1. Fuel Poverty - Engaging the NHS definitions of fuel poverty (10%) and “vulnerable” impact on health and demand for health services win-win for health and sustainable development targeting the “financially and clinically vulnerable” populations responsively accessing the services – need for “front facing” services name of strategy = “Affordable warmth –avoidable ill health”

2. Fuel poverty – engaging the NHS Outline of approach Presenting information is a “health focused way” Analysis of data in a “health focused way” - & attempt at sharing data Initiatives such as EAGA flu-mail out training of front-line staff Thermal energy survey (AM) Joint strategy (AM)

3. Health perspectives The term “fuel poverty” doesn’t engage the Health service very strongly Health care providers don’t see how they contribute to this What is in it for the NHS? Concerns are about prevention and treatment of ill-health (mostly the latter) Local authority staff need to think about how to “sell to NHS” including putting NI 187 in LAAs

4. Health effects 24˚C and above there is a risk of cardio vascular problems, strokes and heart attacks Indoor temp 18-24 ˚C no threat to health Below 16˚ C reduced resistance to respiratory infections Below 12˚C core body temperature drops- BP rises – risk of cardiovascular disease Below 9˚ C after two or more hours body temperature falls

5. Excess winter deaths of Greenwich residents aged over 65: a comparison of winter and summer deaths between 1996-99 and 2003-06 (APHR)

6. Excess Winter Deaths in Greenwich: Main Causes Excess Winter Deaths: All Ages (per three year period) PeriodAll Causes Circulatory Disease Respiratory Illness 1996-99355164 unavailable 1997-00333190 unavailable 1998-01425222unavailable 1999-02378173unavailable 2000-0326388unavailable 2001-041712978 2002-0528359112 2003-0623038105 Pattern mirrors national picture Excess winter deaths in all years, especially colder winters of 1999-00, 2000-01, and 2004-05 Two groups account for large proportion of the excess deaths: respiratory illness and circulatory disease. Numbers of deaths from cancer, for example, do not seem affected by time of year. Risk of excess winter death increases with age

7. The benefits of affordable warmth : Increases life expectancy and reduces inequalities in health Promotes independent living and social well- being. Improves mental well-being Amongst children, improves educational achievement through providing warm space to study, and reduces non-attendance at school due to sickness.

8. Mosaic UK profile of Respiratory Diseases

9. Greenwich

10. Fuel poverty – local information SAP ratings for types of properties Census information on heating Thermal survey Location of grant uptake Local knowledge Local estates surveys (damp)

11. SAP Rating* - Greenwich 43 = private sector = average 47 = RSL = average 48 = private rented = average 62 = council = Good *2002 stock conditions survey – council property now 72 private sector little investment since

12. Percentage of private sector non-decent dwellings:2006

13. Percent of dwellings which fail each of the four decent homes components

15. Flu mail out – private sector PCT does a central mail-out EAGA partnerships provided materials PALS notified response good – 2% uptake from 27,000 483 grants taken up (2004-5) and repeated since 2301 grants between 4/5 & 8/9 Linked in Welfare benefits review at same time LA staff provide training to front line profs and guidance

16. Local AuthorityFlu Jab Letters EAGA grants Grand Total Kingston upon Thames111 Richmond upon Thames11 Bromley442 Southwark153 Wandsworth53 Hackney154 Brent160 Haringey165 Tower Hamlets567 Ealing1068 Bexley2671 Lambeth472 Lewisham381 Croydon191 Greenwich212277 Barking and Dagenham225313 Newham262355 Havering363410 Redbridge344433 1,5193,342

17. Aims of the training session (eg from Scotland) Aims of the session To raise the awareness of front line health professionals to the health implications of cold, damp and mouldy housing. To alert these front line health staff to the various sources of help, advice and financial assistance that are available to combat these problems. Objectives To outline the condition of the housing stock in Scotland and its financial implications for householders. To review the research to date linking ill health with cold, damp and mouldy housing conditions. To highlight the range of initiatives available to the householder to improve the energy efficiency of their home. Learning outcomes The participant will be able to identify householders vulnerable to fuel poverty. The participant will be able to alert the client to sources of free and independent help and advice. The participant will be able to inform the client of the range of financial assistance that is available. 2

18. What next Ideal = one stop shop – accessible for “users”- overcome tenure specific grants and action (eg multi - occupancy) Clear criteria with priority across groups for “vulnerable” people most in need Training for front-line staff (next slide) Analysis of survey and census info to identify areas and practices with greatest need (2011) Monitor progress as part of fuel poverty strategy - tbc

19. Conclusions Joint working requires joint understanding of different perspectives Moaning about “them” wont help – “understanding them” will help Start simple and build on the opportunities Better analysis of the issues helps Be aware of sensitivities Keep going