1. Health and Winter Warmth Simon Church Health and Winter Warmth Campaign Manager Eaga plc / South East Public Health Group

2. What is fuel poverty? A combination of poor energy-efficiency in homes and low income. Fuel poor households need to balance the need for fuel and other essentials. Over 3 million households in England are classed as fuel poor. For each 1% increase in fuel bills 40,000 more households go into fuel poverty The need to spend more than 10% of household income to keep warm.

3. Causes of fuel poverty? Energy efficiency – is there proper insulation and heating? In the private sector, 38% of lofts have less than 4” of loft insulation and 77% of houses with cavity walls have not had them filled with insulation. There are still 1.75m households in England without central heating. Income - the costs of heating a property form a greater proportion of total income for those on low incomes A Benefit Entitlement Check identifies if they are eligible for unclaimed income. The average increase identified for customers is about £1,200 per year Fuel costs – are they on the best tariff? Under occupation – commonly occurs where an older person continues to reside in the family home, once the children have left.

4. Who is in fuel poverty?

6. Source: English House Condition Survey, 2001

7. Links between cold homes and health Average numbers of deaths from lung cancer

8. Links between cold homes and health Cardio-vascular disease:  The cold increases blood pressure.  A rise in blood pressure during the cold increases the risk of heart attacks and strokes. Respiratory Illness:  The cold lowers resistance to respiratory infections.  Coldness impairs lung function and can trigger broncho-constriction in asthma and COPD. Dampness is associated with cold houses; damp increases mould growths, which can cause asthma and respiratory infections. Cold houses affect mobility and increase falls and other injuries:  Symptoms of arthritis become worse in cold damp houses.  Strength and dexterity decrease as temperatures drop, increasing the risk of non- intentional injuries.  A cold house increases the risk of falls in the elderly. Mental and social health:  Damp, cold housing is associated with an increase in mental health problems.  Some people become socially isolated as they are reluctant to invite friends to a cold house.

9. Why prescribe warmer homes? (Ambrose 1996 & 2000): Annual healthcare costs per household (primary care plus some hospital costs) were £515 in the Stepney sample and £72 in the (recently improved housing) Paddington sample A follow up study of the Stepney area in 2000, after re-housing or existing housing improvements had taken place, showed a drop in illness days per person per day from 0.37 to 0.05. Howden-Chapman (2007) Study of insulation improvements in low income communities with a control group (1,350 households). Residents of the insulated homes reported significantly improved quality of life, decreased wheezing, and fewer GP visits and sick days from school and work.

10. Why prescribe warmer homes? Warm Front improvements are associated with:  a significant increase in both living room and bedroom temperatures, often above the level that poses a risk to health.  In the short and medium term, receiving a Warm Front grant is associated with significantly better mental health  reductions in relative humidity and risk of mould, reducing the risks of asthma and respiratory disease.  predicted significant reductions in heart and respiratory disease, with significantly fewer people dying from cold related living conditions.

11. Why the Health Sector is important The most vulnerable are least likely to respond to traditional marketing methods. Word of mouth, recommendations from trusted sources and reassurance are vital. Only 2-3% of all Warm Front referrals come from directly health related sources (mostly from joint flu jab mailshots) Warm Front has £350M annual spend on heating and insulation a new or replacement heating system every working minute. Opportunities for reducing health inequalities are being missed, as those with less health needs take up grants.

12. Why the Health Sector is important Since June 2005: 426,000 qualifying referrals have been made to Warm Front An application form in the last Keep Warm Keep Well resulted in 2,300 referrals Flu jab mailings with a limited number of PCTs have resulted in 7,000 referrals So health have been responsible for 2.2% of Warm Front referrals

13. How the Health Sector can help Awareness amongst staff Training about the issue, identifying a cold home, a basic understanding of what help is available, links to local or national agencies Advice Keep Warm Keep Well, face to face advice with clients, joint or bespoke coordinated mailings on fuel poverty Referral Pathways Local Area Agreement targets, SAP and CAF processes, partnerships with local agencies, direct referrals to national schemes.

14. Partnerships are vital and achievable

15. What support can be offered Awareness amongst staff A pack of training materials and handouts that can be used to cascade train from line staff. Assistance in providing the first level of that training. Direct Referral Generation Support for joint flu jab mailshots Bespoke mailings to specific vulnerable clients – all costs covered. Feedback Information on the scale of the issue in your area and the benefits resulting from partnership working and referrals.

16. Thank you & Questions