Building Health into Homes: Moving Occupational Therapy Upstream

The launch of the Royal College of Occupational Therapists’ Building Health into Homes report at the House of Lords on 10th June, felt like an important moment for occupational therapy and for everyone working across housing, health and social care. After 27 years as an occupational therapist, I have repeatedly seen how profoundly the home shapes what a person can do. A home may support someone to care for themselves, work, rest and participate in their community. It may also increase risk, restrict daily life and create dependence that care planning alone cannot resolve.

This is why the report's central message matters: housing cannot remain separate from health and care. Nor should occupational therapists provide intervention only once a person is in crisis and an adaptation is required.

Timely adaptations remain essential, but our contribution should begin much earlier, in planning, design, allocation, commissioning and service development. Occupational therapists understand the relationship between the person, their environment and the occupations that give daily life meaning. That perspective can help prevent poor decisions rather than simply lessen their consequences.

I was particularly pleased to see our work with the London Borough of Newham included in the report. Newham’s planning department commissioned The Occupational Therapy Service to develop evidence-based housing design guidance for neurodivergent residents and people with learning disabilities. The work combined research, visits to new housing schemes and co-production with residents, families and professionals. It showed what becomes possible when occupational therapists are commissioned upstream while homes and policy can still be shaped.

Our partnership with AKW offers a practical example of how timely adaptations can be delivered differently. The Clinical Adaptation Service brings independent occupational therapy assessment, clinically-led specification, technical surveying, quotation and supply into one coordinated pathway. Connecting these stages from the outset can reduce duplication and delay, identify constraints earlier and help ensure adaptations are clinically appropriate, technically deliverable and able to meet a person's needs over time.

These examples are delivered at different points in the housing system. In Newham, occupational therapy expertise was commissioned upstream to influence planning and inclusive design. Through the AKW partnership, it is embedded in an operational pathway intended to deliver adaptations more quickly and coherently.

We need both approaches: occupational therapists helping to shape better homes and policy before problems arise and joined up services capable of responding promptly when needs change. Strategy matters only when it changes people's homes and lives.

Building Health into Homes gives us a persuasive national case for change. The next task is to turn that ambition into action across planning departments, housing providers, health systems and local authorities.

I look forward to exploring that challenge further at the Housing LIN HAPPI Hour webinar, Building Health into Homes: How Occupational Therapy Can Unlock the Connection Between Housing and Health, on the 21st of July 2026.

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And if you found this of interest, check out the dedicated webpages curated by the Housing LIN on Occupational Therapists – Helping to get the housing design right.