1. A simple question?
We want to talk to you about the effects cold homes is having on your patients health, your workload and how you can help.
A part of this presentation has been borrowed from Brighton and Hove CCG and it shows how across the country the NHS is waking up to the effect that cold homes can have on health and what we can do about it.
Dr Sarah Machale – Crocus Medical Practice, Saffron Walden
Kate Robson – Citizens Advice

2. Winter in the NHS Winter 2017 in the NHS
Every year we see the headlines and the black alerts.
Winter in the NHS
Winter 2017 in the NHS

3. Cold Weather and Health
There is a strong evidence base on the risk to health from cold weather
The effects are predictable and largely preventable
But did you know that evidence shows that you can predict surges in admissions and deaths after a very cold spell?

4. Cost to the NHS of Cold Homes
In 2014/15
43,900 Excess Winter Deaths (EWDs) in England and Wales were attributable to fuel poverty and cold homes.
For Every EWD there are an estimated 8 hospital admissions (or 10% of Hospital admissions)
For every EWD there are also 100 extra GP consultations (Roche, 2010 UK Health Forum).
That’s 439,000 extra GP consultations each winter attributable to fuel poverty and cold homes
£1.36 Billion a Year
(Age UK)
Cost to the NHS of Cold Homes
And that cold homes caused 43,900 Excess winter deaths in 2014/15 - that is more deaths observed in the winter months between December and March than the average for the rest of the year.
It is estimated to be costing the NHS 1.36 billion a year.
Not only that but look at the increase in hospital admissions and Gp consultation numbers.

5. Excess winter deaths in the UK are higher than in Finland
But how do we know this is related to cold homes and fuel poverty and not just cold weather?
• The UK has one of the highest excess winter death rates in Europe with thousands of people dying needlessly every year because of excessive cold temperatures in their home during the winter months. Excess winter deaths are preventable. Other European countries (which may even be colder) see far fewer deaths each year because their homes are more energy efficient.
• Evidence points to a strong link between cold-related deaths and lower temperatures indoors.
People living in the coldest quarter of homes have a 20% greater risk of dying than those in warm homes.

6. HSE: Cold Homes is the 2nd biggest Health Hazard in the UK
According to the Heath and Safety Executive cold homes is the 2nd biggest Health Hazard in UK homes

7. Health impacts of cold homes
The Health Effects of Cold Homes
EXCESS WINTER DEATHS, HOSPITAL ADMISSIONS AND GP CONSULTATIONS
of these
40% Cardiovascular
33% Respiratory
MENTAL HEALTH
4x more likely
In all ages
CHILDREN
Asthma risk doubles
Mental health problems X4
Respiratory illnesses 1.5-3X
Low weight gain in babies
Estimated to cause
10-11% falls
Health impacts of cold homes
But what conditions are causing these extra winter deaths, admissions and GP consultations?
As this slide demonstrates 40% of the excess winter deaths are caused by cardiac causes such as heart attacks and 33% caused by respiratory causes such as infections, COPD, asthma and influenza. In children the risk of asthma doubles if they live in a cold home and these children can have up to 3 times the incidence of respiratory diseases and a four fold increase in mental health problems. In turn this adversely affects their school attendance and attainment. Other direct Health Impacts include 10% greater risk of falls and worsening of arthritic conditions . Indirect health impacts include an increased incidence of mental health illnesses such as depression, and risk of carbon monoxide poisoning if boilers, cooking, and heating appliances are poorly maintained or poorly ventilated.

8. How Indoor Temperature affects health
Why does this happen? At lower indoor temperatures the airways narrow making it harder to breathe and the resistance to infection is lowered increasing the incidence of respiratory illnesses. Meanwhile, as the blood pressure and viscosity rises the incidence of strokes and heart attacks increase.

9. Fuel Poverty is associated with increased mental problems
This slide summaries the effect fuel poverty has on mental health. It is worth noting that the term fuel poverty means ….

10. Fuel Poverty in West Essex
But this wouldn’t affect my patients would it?
Uttlesford has rates of fuel poverty ABOVE the national average at 11.1% of households. That means that more than1 in 10 patients is living in a cold home. The District and County Councils have identified it as one of their main priorities and are putting funding in to help reduce fuel poverty and we need to know how to help patients access this help before it disappears.

11. Most energy inefficient homes are owner occupied
2/3 of energy efficient homes are owner occupied and a further ¼ are privately rented. This is why we need to offer help with cold homes to all patients as otherwise we are at risk of making false assumptions as to who is at risk.

12. NICE guidelines March 2015    
Indeed In March 2015 NICE introduced guidelines

13. Pregnant women
People on a low income
People who move in and out of homelessness
People with addictions
People who have attended hospital due to a fall
Recent immigrants and asylum seekers
People with cardiovascular conditions
People with respiratory conditions (in particular, chronic obstructive pulmonary disease (COPD) and childhood asthma)
People with mental health conditions
People with disabilities
Older people (65 years +)
Young children (under 5)

14. Is your home warm?

15. How do we make every contact count?
CCG
Involve Community Services, Mental Health Services,
Care of the Elderly and Falls services
Primary Care
Think about your high risk patients
Add it to templates in chronic disease clinics and frailty reviews
Ask “Are you finding it hard to keep your home warm?”
Refer for warmer homes support
How do we make every contact count?

16. Learning from the Warm Homes Oldham Evaluation Report 2015
Recommended that they needed to:
Increase the number of referrals directly from Health Organisations (which were very low)
Refer more individuals to the Citizens Advice for income maximisation (of 102 benefits checks undertaken 33 individuals secured additional income with the average household income increase equating to £ a year)
But why should we refer from the NHS?
We need to learn from the experiences in other areas.
Oldham Council have evaluated their warmer homes initiatives with the help of Sheffield Hallam University and published their learning. They identified the need to increase referrals from the NHS directly in order to target those most effectively with at risk Health Needs and maximise the impact and cost savings for the NHS.
It is estimated that the NHS could save £600m annually
Why direct referrals? – Evidence shows that Individuals get fatigued with repeating their story and give up- just think about your patients experiences with the Mental health services.
Why is income maximisation needed? To reduce fuel poverty by increasing household income along with improving energy efficiency in the home

17. Reduced GP consultations,
Reduced out-of-hours calls
Reduced attendances at walk-in centres
Reduced district nurse visits
Reduced drug prescriptions.
Reduced emergency department visits.
Reduced inpatient admissions.
Reduced social care service costs.
Reduced excess winter deaths
Potential savings to NHS of implementing NICE 2015 guidelines on cold homes

18. What can be done...Warmer Homes Initiatives?
Take actions to reduce energy costs – for example; find a better energy tariff; apply for a warm homes discount; identify grants to improve energy efficiency in the home.
Take action to increase income – ensure that people are claiming everything they are entitled to - like pension credit, non-means tested disability benefits, ensure people are supported with benefit appeals if appropriate.
Deal with debt and utility bill problems – look at practical steps to manage or write-off debt.
Deal with housing issues – support people to find handyman services, support relationships with landlords in terms of repairs and heating issues, start a discussion about moving to more suitable housing.
Grants like Npower’s – ‘health through warmth’ targets people with long term illness and low income – they will help with repairing or replacing a broken boiler or heating system. The district councils also have small grants and home improvement grants – that depending on eligibility can even be used and applied as a charge on the house – so it’s only paid back when the house is sold.
Appeals – in Uttlesford, Citizens Advice have a 87% success rate in overturning unfair or incorrect benefit decisions (shocking!)
Debt – we regularly use the British Gas Energy Trust to deal with Utility debt as an example.

19. How to
refer?
In West Essex – you can refer through Frontline on a PC or secure App, or you can ask one of your receptionist team to make a referral. Search cold or warm and a service will pop up!

20. 01 02 03 Conclusion Identify patients at risk Make every contact count
Refer directly 03
Conclusion
Conclusions

21. And next winter….