Poor quality and cold homes

In 2015, the cost of poor housing to the NHS has been assessed by the Building Research Establishment (BRE) as £1.4bn per annum. And other recent research shows that over the past five years hospital admissions for chronic lower respiratory diseases, such as bronchitis and emphysema, have been 40% higher in England than in Sweden.

There is no single national government programme to improve the quality or thermal comfort of homes. Money to make homes warm comes from a variety of sources, including DECC and energy companies, and there are a variety of different conditions attached.

Health partners can help to target limited resources effectively by helping to identify those most at risk of ill health from cold homes and referring these individuals into local scheme or service.

NICE Guidance on excess winter deaths and cold homes

Public Health England Cold Weather Plan

Local schemes to make homes warmer and warmth more affordable for households

Identifying and referring those most at risk of poor health due to a cold, damp home

Social homes in poor condition

NICE Guidance on excess winter deaths and cold homes

Recent NICE Guidance (March 2015) recommends that local Health and Wellbeing Boards should ensure that a single-point-of-contact health and housing referral service is designed and commissioned to help vulnerable people who live in cold homes. Your Director for Public Health should be able to put you in touch with the relevant individual tasked with this and with taking action on cold homes.

This guidance draws on evidence from 3 reviews by the London School of Hygiene and Tropical Medicine. Statements from these reviews can be found by following the links below:

Review 1: Factors determining vulnerability to winter and cold-related mortality/morbidity

Review 2: Interventions and economic studies

Review 3: Delivery and implementation of approaches for the prevention of excess winter deaths and morbidity

Public Health England Cold Weather Plan

The Cold Weather Plan for England 2014 recommends a minimum daytime indoor temperature for homes in winter of 18°C (65F), and maintaining an overnight temperature at or above this level for those aged 65 and older with pre-existing medical conditions. It sets out actions for local partners to consider taking when developing local cold weather preparedness arrangements. Several of these relate to housing and are for health frontline staff and commissioners. They include:

  • Commissioners of health and social care and local authorities – Ensure a local, joined-up programme is in place to support improved housing, heating and insulation, including uptake of energy efficient, low carbon solutions.
  • Frontline staff (health and social care, voluntary and community sector) – Work with at-risk individuals, their families and carers to ensure that they are aware of the dangers of cold weather and cold housing and how access support; ensure that there are clear arrangements for ‘signposting’ to other services (eg home insulation schemes; benefits entitlements) when identified in “clinical” situations.
  • GPs and practice staff – Ensure GPs and staff are aware of local services to improve warmth in the home.
  • GPs and practice staff – When making home visits, be aware of the room temperature in the household and, if required, know how to advise on levels that are of concern and as necessary to signpost to other services.


Local schemes and services to make homes warmer and warmth more affordable for households

At the local level, several housing organisations play roles in tackling fuel poverty and helping to keep homes warm. These are:

  • Councils – some councils have specific ‘affordable warmth’ programmes to enable households to keep warm and all councils have powers to enforce against poor standards. Action on poor quality and cold homes is usually driven by the Environmental Health or Housing Strategy Team. Increasingly Public Health Teams are getting involved.
  • Home Improvement Agencies – FILT, a charitable arm of Foundations, has developed a partnership with several of the ‘Big Six’ energy companies to provide money through the Energy Company Obligation (ECO) for works such as insulation and draft-proofing in poorly heated homes occupied by vulnerable people.
  • Landlords (housing associations, councils, ALMOs) – they have experience of energy-saving technology and improvements that can be made to homes to reduce energy use and bills. Some also advise residents about how to reduce their fuel bills and some help them to switch energy suppliers to keep bills down.

In some localities, these and other partners are working together to provide a joined up ‘system’ to identify and address the need of households that are at risk of ill health through cold or damp homes. The NICE guidance is prompting others to develop such a system. Health partners need to get involved because they play a crucial role in identifying and referring people into the system.

The Liverpool Healthy Homes Programme, phase 1, is estimated to deliver savings to the NHS of up to £22m, for an investment of £6m. Read more here

Case Study: The Lancaster HIA Warm Homes Service

Identifying and referring those most at risk of poor health due to a poor condition, cold or unsafe home

CCGs and GPs should consider how they can support development of a joined up system for dealing with poor condition, cold or unsafe homes. For example,

  • Could you refer patients you know to be ‘at risk’ of ill health due to a cold, damp or unsafe home into a local scheme, a Home Improvement Agency or to the Council’s Environmental Health team?
  • How could risk stratification help to identify those patients most at risk of ill health due to cold, damp homes?
  • How might you go about sharing this data with relevant local partners, in order to address the wider determinants of health, with patients’ consent? Some GPs are finding ways of doing this such as through sending joint letters to patients, inviting them to take up a free home assessment with a relevant housing partner.

Local housing partners can then target the improvements at those patients who are most ‘at risk’, reducing their reliance on the NHS.

Social homes in poor condition

Councils’ powers to enforce against poor standards also apply to social housing that is in poor condition. If your patient can’t resolve the issue through dialogue with their landlord, you could refer them to the local council environmental health team.