Tackling cold homes
“Over its lifetime, the NHS has become an effective service for the treatment of illness. If it is to remain successful for another 60 years, it will need a cultural change towards the prevention of poor health” (NHS Future Forum, 2016, The NHS’s role in the public’s health).
We often hear about the pressure on NHS services due to smoking and physical inactivity. We hear much less about the impact of cold, unhealthy homes. Yet cold homes are a bigger killer than smoking, lack of exercise and alcohol abuse (ACE, 2015). During the 2014/15 winter there were 44,000 more deaths than during the corresponding summer period (ONS, 2016), with at least a third of these attributable to cold homes (World Health Organisation, 2010).
Cold-related ill health is an even bigger problem. For every winter death, there are 8 emergency hospital admissions. Respiratory and cardiovascular heart diseases and mental health issues among teenagers are all linked to cold homes. Cold homes also exacerbate existing illness, reduce dexterity and increase the risk of falls and accidents in the home (Marmot, 2011).
It is these statistics that prompted the National Institute for Health and Clinical Excellence (NICE) to issue guidance to local health providers on tackling winter mortality and ill health due to cold homes. This crucially recommends that local Health and Wellbeing Boards act to reduce cold-related ill-health. Specifically, it recommends Boards commission ‘single point of contact’ housing and health referral services and make sure front-line workers use such services.
We think local Citizens Advice offices are well placed to deliver the referral service NICE recommends. We provide a wide range of advice services, including on improving home energy standards. We work closely with other advice providers and local services to make sure our clients get the help they need with the least fuss possible. And there is growing recognition of the role advice can play in preventing ill-health, as highlighted in our recently published health and social care action plan.
The Energy and Service Design & Development teams have therefore come together to set up an innovative pilot that will design, test and evaluate a new cold homes referral service. In the long term we hope to convince health and social care providers that we have a service model that can effectively tackle cold homes, improve the health of vulnerable households and reduce NHS and social care costs. A model that local offices throughout the country will be able to replicate with health and social care funding.
We recently invited local offices to submit proposals to take part in the pilot, offering a small grant to help pay the costs of six offices. We received a huge response – 38 high quality bids. We were struck by the amount of activity already taking place, including sophisticated referral arrangements with other advice providers, advice on prescription schemes and multi-agency partnerships coordinated by local offices that deliver practical help for vulnerable clients.
Selecting six offices therefore proved to be a very difficult task, complicated by wanting to make sure there was a good geographic spread and that rural areas were covered. We now have our six offices, plus a further two taking part through separate funding. But we will share information throughout the design process and pilot which we are sure will be of interest and value to other local offices.
The hard work now starts, beginning with the co-design stage with the eight offices. We will provide further updates on our work as the project progresses. Fortunately, the project will be supported by agencies who have successfully set up a cold homes referral service in their area, including Brighton and Hove Citizens Advice. We are also setting up an advisory group of senior representatives from government and health bodies to support the project, including the co-chair of the NICE committee responsible for the guidance.
The project faces challenges. Grants for improving home energy standards are limited. Moving the NHS towards the prevention of ill health represents a substantial change in culture but it is a challenge that the NHS is starting to face. The NHS five year forward view, for example, requires health and social care systems to work with local partners to produce sustainable transformation plans. This project, guided by its expert advisory panel, and our health and social care action plan stands us in good stead to help the NHS build local approaches to tackling health inequalities.