiative program has been successful in identifying person centred pathways to meet the different needs of individual rough sleepers.


The robust NSNO assessment process applied by Noah Enterprise and other agencies working as part of the overall Action Group enabled early identification of those new to the streets. This enabled early intervention to help individual’s access private sector tenancies utilising NSNO funding to assist with deposits and rent in advance.  The success of this initiative is evident in the significant decrease in the number of individuals who have been rough sleeping for just a short period.


Housing Care and Support


Older People


 The population of Bedford Borough is ageing. Since 2001, there has been a significant growth in the over 50’s population within the Borough. This trend is projected to continue with a significant growth in the over 65’s population within Bedford Borough over the next 20 years.  The number of people aged 65+ is forecast to rise by 61% between 2013 and 2033. Older age groups are projected to rise by much higher levels, with the population aged 85+ increasing by 132%. The number of people aged 65+ as a proportion of the total population will rise from 16.7% to 22.5%. This will create increased demand for personal support and care. The reliance on nursing and residential services to provide support and care will be reduced by planned growth in Extra Care accommodation and other community support services 7


Alongside the demographic changes that are projected to take place within Bedford Borough, the aspirations of older people are also changing. Most significantly, more people are expressing a desire to remain within their own home and receive care in that setting. Plans will need to include the increased availability of telecare, telehealth and reablement services, the requirement to reduce reliance on domiciliary care in the light of shrinking care budgets, and increasing pressure on budgets for aids and adaptations provided to homeowners by the Council with more people wishing to remain at home. This presents a significant challenge when projecting the future accommodation needs of the older person’s population in Bedford Borough.


The number of older people within Bedford Borough is projected to increase significantly over the next 20 years. This will place increasing pressure on housing services and Adult Social Services to deliver accommodation solutions that meet the needs and aspirations of the older person’s population.  The terms “older people” or “older persons” are general terms usually referring to people over 65 years of age. In recent times, anyone over the age of 50 may have been classified in the older persons demographic.


 The Borough has a slightly younger age profile than either the East of England or England with a median average age in 2013 of 39.6, compared to 41.2 in the region and 39.7 in England. The proportion of older people is also lower, with 16.8% of the Borough’s population in 2013 aged 65+ compared to 18.7% in the East of England and 17.3% in England.


There are significant differences between the demographic profiles of the Borough’s urban and rural areas.  Bedford and Kempston has a much younger age profile, with only 32% of its population aged 50+ compared to 40% in the rural area.


While the Borough’s total population rose by 9% between 2001 and 2013, older age groups increased at a significantly higher rate, with those aged 75-84 rising by 17.6% and those aged 85+ by 40.8%:


Projections of the potential increase in Bedford Borough in numbers of people aged 50+ between 2013-2021 and 2013-2031 are shown below.


Figure 16: Growth in population 50 and over


2013-2021 Change

2013-2031 Change











% Change 2013-2021



% Change 2013-2031





























Total Population







Sources: ONS, 2013 Mid Year Population Estimates and ONS, 2012 based Subnational Population

Rates of limiting long-term illness by age have been combined with population projections for the Borough to project the numbers of older people suffering from a long-term illness or disability:


Figure 17: Population 65 and over and limiting long-term illness








People aged 65-74 with a limiting long-term illness






People aged 75-84 with a limiting long-term illness






People aged 85+ with a limiting long-term illness






Total Population aged 65 and over with a limiting long-term illness






 Source: POPPI, accessed December 2014


The number of people aged 65+ in Bedford Borough who are projected to live alone will rise significantly over the next 20 years.  Older age groups are projected to rise by much higher levels with the population aged 85+ increasing by 132% between 2013 and 2033.  The number of people aged 65+ as a proportion of the total population will rise from 16.7% to 22.5%. This will create increased demand for personal support and care. The reliance on nursing and residential services to provide support and care will be reduced by planned growth in Extra Care accommodation and other community support services.  This is important for understanding the demand for future housing may also act as an indication of the need for support for those who may experience social isolation.


Alongside the demographic changes that are projected to take place within Bedford Borough the aspirations of older people are also changing. Most significantly, more people are expressing a desire to remain within their own home and receive care in that setting. Plans will need to include the increased availability of telecare, telehealth and reablement services, the requirement to reduce reliance on domiciliary care in the light of shrinking care budgets, and increasing pressure on budgets for aids and adaptations provided to homeowners by the Council with more people wishing to remain at home.  This presents a significant challenge when projecting the future accommodation needs of the older person’s population in Bedford Borough.


The following Care Homes for older people operate in the Borough

Figure 18: Registered Care Homes in Bedford Borough


Care Homes




Anjulita Court


Methodist Homes

Annandale Lodge


Lansglade Homes Limited

Beacon House


Lansglade Homes Limited

Bedford Charter House



Brook House


Risely Beds Limited

Bushmead Court


Calsan Limited



Contemplation Homes Limited



St. Andrews Care Homes Limited

Dial House Nursing & Residential Home


Dial House Care Limited

Elcombe House


St. Andrews Care Homes Limited

Fenwick House


Wagh Limited (Fenwick House)

Henrietta House


Lansglade Homes Limited

Hepworth House


Private Individual



Bedford Borough Council

Holly Tree Lodge


Holly Tree Lodge

Kimbolton Lodge


Kimbolton Lodge Limited

Lansglade House


Lansglade Homes Limited

Lillibet House


Private Individual

Lillibet Lodge


Private Individual

Manton Heights Care Centre


Ranc Care Homes Limited

Milton Ernest Hall


Ross Healthcare Limited

Oasis House


GB Care Limited



Bedford Borough Council

Parkview Lodge


Private Individual



Bedford Borough Council

Renhold Community Home


Choice Support



Bedford Borough Council

Salvete Care Home


Private Individual

Sharnbrook House


Greensleeves Homes Trust



Bedford Borough Council

St. Margarets


Calsan Limited

The Airedale Nursing Home


Tanh Limited

The Mallards


Lansglade Homes Limited

The Willows


Hestia Health Care Limited

Waterloo House


Waterloo House Care Homes Limited





There are a number of proposals for new residential care and nursing care provision. These proposals are at various stages of development. The delivery of these schemes, and the timing of that delivery, is not certain.

Figure 19: Proposals for new care homes (planning applications)


Proposals for new Residential Care provision



Bedford Charter House


Bedford Road Wilstead


Turvey Station


Wyboston Lakes





Proposals for new Nursing Care provision




The Broadway


St Leonards Street





Extra care housing is a form of provision that sits between sheltered housing and residential or nursing care homes. It offers older people a wide range of facilities and access to on-site care while allowing them to retain ownership or a tenancy of a flat within the development. This supports the maintenance of a higher level of independence for longer and a more gradual transition as care needs increase. The support for a community and the informal provision of care by residents is also important.


Following the adoption of the Older Persons Accommodation Strategy new Extra Care schemes have been delivered at St Bedes (104 flats including 51 for rent and 53 for shared ownership) and Gordon Colling House (55 flats for rent). There is now a waiting list of 170 applicants for the scheme at St Bede’s with strong interest in the shared ownership homes.


There is a need to clarify the schemes that are regarded as extra care schemes (as opposed to care homes and sheltered housing). There are 10 schemes providing 421 places to review.


 There are proposals to extend extra care provision over the next few years. The delivery of these schemes, and the timing of that delivery, is not certain.          


Figure 20: Proposals for new extra-care schemes (planning applications and allocations)

Proposals for new Extra Care provision




Bedford Charter House


River Valley Park


Fields Road Wooton


Turvey Station




Wyboston Lakes





Supported Housing


Tenancy failure and social isolation can result in significant increases in the number of presentations to health and social care services 28.  They can also increase a person’s vulnerability to developing long term conditions particularly amongst the older population 29  With more than 75% of the older population owning their own home and 51% of the over 75’s living alone30 this is an increasing issue which has significant potential to impact on health and social care services. 


At any one time, the Council is supporting 1,504 people to gain or maintain their accommodation.  In the calendar year of 2014, 1,927 individuals were assisted in one of the contracted housing related support services in Bedford, the majority of which were older people.  More than £3 million is invested in these services each year by the Council.  These services are invaluable in terms of reducing social isolation, early identification and intervention preventing more acute needs arising and maintaining a person’s level of independence.


The table below shows the number of units of accommodation available for individuals with a housing related support need.

Figure 21: Accommodation with housing related support

Client Group

No of Units

Floating Support


Extra Care/Frail Elderly


Traditional On Site Warden


Older Peoples Community Living with Flexible Support


Older Peoples Floating Support




Physical and Sensory Impairment


Learning Disabilities 


Mental Health


Single Homeless and Rough Sleepers


Young People at Risk


Teenage Parents


Domestic Abuse


Total number of units



Source: Bedford Borough Council Supporting People Service


Data is collected from individuals leaving a service, except for older persons services.  This is known as Client Record Form data.  Over the April 2013 to March 2014 period there were 683 CRF’s submitted for SP services in Bedford Borough, representing a 6% increase on 2012-13. The table below gives a breakdown of the types of service and the number of clients that went into them.


Figure 22: Types of support service


Service Type

Number recorded

Homeless Hostel (including Mental Health hostels)


Rough Sleeper services


Domestic Violence services (refuges & IDVA service)


Young Person services (including Teenage Parents)


Floating Support (generic & specialist)


Offender services


Learning Disability services


Physical Disability services


Sensory services


Mental Health services


Source: CRF data 2013/14

Client Profile:


  • Gender:    Of the 683 CRF’s recorded 313 (46%) were for males and 370 (54%) were for females.
  • Age:          The majority of those accessing services were either under 20’s (14%) or within the ‘20 to 24’ age band (18%).
  • Ethnicity: Two thirds (65.6%) of those accessing services were recorded as being White British.  Within the BME groups, the most commonly represented were ‘Any Other White’, ‘White & Black Caribbean’, ‘Pakistani’, ‘Indian’, ‘Black Caribbean’, ‘Black African’ and Bangladeshi.
  • Economic Status:           The vast majority (41%) of those accepted in to services were recorded as ‘Job Seekers’. After this the most common status recorded was ‘Long Term Sick/Disabled’ (18%), ‘Not Seeking Work’ (15%) or ‘Other Adult’ (12%). Compared to 2012-13 figures, this shows a significant decrease in the ‘Long Term Sick/Disabled’ and ‘Not Seeking Work’ categories, which accounted for 20% and 24% of records in the previous year.


Client Needs: Disability:


  • 156 (23%) of CRF’s recorded the client as having a Disability, which represents a 10% decrease on the 2012-13 figures for clients with a disability entering services.
  • 46 (29%) were identified as having more than one area of disability.
  • Of the 156 recorded, more than half (54%) identified their disability as ‘Mental Health’, while 27% had a Mobility related disability and 22% were identified as having a Progressive Disability/Chronic Illness.


Figure 23: Supporting people clients: Nature of disability


H6 2015

Source: CRF data 2013/14


Client Groups


CRF’s use the ‘Supporting People’ needs groups to identify client’s needs. Up to 4 different needs groups can be selected for each client – a ‘Primary’ Need Group and up to 3 ‘Secondary’ Need Groups.


Figure 24: Supporting People Client Groups


H7 2015

Source: CRF data 2013/14

The most commonly identified client needs groups were ‘Single Homeless with Support Needs’, ‘People at Risk of Domestic Abuse’, ‘People with Mental Health Problems’ and ‘Young People at Risk’.


Almost half of clients (48%) had more than one needs group selected. 35% were identified as being in 2 groups, 7% as being in 3 groups and 6% as being in 4 groups (the maximum that can be selected). This is comparable with the 2012-13 data findings where 53% of clients were recorded with multiple needs groups.


For those where 2 needs groups were indicated, the common combinations were;

  • Single homeless or rough sleepers & mental health problems x 17
  • Single homeless or rough sleepers & drug or alcohol misuse problems x 22
  • Mental health problems & drug or alcohol misuse problems x 11


For those where 3 needs groups were indicated, the more common combinations were;


  • Single homeless or rough sleepers & mental health problems x 10
  • Single homeless or rough sleepers & drug or alcohol misuse problems x 8
  • Mental health problems & drug or alcohol misuse problems x 3
  • Single homeless or rough sleepers & mental health problems & drug or alcohol misuse problems x 8


For those where 4 needs groups were indicated, the more common combinations were:


  • Single homeless or rough sleepers & drug or alcohol misuse problems x 15
  • Single homeless or rough sleepers & offender/at risk of offending & drug or alcohol misuse problems x 5
  • Single homeless or rough sleepers & mental health problems & drug or alcohol misuse problems x 16
  • Single homeless or rough sleepers & offender/at risk of offending & mental health & drug or alcohol misuse problems x 3


Other Need Indicators


There were 193 clients recorded as having been accepted as requiring services under the four listed statutory frameworks, which equates to just over a quarter (28%) of all clients.

 Of the 193 clients, 52 (27%) had been accepted under more than one framework. A full breakdown is shown below.


Figure 25: Supporting People clients by statutory framework




Care Management (Social Services)


Secondary Mental Health Service


Probation Service/Youth Offending Teams


Drug Interventions Programme (DIP)





Source: CRF data 2013/14

Other CRF submission data showed the following:


  • 32 clients recorded as being under Care Programme Approach (CPA), and 10 of these were also recorded as being accepted under one of the statutory frameworks above
  • clients were subject to Multi Agency Public Protection Arrangements (MAPPA)
  • 169 clients were subject to the Multi Agency Risk Assessment Conference (MARAC) process
  • clients had Anti-Social Behaviour Orders (ASBO)
  • 9 clients were identified as being ‘Ex Armed Forces’


Out of Area Supporting People Clients

The CRF data shows that 53 clients (8%) entered Bedford Supporting People services from other areas, compared to 78 in 2012-13. This equates to a 32% reduction in out of area clients. This decrease would suggest that both the Supporting People CAPITA system and the Bedford Reconnection Protocol are working effectively to prevent those with no local connection to Bedford from directly accessing services without prior agreement with either Supporting People or the Housing Options Team.


Housing Support is also provided to other groups within the community. The support needs of these groups are set out in the Joint Commissioning Strategies. Their accommodation needs will be considered through the Care and Support Accommodation Strategy and will feed into a fuller analysis in future versions of the JSNA.


Gypsies and Travellers

Gypsies and Travellers suffer some of the poorest health and education outcomes in the UK today.  From long running research undertaken by the Ormiston Trust Gypsiesand Travellers have:


  • Low access to preventative health services – often due to lack of a settled address
  • Life Expectancy around 50 compared to 78 in the settled community
  • Infant mortality 7 to 12 times higher than the settled community


Gypsy and Traveller children are those most at risk within the education system.  OFSTED suggests that up to 10, 000 Travelling children nationally are not even registered with a school


These facts highlight some of the significant issues faced by the Gypsy and Traveller community.  Engaging with the community can be challenging due to mistrust of those in positions of authority by the Community as well as misconceptions still held by statutory providers. 


The Council owns and manages two permanent sites for members of the Gypsy and Traveller community.  These are Kempston Hardwick – 22 plots and Willow Drift – 14 plots.  The Council is one of the few in England and Wales to have used HCA funding in recent years to extend it provision of Traveller sites through the provision of six new pitches at Kempston Hardwick (bringing the total to 22) and the new site at Willow Drift. The new site is operated in conjunction with a residents association which offers the opportunity for a more meaningful engagement by the community with Health and Education services.


There are no permanent private sites in Bedford. The Gypsy and Traveller Accommodation Assessment 2012 found that this met the need for sites in Bedford to 2021. There are periodically unauthorised encampments and unauthorised developments. A new assessment will be carried out as part of the preparation for the Local Plan to 2032.


National and Local Strategies

National Housing Strategy

The Government published “Laying the foundations: a housing strategy for England” in 2011.  The key points were:

  • the need to get the housing market moving again, in particular new house building
  • more support for local areas that want to deliver larger scale new development to meet the needs of their growing communities
  • new incentives for housing growth through the New Homes Bonus, Community Infrastructure Levy and proposals for local business rates retention.
  • providing appropriate support, protections and opportunities to struggling households and to making the best use of social housing to provide stable homes for those who need them most.
  • delivering the Zero Carbon Homes standard for all new homes from 2016


National Strategy – Conditions

The major new initiative in relation to housing conditions that the current government has taken has been the Green Deal and the Energy Companies Obligation. The Green Deal is a government backed initiative which can help to improve the energy efficiency of homes following a Green Deal Assessment to determine suitable measures. There are a number of options for paying for the improvements, including Green Deal financewhere the cost of the recommended measures are repaid through energy bills. There are significant barriers to take up including the costs of the assessment, the Green Deal Plan’s interest rates and fears that householders have about the estimated savings, which are not guaranteed which could possibly lead to higher energy bills, and the fact that the loan stays with the home. The number of Green Deal plans has been very low compared to the government’s target of 10,000 plans by the end of the launch year.

The Green Deal was launched at the start of 2013 but, nationally, just over 7,000 households had signed up for a Green Deal plan by the end of October 2014. The Energy and Climate Change select committee in September 2014 said “With such extremely low levels of take-up eighteen months into the life of the policy, the Green Deal has so far been a failure,” 20


The Select Committee recommended that homeowners should be offered new incentives such as discounts on stamp duty or council tax in return for carrying out work to improve the energy efficiency of their homes.

The Green Deal Home Improvement Fund, which was re-launched in December 2014, is an incentive scheme which allows money to be claimed back on the cost of Green Deal Assessments and installed energy efficiency measures, and has been overwhelmed with applications.


The Energy Companies Obligation (ECO), also introduced in January 2013, obliges energy companies to help improve the energy efficiency of homes and was intended to work alongside the Green Deal to provide additional support in the domestic sector, with a particular focus on vulnerable consumer groups and hard-to-treat homes. Nearly 1 million ECO measures have been installed nationally.


As with many schemes securing take-up in the private rented sector is an even bigger challenge than securing take-up by owner-occupiers.    


Other council initiatives


Liverpool City Council have introduced a healthy homes scheme where they visit areas with the greatest need and provide help and advice to residents to prevent hazards to improve their health.  This includes advice on dealing with excess cold, damp and mould, fuel poverty and how to prevent falls on stairs and flat surfaces.  They work with a number of other partners including the fire and rescue service, the Citizens Advice Bureau, Age Concern, Experts Patients Programme, Liverpool Addiction Services and the Council Benefit Maximisation Team amongst others. The Council is running a pilot until March 2014, based on this scheme. Using the Liverpool example, the Council has commenced a Keeping Cosy pilot project where Environmental Health Officers will provide tenants with advice and leaflets  to help  them to use heating more efficiently and keep affordably warm. Landlords will be provided with advice and leaflets on energy efficiency measures and source of funding.


National Strategy - Supply


The Government has introduced the National Planning Policy Framework which, together with Planning Policy Guidance represents a significant change to the way in which the planning system operates with a presumption in favour of sustainable development.

The Regional Spatial Strategies which set housing targets for local authority areas were abolished. Local Authorities now have a Duty to Co-operate to ensure that needs that cannot be met in one area are met in another. Significant pressures for Bedford arise from London and Luton. The Council has a local development Framework which extends to 2021 and is working on a new Local plan which will extend to 2032.


The Government has consulted on a Standards Review and is likely to implement its findings in the next few months.  The review covers accessibility, space, security, water efficiency, energy, indoor environmental standards, materials, process and compliance. A key theme of the review is a rationalisation and simplification of standards with a reduction in local variation. The standards of new housing will have implications for the health and well-being of their residents. 


With regard to accessibility, which is a particular health concern, the review proposes three standards


  • Category 1 – visitable dwellings
  • Category 2 – accessible and adaptable dwellings
  • Category 3 - wheelchair user dwellings


Category 1 dwellings are covered by Part M of the Building Regulations. The review considered improving the mandatory requirements and this did find considerable support, but due to concerns about cost and design implications for new homes the Government decided that it will not change the technical requirement of the mandatory elements of Part M at this time. The update that will take place will be intended to retain existing standards. The Government has agreed to start work on scoping research to improve evidence on accessible housing, with a particular focus on the social, health and welfare benefits that improved accessibility could bring.


The optional requirement referred to as ‘Category 2 Accessible and Adaptable dwellings’ provides higher levels of accessibility and adaptability than Category 1 dwellings. The requirements are similar to current requirements for the Lifetime Home Standards and have been developed from the standards as set out in the illustrative standards in the 2013 consultation. Category 3 dwellings are intended to be capable of meeting or being adapted to meet the needs of a wide range of household members including most wheelchair users. A requirement that a dwelling must be fully wheelchair accessible will only be possible for properties covered by the Local Authorities allocations policies. For all other properties the requirement will be that the properties should be wheelchair adaptable. The standards for Category 2 and Category 3 dwellings will be set nationally. The extent of the need for them will be determined through the development of the new Local Plan and in the first instance will be considered in the Strategic Housing  Market Assessment.


Local Strategies

Bedford Borough Council’s Housing Strategy 2012 sets out the following objectives under which there are a range of specific objectives and an action plan http://www.bedford.gov.uk/housing.aspx .


  • Gather and evaluate evidenceabout housing needs within the Borough including housing conditions and the needs of different age cohorts, household types, rural and urban households, black and minority ethnic households, both now and in the future.
  • Develop a robust approach to allocations and tenancies that meets the needs and priorities of the borough and maximises the use of available resources.
  • Work with the planning system to deliver additional affordable housing that meets identified needs within sustainable communities.
  • Work collaboratively with developers, Registered Providers (RPs), funding agencies and other partners to bring forward the development of strategic sites.
  • Ensure that the Borough responds to changes to the funding of affordable housing, maximises access to available funding and uses resources effectively.
  • Encourage rural communities to identify housing needs and work with them to deliver local needs housing.
  • Work with partners to improve the fabric of the existing stock in particular to improve energy efficiency reducing the carbon footprint of housing in the borough and fuel poverty.
  • Target long term empty homes and bring these back into beneficial use.
  • Prevent homelessness through the provision of housing advice and through identifying housing options for persons at risk of homelessness.
  • Plan for the implications of an aging population including supporting people in their existing homes and providing specialist accommodation.
  • Support the adaptation of existing homes and the provision of new homes that are accessible to people with different abilities.


Planning Policy is a key influence on new housing supply and is developed by the Planning Policy team and is subject to examination by the Planning Inspectorate before it can be approved by the Council. Individual planning applications are managed by the Development Management team and are determined by the Planning Committee. Decisions of the Planning Committee are subject to appeal to the Planning Inspectorate. The current Local Development Framework is the Core Strategy and Rural Issues Plan 2008. This plan runs to 2021. Work on a new Local Plan to 2032 is in progress. http://www.bedford.gov.uk/environment_and_planning/planning_town_and_country/planning_policy__its_purpose.aspx


The Tenancy Strategy 2014-2017 is generally focussed on supporting affordable and social rented tenants in remaining in their homes while making best use of large properties and properties with adaptations. The strategy seeks to ensure that tenants have the support they need where a move needs to be considered because the property no longer conforms to their requirements. The Tenancy Strategy influences the approach of housing associations to tenancies. It is not mandatory on housing associations. Decisions about individual cases will be taken by the housing association that is the landlord in accordance with its Tenancy Policy – not by the Council. http://www.bedford.gov.uk/housing.aspx


The Empty Homes Strategy 2013-2017 is designed to limit the waste of this critical resource and to prevent neighbourhoods being blighted by empty properties with the risks associated with disrepair, crime and vandalism. It identifies that there is a significant issue in Bedford with of long-term empty homes and a range of strategies for tackling this problem. http://www.bedford.gov.uk/housing.aspx


The Affordable Warmth Strategy (2013-16) and Action Plan (2014-15), aims to tackle fuel poverty and comprises initiatives to:


  • reduce households’ energy costs (including help accessing national schemes)
  • increase households’ income
  • raise awareness of other help which is available


The Affordable Warmth Strategy and Action Plan are available at: http://www.bedford.gov.uk/environment_and_planning/sustainability/keeping_warm_at_home.aspx


The Older Persons Accommodation Strategy 2011-2016 identified the balance of types of specialised accommodation for the elderly that would be appropriate for Bedford. It identified an over-supply of outdated sheltered housing schemes for rent and the need for extra care schemes and additional sheltered housing schemes for sale. It also identified a limited need for additional care homes, particularly those offering nursing and specialist care.


The Supporting People Strategy 2012 – 2017 identified a need to remodel the provision of housing related support services within Bedford Borough Council to achieve the following vision: “To provide accessible high quality and cost effective housing-related support for vulnerable people that promotes independence, social inclusion and complements other services. Working in partnership with stakeholders and in consultation with service users, we will ensure services respond to local need, are accessible, equitable, flexible and provide the best possible outcomes for those who use them.” The objectives included:



  • Effectively procure, and where appropriate, amalgamate services to deliver improved economies of scale and greater efficiencies including the procurement of larger accommodation based services to deliver better economies of scale
  • Develop a Complex Needs provision (a hostel scheme with high levels of support for rough sleepers and others with complex needs who cannot sustain tenancies and face exclusion from hostels
  • Change the delivery of older persons services to transition the service to a more community based provision with less emphasis on sheltered accommodation
  • Change the delivery of accommodation based services to those with a Learning Disability with a focus towards those with semi-independence of those who can be helped towards independence
  • Jointly develop provision for early invention with Children’s services, such as the Independent Domestic Abuse Programme and ensure that existing provision is complimenting the aims and objectives of Children’s services


The Homelessness Strategy is being revised to take in to account changes in legislation, welfare reform and best practice. It is being developed by Bedford Borough Council and its partners, to actively work to reduce and prevent homelessness within the Borough. In line with the requirements of the Homelessness Act 2002, the strategy is being compiled based on detailed research and consultation about homelessness in the Borough in 2014. The review includes an examination of levels and trends in homelessness together with a review of the existing provision of support and other services for those facing homelessness in the Borough.


The Care and Support Accommodation Strategy will consider the needs of a range of groups: adults and children with learning disabilities and with physical and sensory disabilities; people experiencing dementia, autism and mental health Issues; young people in need and cared for children; people with drug and alcohol Issues, people experiencing domestic abuse. There are a range of policies in place addressing the needs of the groups. The Care and Support Accommodation Strategy will aim to complement these strategies, drawing out housing issues.


What is this telling us?


The Marmot Review: Fair Society, Healthy Lives 2010 states that health inequalities result from social inequalities and that action on health inequalities requires action across all the social determinants of health, including housing.  Creating a fairer society is fundamental to improving the health of the whole population and ensuring a fairer distribution of good health.  Inequalities in health arise because of inequalities in society – in the conditions in which people are born, grow, live, work, and age. So close is the link between particular social and economic features of society and the distribution of health among the population, that the magnitude of health inequalities is a good marker of progress towards creating a fairer society.


The Review contains objectives relating to housing and health


  • Develop common policies to reduce the scale and impact of climate change and health inequalities
  • Improve community capital and reduce social isolation across the social gradient.


Further to these objectives the review recommends prioritising policies and interventions that reduce both health inequalities and mitigate climate change, by:


  • Improving active travel across the social gradient
  • Improving the availability of good quality open and green spaces across the social gradient
  • Improving the food environment in local areas across the social gradient
  • Improving energy efficiency of housing across the social gradient.


It further recommends the full integration of planning, transport, housing, environmental and health systems to address the social determinants of health in each locality and support for locally developed and evidence based community regeneration programmes that remove barriers to community participation and action and reduce social isolation.


For those over 75yrs there is an increased risk of excess winter death with a higher risk for females. Over 65yr olds are also the second highest category of age group to be more likely to have a category 1 hazard in their home     which could increase the risk of hip fracture


Applying the Decent Homes Standard, overall non decency rates differ little between White British heads of households (24.4%) and Black & Ethnic Minority (BME) heads of households (23.7%).  BME households had the highest levels of disrepair and thermal comfort failure whilst White British households had higher rates of category 1 hazards.


16-24 year olds are more likely to live in properties with thermal comfort failure (25.4%).


Income inequality and housing affordability are key determinants of housing careers and consequently of the health outcomes that are linked to housing.  For those unable to buy access to the private rented sector social housing is essential.


Reductions in funding for affordable housing and changes to the planning system are reducing the supply of affordable housing. The government’s intention is that overall supply should increase as a result of the changes and that access to housing should therefore become easier for all but the poorest.


2013/14 saw an increase in overall supply in Bedford, significantly assisted by the government’s Help to Buy programme, but a fall in the number of affordable dwellings completed from recent years. However, the Council did meet its target of 200 affordable dwellings per year. Households dependant on Housing Benefit are struggling to secure accommodation in the Private Rented Sector.  Increasingly Private Landlords and Agents will not accept Housing Benefit.  Research carried out by CAB in Bedford in 2012 found that out of 284 properties available with local letting agents only 18% would be made available to households dependent on Housing Benefit. 


There is a reduction in the number of properties available within Local Housing Allowance rates. This invariably means that properties available to those in receipt of Benefits will be those with a lower market value and in areas of higher deprivation.


The Borough is not insulated from the broader housing market. Much of the new housing will meet pressures for housing from London and Luton.


At 31st March 2014, nationally 12,910 households in temporary accommodation were accommodated in another Local Authority district.  Many London Authorities are paying high incentives to Landlords outside of their area to secure accommodation in other Local Authority areas.  This reduces further the availability of Private Rented Accommodation locally.


What are the key inequalities?


There is a need to address excess cold and fuel poverty both through the provision of improved advice and referral systems and through the provision of energy efficiency measures the Landlords and tenants in particular may be unaware of the options available to them to improve thermal efficiency and reduce excess cold.    


 Although it is early into the scheme there are approximately 1000 HMOs not yet licensed through the additional licensing scheme.


Landlords and tenants may leave their properties in disrepair thereby increasing the likelihood of falls.


There is a continuing shortage of housing of all tenures and a need to address affordability. The worsening of affordability puts great pressure on household budgets and leads to households living in unsuitable housing that does not support their health and well-being.


There is a continuing shortage of social housing and private rented sector housing that is accessible to people on low incomes.


There is a lack of appropriate accommodation with a high level of support for homeless people with complex needs who are unable to sustain tenancies and are in many cases excluded from hostels. It is clear that rehousing alone will not provide solutions for the majority of those who are rough sleeping and who have complex issues. The lack of a Complex Needs Housing Unit, the main aim of which will be to equip rough sleepers with the life skills for sustainable independent living and assist them with access to good quality housing, is a contributing factor to the reason we have a significant number of long term rough sleepers.


In order to maintain the assessment and early intervention for people new to the streets and in turn continue the reduction in short term rough sleepers and prevention of people becoming entrenched into a life style of rough sleeping, Bedford Borough Council will use the annual snapshot information to engage further with local agencies to tailor services to the individual needs of rough sleepers, however the ending of the NSNO funding will impact significantly on our ability to provide:


  • Street Outreach Services
  • Reconnection Services
  • Assistance to access private sector tenancies


The funding for the Street Outreach Service comes to an end on 31st December 2014 and The Reconnection Services will end on 31st March 2015. 


The impact of welfare reform has not been fully seen in the statistics contained in this chapter.  It is important to consider what trends may be developing due to welfare reform that may impact on a person’s independence and health.


There is a continuing need to improve the accessibility of housing and its suitability for people with disabilities.


A range of housing related to care and support needs is required as well as improved domiciliary services.


One focus of the Care Act 2014 is information advice and advocacy services. There is a knowledge network in Bedford and ongoing work to improve that network. This includes departments within the Council, GP services and other health services organisations and voluntary organisations. There is an active proposal to develop a Lifestyle Hub. This proposal is being brought forward by the Council but will be based in the hospital. Independent advice and information is offered by Age Concern, the CAB, Carers In Bedfordshire, the Alzheimers Society, and the Tibbs Dementia Foundation.


Work is in progress to review the information and advice offered, identify gaps and possible areas for improvement. It is important that access to advice on housing and appropriate referral strategies is included within that.


There is a recognised need for a channel shift which will include improved IT and better on-line advice and information. This requires the development of an on-line directory and Frequently Asked Questions in housing as in other areas.




  1. To review how the Council can be more effective through better internally joined working and with Partners in addressing some of the needs identified in the JSNA.
  2. To review existing referral systems and examine the value and the feasibility of developing a community referral to provide a single point of contact for all non-statutory provision, linking in with statutory providers where appropriate. 
  3.  To undertake a joint review with the incoming Mental Health Trust provider to identify better ways of referring and managing clients with a mental health need, preventing homelessness, identifying opportunities for early intervention and managing complex cases
  4. To examine the feasibility of piloting a healthy homes initiative in Bedford to target the most vulnerable areas to help prevent excess cold.
  5. To develop the Care and Support Accommodation Strategy to identify opportunities for more effective services and more cost effective delivery of services.
  6. To undertake a joint review with GP’s, Social Care and other primary contact services is undertaken to identify individuals who may be suffering with loneliness but do not have any other significant health issue at this time.
  7. To develop a response to the standards review identifying issues and options within the new nationally determined framework.



  1. To carry out a new Stock Condition Survey to provide data that is updated and supports more effective targeting of interventions.
  2. To encourage and support landlords to help their tenants become more energy efficient. 
  3. To improve co-ordination in relation to new developments both with regard to the provision of health services and the development opportunities.




World Health organisation http://www.euro.who.int/en/health-topics/environment-and-health/Housing-and-health


Parliamentary Office of Science and Technology published a document on housing and health in January 2011 http://www.parliament.uk/documents/post/postpn_371-housing_health_h.pdf (Accessed 16th December 2014)


World Health Organisation: The World Health Report – Research for Universal Health Coverage 2013 http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf (Accessed 16th December 2014)


Department for Communities and Local Government: Live Table 104 Dwelling Stock by tenure: England https://www.gov.uk/government/statistical-data-sets/live-tables-on-dwelling-stock-including-vacants (Accessed 16th December 2014)


Bedford Borough Statistical Profile – Housing and Households June 2014

Bedford Borough Council: Income and Benefits http://www.bedford.gov.uk/health_and_social_care/bedford_borough_jsna/wider_determinants/employment_and_income/income_and_benefits.aspx (Accessed 16th December 2014)


Bedford Borough Council: Population Estimates and Forecasts http://www.bedford.gov.uk/council_and_democracy/statistics_and_census/population_estimates.aspx  (Accessed 16th December 2014)


Bedford Borough Council, July 2011, Private Sector House Condition Survey  http://www.bedford.gov.uk/housing.aspx  (Accessed 16th December 2014)


ODPM 2003 Statistical evidence to support the housing health and safety rating system volumes I.II and II ODPM London.


Public Health England (2013).  Excess winter mortality report 2012 to 2013.  https://www.gov.uk/government/publications/excess-winter-mortality-2012-to-2013  Accessed 10th March 2014)


The Marmot Review Team (2010).  Fair Society Healthy Lives.  Strategic review of health inequalities post-2010.  http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review  (Accessed 10th March 2014)


David Buck and Sarah Gregory (2013).  Improving the public’s health.  A resource for local authorities.  http://www.kingsfund.org.uk/publications/improving-publics-health  (Accessed 10th March 2014)


Department of Energy and Climate Change (2013).  Fuel poverty methodology handbook 2013.  https://www.gov.uk/government/publications/fuel-poverty-methodology-handbook-2013  (Accessed 11th March 2014)


Department of Energy and Climate Change (2013).  The fuel poverty statistics methodology and user manual.  https://www.gov.uk/government/publications/fuel-poverty-methodology-handbook-2013 (Accessed 7th July 2014)


Department of Energy and Climate Change (2014).  Annual fuel poverty statistics report, 2014. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/319280/Fuel_Poverty_Report_Final.pdf  (Accessed 7th July 2014)


Department of Energy and Climate Change.  Fuel poverty statistics.  https://www.gov.uk/government/collections/fuel-poverty-statistics#2012-statistics  (Accessed 20th October 2014)


Keatinge, W.R., Donaldson, G.C., Bucher, K., Jendritsky, G. & al, e. 1997, "Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe", The Lancet, vol. 349, no. 9062, pp. 1341-6.


Department for Communities & Local Government: English Housing Survey Headline Report 2011-12. https://www.gov.uk/government/collections/english-housing-survey#2011-to-2012


Bedford Borough Council, October 2012, Consultation on a new HMO (Houses in Multiple Occupation) licensing scheme in Bedford. 


House of Commons Energy and Climate Change Committee: The Green Deal: watching brief (part 2) http://www.publications.parliament.uk/pa/cm201415/cmselect/cmenergy/348/348.pdf (Accessed 16th December 2014)


Department for Communities & Local Government: Live Table 1008: additional affordable homes provided by local authority area https://www.gov.uk/government/statistical-data-sets/live-tables-on-affordable-housing-supply

(Accessed 17th December 2014)

Department for Communities & Local Government: Statutory Homelessness January to March Quarter 2014 England (Revised) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/339003/Statutory_Homelessness_1st_Quarter__Jan_-_March__2014_England_20140729.pdf  (Accessed 17th December 2014)


Gov.UK: Homelessness Statistics https://www.gov.uk/government/collections/homelessness-statistics (Accessed 17th December 2014)


Steward J. L. Effective Strategies and interventions:  Environmental Health and the private housing sector, University of Greenwich March 2013 CIEH p36-37


Independent Inquiry into Inequalities in Health Report, Sir Donald Acheson, 1996 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/265503/ih.pdf (Accessed 28th January 2015)


Department of Health (2007) Implementation Plan for Reducing Health Inequalities in Infant Mortality.(Accessed 28th January 2015)

Quantifying the cost of poor housing, BRE. http://www.bre.co.uk/page.jsp?id=2369 (Accessed 28th January 2015)


The Creativity and Aging Study: The Impact of Professionally Conducted Cultural Programs on Older Adults – Cohen 2006 http://artshealthnetwork.ca/resources/creativity-and-aging-study-impact-professionally-conducted-cultural-programs-older-adults-?page=28

(Accessed 28th January 2015)


Social Relationships and Mortality Risk: A Meta-analytic Review – Holt-Lunstad 2010 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910600/ 

(Accessed 28th January 2015)


Office of National Statistics  http://www.ons.gov.uk/ons/index.html   (Accessed 28th January 2015)


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