1. Warm and Well Families Vanessa Powell-Hoyland Public Health Improvement Coordinator Doncaster Metropolitan Borough Council

2. jo's slides Overview  Background  Local Authority perspective  Starting Well and Developing Well  KWILT to WWF  Methodology  Findings  Outcomes  Doncaster MBC

3. Health impacts of cold homes Warm Well Families: Background Emerged from KWILLT Feedback from people at frontline and policy level Conducted in Doncaster and Rotherham Different recruitment methods Changes regarding fuel poverty, energy, health, welfare

4. jo's slides Rationale  We need to understanding who is vulnerable and why?  What influences peoples behaviour  Home temperature  Accessing help  Different messages  Challenge assumptions

5. jo's slides

7. Starting Well and Developing Well Warm Well Families Aim: To understand the influences and decisions of households with children with asthma regarding keeping warm and well at home in winter. Methods:  Individual interviews  35 families  25 health, education and social care staff  5 group interviews  1 with parents (n=20)  4 with staff (n=24)  Framework analysis

8. jo's slides Doncaster family recruitment was via Children Centres and Rotherham's through a third sector organisation called GROW. The funding was through Consumer Futures (now CAB), Doncaster and Rotherham Public Health teams Recruitment

9. jo's slides Data used to support the recruitment Emergency Hospital Admissions for 0-5 Proportion of children living in Poverty Proportion of community's non white Proportion of social housing

10. Health impacts of cold homes Doncaster

14. jo's slides Families and cold homes

15. What did we focus on? Children and asthma The UK has one of the highest incidences of paediatric asthma in the world. Asthma accounts for 1 in 250 deaths worldwide and was the 25th leading cause of disability adjusted life years (DALYS) in the world in 2001. Asthma also accounts for more emergency bed days and emergency admissions to hospital for children and young people than any other paediatric long term condition An estimated 75% of hospital admissions, and as many as 90% of deaths from asthma, are preventable. Prevalence of asthma: UK 5.9% Rotherham 6.1% Doncaster 6.8%

16. Excess respiratory illness in winter

17. Health impacts of cold homes Temperature Measurement Tiny Tags placed in 2 rooms for 2 weeks prior to interview. Measuring Humidity and Temperature every 5 minutes. Temperature and humidity graphs developed for each household

18. Health impacts of cold homes Warm Well Families What we found

19. Health impacts of cold homes Themes Knowledge and awareness Contextual factors Behaviours Attitudes and beliefs Social support and social factors

20. Health impacts of cold homes Behaviours Payment methods Management of asthma Times of heating Experience of cold Use of home space “I’m happy how I’m paying it but if I get a meter, sometimes I have money and sometimes I don’t have money, struggling, I’m already struggling really hard as well

21. Health impacts of cold homes Tiny Tag data

22. Behaviours http://www.shu.ac.uk/research/hsc/ourexpertise/warm-well- families ’he wakes up and he’ll come and wake me up and mummy I'm cold, I'm cold, and you can hear it on his chest. So the warmer he is, the better he is”. (P13) The bathroom is covered in it, I've got damp all along that back wall behind you, all along that wall. Get black mould up in my daughter’s bedroom, it’s everywhere". (P4)

23. Turning insight into action

24. Psychological Factors Perception of Risk Child becoming ill Losing home Getting into debt Responsibility & Blame Child's health Damp/condensation/mould Condition of house Heating regime/equipment Priorities & Choice Heat: luxury or need? Needs of family members Roof over head Paying the bills/balancing the budget Food/heating regime Safety of family/possessions Knowledge & Beliefs Causes of asthma Causes of mould/damp Cost heating and energy saving measures Preventative action Who can help Who to trust and not trust They have no choice sometimes Fear Losing home Debt Child becoming ill Blame Shame or embarrassment/stigma/loss of privacy Being judged Losing control

25. Contextual Factors Literacy, IT and access to telephone/broadband Need to move house Communication/negotiation skills Capacity to plan ahead Social Connections Previous experiences Social Norms Time pressure and the pressures of daily life Household Income Pre-payment meters Housing type/condition Tenure Conflicting /incorrect information and communication Difficult to control heating systems – ‘on or off’ Social and service exclusion Perception of Risk Responsibility & Blame Priorities & Choice Fear Knowledge & Beliefs Psychological Factors Trade-Off Zone

26. Pen Portraits http://www.shu.ac.uk/research/hsc/ourexpertise/warm-well- families

27. Applying the findings

28. How this might help Adam and Steph What might the interventions be?Where/how do we talk with them What are the possible real costs to them – key considerations when designing interventions What are the key messages? A trusted contact to offer support and sign-posting Reliable and simple information accessible through appropriate channels of communication Means to access channels of communication Back to work advice and courses A mechanism to reduce isolation and gain a support network Many young couples/mums will get help and advice from friends and family. They will often use social media as a means of communication. Adam and Steph are restricted in their ability to utilise these channels and therefore feel alone and have poor knowledge of their entitlements. In order to begin engagement and support we could consider – The GP and the nursery staff. Peer support through informal groups – advertised through GP, nursery or local free papers/radio Feeling of failure Embarrassment Fear of losing family/independence For professionals Don't assume people are coping There are multiple factors that drive behaviour Don't under estimate the psychological factors that drive behaviour There is help out there - get to know your local referral schemes For Adam and Steph Help for families with heating, child care or getting back to work Easy and simple ways to access interventions They are not alone

29. Outputs: Book of Damp

30. Outputs: Papers BMJ Open - provisionally accepted

31. Health impacts of cold homes

32. Improve awareness and understanding of fuel poverty for residents, in all tenures. Develop a shared understanding of the problem and local need through a robust Joint Strategic Needs Assessment (JSNA) Increase the energy efficiency of Doncaster’s private housing stock. To improve income maximisation for fuel poor residents Maintain and develop Doncaster’s Affordable Warmth Referral System

33. Health impacts of cold homes Informing policy

34. Health impacts of cold homes In 2014/15------152 participants trained to identify vulnerable people living in cold homes based on the recommendation from the WWF research and implementing the pen portraits. 428 winter warmth resource's given to vulnerable families

35. Health impacts of cold homes Winter warmth road shows  Winter 2014/15- 12 road shows delivered= 79 hard to reach community members engaged

36. Health impacts of cold homes Fully funded boiler on prescription program 3 year project for 2014/17 Eligibility Scoring system dependent on number of factors including health, financial, geographical (targeting EWD areas) and heating requirement. Priority families with children with asthma and living in fuel poverty

37. jo's slides

38. Health impacts of cold homes Acknowledgements GROW

39. Health impacts of cold homes Report and Correspondence angela.tod@manchester.ac.uk P.nelson@shu.ac.uk vanessa.powell-hoyland@doncaster.gov.uk A.Cronin-De-Chavez@shu.ac.uk catherine.homer@rotherham.gov.uk amanda@ajstocks.co.uk Reports and Executive summary http://www.shu.ac.uk/research/hsc/ourexpertise/war m-well-families