Angela Mawle Chief Executive

1. Angela MawleChief Executive

2. UKHECA National Home Energy Conference Wednesday 17th May 2006

3. The UKPHA Fuel Poverty Project

4. Who we are The UKPHA is an independent, UK-wide voluntary association, which brings together individuals and organisations from all sectors, who share a common commitment to promoting the public’s health. The UKPHA is a membership organisation which aims to promote the development of healthy public policy at all levels of government and across all sectors, and to support those working in public health either professionally or in a voluntary capacity.

5. Our priorities • Combating health inequalities • Working for a fairer, more equitable and healthier society • Promoting sustainable development • ensuring healthy environments for future generations • Challenging anti-health forces • Promoting health-sustaining production, consumption and employment.

6. What is Fuel Poverty? • A fuel poor household is one that needs to spend in excess of 10 % of income on all fuel • It is estimated that 22% of all households in England are classed as fuel poor *fuel povertystrategy, DETR (2001) • Almost 9 million people live in these homes in the UK

7. Discomfort and risk of respiratory disease, bronchitis etc Risk of cardiovascular problems, strokes etc Risk of hypothermia Comfortable temperatures Health Effects of Living in a Cold Home 18º C 15º C 12º C 9º C

8. Fuel Poverty and the NHS Costs to the NHS Over £1 billion per annum Thousands of hospital beds taken up Increased waiting times for treatments of other ailments Alleviating fuel poverty Reduced hospital admissions and re-admissions Lower treatment costs Reduced waiting lists

9. Excess Winter Deaths What are excess winter deaths? Excess winter deaths are defined as deaths occurring in the winter months (December to March) minus the average of deaths occurring in the two non-winter periods (August to November and April to July)

10. “If just 5% of our clients were saved ten days’ in-patient care for illness caused by poor heating, the NHS would save £40m each year and release 150,000 bed days.” DETR Fuel Poverty Strategy 2001

11. Fuel Poverty Indicator(Centre for Sustainable Energy) • Matches Census and English House Condition data • unemployed • Under-occupied (0.5 rooms per person) • no car • single pensioner • no central heating • private renter • lone parent • disabled • Predicts the fuel poverty level of any given area

12. LONDON, 1990 - 1994 150 125 100 Cardiovascular deaths/day 75 50 25 0 01jan1990 01jan1991 01jan1992 01jan1993 01jan1994 CVD deaths Mean temperature

13. Attitudes to risk& behaviour • Latitude differences in clothing behaviour • How do older people respond to • Forecast of cold weather? • Cold weather? • Do older people live in older houses? • Should older people be taking aspirin in winter? • Is our flu immunisation programme optimal?

14. The Economics of Fuel Poverty

15. Fuel Poverty:The impact of rising energy prices Source: William Gillis, presentation at HHFPF conference 07.03.06

16. The Economics of Fuel Poverty • A key issue is targeting those most in need • Significant resources are available Warm Front: £320 million EEC £225 million Local authority programmes Source: William Gillis, presentation at HHFPF conference 07.03.06

17. The Health, Housing and Fuel Poverty Forum (HHFPF)

18. HHFPF • Launched in March 2005 by the UK Public Health Association, on behalf of the Health Sub Group of the Energy Efficiency Partnership for Homes. • Aims to maximise the contribution which the health and housing sectors make to the delivery of energy improvements to vulnerable households. • The Core Group brings together key players with strategic influence in different sectors. It meets four times a year to identify strategic opportunities to progress the forum’s purpose, and take appropriate action.

19. The HHFPF Core Group • Professor Rod Griffiths (Chair) President of the Faculty of Public Health • Dr Mike Gill Regional Director of Public Health, South East Region, DoH • Lindsey Hayes Head of Primary Care, Royal College of Nursing • Duncan Sedgwick Chief Executive, Energy Retail Association (ERA) • William Gillis Chief Executive, National Energy Action • Professor Carol Black President, Royal College Of Physicians • Mervyn Kohler Head of Public Affairs, Help the Aged • Stephen Battersby Chartered Institute of Environmental Health • Sue Adams Director, National Care and Repair • John Clough Chief Executive, EAGA Partnership • Peter Lehmann Chair, Fuel Poverty Advisory Group • Pam Wynne Head of Fuel Poverty Team, DEFRA

20. 2006 HHFPF Conference The HHFPF conference on 7th March 2006 brought key players together to: • Learn from the results of the latest research into the Health Impact of Warm Front led by Professor Geoff Green from Sheffield Hallam University. • Explore how the HHSRS could be used to tackle fuel poverty • Consider how the Single Assessment Process could be developed to include issues of fuel poverty.

21. The Health Impacts of Warm Front

22. Health Impact Evaluation of Warm Front • Undertaken jointly by University College London, The London School of Hygiene and Tropical Medicine and Sheffield Hallam University over a four year programme.

23. Indoor air quality VENTILATION Cardio-respiratory illness Altered ventilation Mould growth Winter morbidity/mortality Increased temperature WARMTH Energy efficiency Thermal comfort Psycho-social well-being Use of space Social interaction Sense of control Lower fuel use & cost Nutrition Increased disposable income ENERGY USE Local and global environmental impacts Reduced emissions Source: Green et al, presentation at HHFPF conference 07.03.06

24. Source: Green et al, presentation at HHFPF conference 07.03.06

25. Source: Green et al, presentation at HHFPF conference 07.03.06

26. In-depth Interviews • Benefits • improved and more controllable warmth/hot water • perceptions of improved physical health and comfort, esp. of mental and emotional well-being • easing of symptoms of chronic illness • reports of improved family relations • expansion of the domestic space used during cold months • increased privacy within the home • improved social interaction • an increase in comfort and atmosphere within the home • But • as yet no evidence of change in health-seeking patterns • little evidence of substantially lower heating bills Source: Green et al, presentation at HHFPF conference 07.03.06

27. “I shiver even thinking back to what I call the bad old days… I mean sitting here, I’ve got my telly going…and the [pre-intervention] heating’s on and I’m dreading going to the toilet, and I’m dying for a cup of tea, and I’m praying I hear the door opening and [it’s] one of my sons or my daughter so they can make me a cup of tea, cause that’s how bad it was, it was so cold, so cold.” 9819,Liverpool Source: Green et al, presentation at HHFPF conference 07.03.06

28. Health Impact Evaluation of Warm Front • Warm Front measured increased average living room temperatures by 1.6ºC and bedroom temperatures by 2.8ºC, taking them above recommended thresholds 2. This level of improvement will reduce excess winter deaths in the UK. The average cost per life year saved ranged from £4,000 for insulation to £21,000 for heating plus insulation over a 20 year horizon. 3. Higher temperatures, satisfaction with the heating system and less difficulty paying heating bills are all associated with better mental health and well-being. 4. Warm Front improvements are associated with more resident control over their homes, less insecurity, a greater feeling of safety and better mental health and well-being.

29. Conclusions • Energy efficiency may influence health through multiple routes • WF heating + insulation up-grades increase temperatures by approx. 2˚C • No evidence of adverse impact on air quality; there is reduction in mould • Evidence of improved mental status & thermal comfort • (Indirect) evidence of reduced risk of winter morbidity/mortality • Interview evidence of benefits to social interactions, well-being Source: Green et al, presentation at HHFPF conference 07.03.06

30. Housing, Health and Safety Rating system (HHSRS)

31. HHSRS What is it? • Replaces the Housing Fitness Standard from the 6th April 2006. • Formally considers the potential risks to health and safety in residential accommodation arising from hazards in the home. • The Local Authority is required to act upon referrals/reports to perform assessments of dwellings.

32. HHSRS Implications for Health, Housing and Fuel Poverty. • Health workers have a formal route to report suspected poor housing. • Local Authorities are now statutorily required to act upon reports. • Interventions to improve housing conditions can be more strategic than before. • Different hazards can be compared (prioritisation). • Allows a proactive and preventative approach (targeting resources at the most in need).

33. The Single Assessment Process (SAP)

34. Single Assessment Process Aim :” to ensure that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals regardless of health and social care boundaries.” Source: William Gillis, presentation at HHFPF conference 07.03.06

35. Single Assessment Process • Methodology to assess the individual health and wider social care needs of individuals • Introduced 2001 as part of the National Service Framework for Older People • Implemented nationally in 2004 • Now extended to other groups Source: William Gillis, presentation at HHFPF conference 07.03.06

36. Single Assessment Process • SAP requires an integrated approach • Includes an assessment of housing conditions • Four types of assessment: - Contact - Overview - Specialist - Comprehensive Source: William Gillis, presentation at HHFPF conference 07.03.06

37. SAP • Electronic storage and sharing of information • Agencies have been allowed to design their own process or adopt a Health Service approved method • No standardisation Source: William Gillis, presentation at HHFPF conference 07.03.06

38. SAP The single heating question • Will this question help to identify the fuel poor? • Who answers the question – client or professional? • Could a limited number of additional questions be drafted which would improve effectiveness? Source: William Gillis, presentation at HHFPF conference 07.03.06

39. SAP The training and support issue • What training and support do health professionals need to operated the process more effectively? • Would additional guidance on identifying fuel poverty improve effectiveness? Source: William Gillis, presentation at HHFPF conference 07.03.06

40. The Referral Process The referral process has been consistently identified throughout the March 2005 and March 2006 conferences and by the HHFPF core group as a major obstacle to help for vulnerable people living in cold damp homes.

41. Models of delivery and referral processes

42. Adding to Confusion in the Elderly

47. Elderly SureStart –trialling more effective delivery models? The HHFPF Core Group has identified the following key priorities for tackling fuel poverty in the Elderly SureStart initiatives: • Partnership development • Assessment tool for health partners • Streamlining and co-ordinating the targeting and assessment processes • A one-point-of-contact referral system.

48. www.warmerhealthyhomes.org.uk

49. Angela MawleChief Executive