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Partners’ Event
Martin Chadwick
Chief Officer, Beat the Cold
24 March 2015
Sky Room, North Staffs YMCA
Excess winter deaths (2005-10) - County
England
Staffordshire
Stafford
Staffordshire Moorlands
Lichfield
Newcastle-un der-Lyme
South Staffordsh ire
East Staffordshire
Cann ock Chase
Tamworth
0% 5% 10% 15% 20% 25% 30% 35%
Excess winter mortality index (percentage)
Source: Public Health Mortali ty Files , Off ice for Nat ional Statistics and mid-year population estimates, Office for
Nation al Statistics, Crown copyright
What is ‘fuel poverty’?
The old definition The new definition
Needing to spend 10% of household income on fuel to achieve warmth for health and comfort
2012 – 4.5m households in UK
Low Income / High Cost –household needs to spend more than average on fuel, but if they did spend that that much it would put them below the poverty line
2012 – 2.28m (England)
‘Gap’ of £1bn
For average household a gap of £443+
By constituencyHouseholds in fuel poverty Excess winter
deathsECO per 1,000
Stoke-on-Trent North
6,165 15.2% 40 93.6
Stoke-on-Trent Central
6,628 18.6% 30 30.5
Stoke-on-Trent South
5,141 13.7% 50 76.8
Newcastle-under-Lyme
5,107 13.8% 47 29.6
Staffordshire Moorlands
4,620 14.1% 30 24.9
Figures from www.actionforwarmhomes.uk compiled by NEA.EWD are five-year averages
By constituencyHouseholds in fuel poverty Excess winter
deathsECO per 1,000
Stone
4,256 12.1% 371 17.7
Stafford
4,842 12.3% 40 17.7
Cannock Chase
4,411 11.1% 20 49
Lichfield
4,123 10.9% 57 20.1
Tamworth
4,043 10.7% 20 31
South Staffs
3,882 10.3% 57 21.9
NICE guideline
Published 5 March 2015
Developed by the Public Health Advisory Committee and the NICE project team
Evidence reviews
Economic modelling
Expert papers
Picture and quotes from NICE web site
‘As a former GP and director of public health, I’ve seen at first hand the effects that living in a cold home can have on a person’s health’
Dr David Sloan, Co-Chair of the NICE committee
‘We must stop the revolving door scenario where people are made ill by living in a cold home, they go into hospital for treatment, but then are discharged back to the cold home’
Prof Gill Leng, NICE
NICE guidelines
Sharp increase in risk of death when outdoor temperatures fall to around 6C
Likelihood of accidental falls may increase Impaired awareness
Cluttered home, especially if living in one room
Hypothermia comparatively rare
Dementia increases the risk of winter death
Greatest seasonal effect seen in people aged 65 to 74 – they may not realise they are at risk
Some evidence that cold temperatures are associated with lower birth weights
Average 25-35g
Vulnerability cuts across ‘class’ and income
NICE Guideline
1 Develop a strategy
Identify people whose health is at risk.
Identify all local interventions and providers
A year round service, with particular provision for ‘normal’ winter temperatures, not just times of extreme cold.
Link to local health and wellbeing strategies and take account of other local and national
2 Single point-of-contact health and housing referral service
Referrals from any who come into contact
Involves ‘face-to-face contact’
Works with carers
Encourage self-referrals
Monitor impact
NICE Guideline
3 Tailored solutions
Address identified need, not ‘off the shelf’
Heating and insulation programmes and grants endorsed by local authorities, including those from energy suppliers
‘Holistic’ energy advice
Access to Home Improvement Agencies
‘Holistic’ energy advice
4 & 5 Identify those at risk and make every contact count
Primary health and home care practitioners
Data in person’s records
Information for person and their carers
Assessment, referral and updating notes requires time
NICE Guideline
6 Other visitors should assess heating needs and refer to single-point-of-contact
And give information to vulnerable residents
7 Discharge vulnerable people to a warm home
Assess well before discharge
Co-ordinate efforts
If needed, refer to single-point-of-contact
Heating replacement
Fuel debt
Timely
8, 9, 10 Training for:
health and social care practitioners,
housing professionals, faith and voluntary sector workers
heating engineers, meter installers, insulation installers
Ventilation
Sensitivity,
Awareness,
Accreditation
11 Raise awareness among public and practitioners
National advice, local variation
NICE Guideline
12 Ensure buildings meet ventilation and other building and trading standards
Building regulations
Identify housing that may expose to risk, especially in private rented sector
Health risks
Cardiovascular conditions
Respiratory conditions COPD
Childhood asthma
Mental health conditions
Disabilities
Older people (65+)
Households with young children (up to school age)
Pregnant women
Greater risk associated with respiratory conditions, but more people die of cardiovascular
What do people say? What do you notice?
Home is usually too cold
Home is draughty
Fuel bills are too high
Worried about paying bills,or in debt
Stays in bed to keep warm
Sits with hot water bottle
Wants to stay in hospital,where it is warm
Cold and damp, smell
Condensation on the walls or windows and mould
Only heating is an electric fire or fan heater, perhaps bottled gas
Using few rooms
Curtains closed in the day
Unopened bills and letters
Home Energy Advice
Can see bills, heating system and controls,meter(s), insulation, house condition
Discuss what the household needs
Negotiate with fuel company,keeping calm and professional
May halt installation of pre-payment meter
May negotiate repayment plan overlonger than 12 months
Warm Homes Discount – worth £140
Mandatory for some, but discretionary for others
Priority Service Register
Makes fuel easier to use and meters easier to see and use
Company is aware of households with medical needs who must have power
Becoming sustainable - prevention
Tablet PC
shows client how to compare companies and tariffs
Speakerphone
client hears the negotiation with a fuel company
‘I heard you talking to the fuel company, so I tried it with my car insurance and got £200 off’
‘Triage’ by telephone
Experience with ‘short’ home visits is that they often convert into ‘full’ home visits
‘Embedded in Aspire’ - RSL
£20k project in 12-13 generated £19,780 estimated direct financial savings
SROI between £1.70 and £2.27 for each £ invested
So far in 14-15 the savings are £18,415 with project budget this year of £12,700.
Plus savings from behavioural change
Behaviour – some examples
To change behaviour, people must be :motivatedCapable(both physically and mentally)
Insulation and boilers – likely savings ‘Virgin loft’ £150
Cavity wall insulation £145
Solid wall insulation £270
May need planning permission
Gutters, downpipes, window sills,reveals affected
BBA certification
Likely 5 days work, with scaffolding
G – rated boiler to A - rated £305
Condensing boiler, programmer, room thermostat and TRV from old boiler without controls
F – rated to A – rated £135
Already has programmer and room thermostat
Volunteers – Cold Weather Plan
‘Engage with local statutory partners to agree how the [sectors] can contribute to the local community resilience arrangements’
‘Agree support, resources and training to maximise effective use of volunteers;
‘Support recruitment of volunteers.’
all: CWP Level 0 – long term planning
‘Set up rotas of willing volunteers to keep the community safe’
CWP Level 1 – winter preparedness
‘Activate the community emergency plan’
CWP Levels 2 & 3 – severe winter weather forecast, response to severe weather
PartnershipResilient Communities
County Council funding
Lead agency: Beat the Cold, working closely with: Marches Energy Agency
Warm Zones cic
Revival Home Improvement Agency
Affordable Warmth Campaign
Western Power Distribution funding
Lead agency: Warm Zones,
Working closely with: Beat the Cold
Marches Energy Agency
Part of‘Warm Homes Healthy People’
City Council funding
Beat the Cold and Warm Zones working together
Resilient Communities to end February Telephone 320
Across all County funders)
Home Advice Visits 22
Heating – simple 6
Heating – large 26
Insulation 5
Awareness sessions 16
City & County leaflets To all primary health care
outlets plus agencies, local authorities, etc
‘Bespoke’ thermometer cards
Some early lessons
Potential for pulling resource together when agencies co-operate
Warm Zone, Health Through Warmth, local authorities
Complexity of aligning with each lower tier authority
Unreliable and inadequate HHCRO funding
Difficult to ‘sell’ the service consistently both over time and geographically
Potential to deliver a range of outcomes
More detail at the end of winter
Partnership
12 months activity – to 28 Feb 2015Telephone 1,259
Outreach 40
Home visits 632
Clients, recorded health need 693
Amount saved £77,860
(Tariffs, WHD, measures paid for by BtC, ‘refunds’)
Emergency Warmth & advice
Condition(s) No
Mobility (incl arthritis) 31
Falls 7
Respiratory 13
Heart condition 15
Mental health issue 13
Dementia 10
Stroke, high blood pressure 10
Diabetes 8
Asthma 9
Facilitated hospital discharge 6
Others incl impaired sight, epilepsy, thyroid, ulcers, learning difficulties
Based on report for 2013-14
Small project funded by CCG
Mainly by referral
Restores heating and/or hot water for vulnerable households
Contractor calls within two working days, often sooner, and allocates his most ‘sensitive’ gas fitters to our clients
Loan of temporary heating
Many households would not cope with finding a reliable contractor so quickly
Emergency Warmth & advice
Health funding complemented HHCRO to create a ‘crisis’ service
Rapid assessment
Small repairs immediately
Temporary heating if waiting for grant or HHCRO work
Seek support from partners
Funding from City allowed follow-up advice visits
High bills
Fuel debt
Unable to use controls
Etc
‘[Your adviser] was very helpful. He came to the house and helped fill in the necessary paperwork which started the whole thing off. Without him we would not have had a clue what to do next.’
Changes4Warmth – response to support
70% - increased confidence to manage fuel use 44% had taken a few actions
24% quite a lot
16% lots Low energy bulbs; turn down thermostat;
switching off lights etc; 65% closing curtains …
92% - improved mental health
35% - improved physical health and wellbeing
42% - maintained physical health
65 volunteers attended training sessions
35 want to attend NEA one-day training
NEA/C&G ‘Energy Awareness’ planned
Core group of 6 – 8 volunteers
Funding from the Big Lottery
‘Rosie and the service was wonderful. She was awesome and dead down to earth.’
But, volunteers not yet confident to go to see members of Changes or to accompany our Advisers
Living Well in Winter – 50+ Forum 80 people at a carefully facilitated
presentation and discussion
270 through outreach on group visits
How should we all pay for reducing carbon emissions and helping vulnerable people?
Current system is not fair
From direct taxation or from fuel company profits
‘Comes from us, regardless of where from’
A system that targets need rather than meeting government and fuel company targets
‘If it is to help vulnerable people, why are vulnerable people paying?’
Living Well in Winter – 50+ Forum
How would you like to find out about helping to keep warm at home?
‘Trust’ is essential
Clear preference for advice and information from agencies other than those who have something to sell
Not cold calling, whether door-to-door or by phone
Divided about leaflets through the door
‘People telling you to keep warm are more usually trying to sell something’
‘Use existing organisations –doctors, forums, NHS’
‘Local radio – trusted’
‘… stating it’s not a con …’
‘by appointment only with someone else present – friend or relative’
50+ Forum - outreach
What do you do to look after yourself in coldest months?
74% - turn my heating up
86% - extra clothing
27% - extra bedding
Using one room and turning off other heating
‘I can’t change provider by myself’
‘Dark nights make me irritable’
‘Trips stop in October time’
40% referred to their health
‘More colds, flu and chesty cough’
‘Difficult to control my weight’
Changes to social life
72% - ‘stay in more’
Not feeling safe out after dark
Apprehension about falling
Copies of both reports available from:
Martin Chadwick
Martin Peake
Beat the Cold,The Bridge Centre, Birches Head Rd, Stoke-on-Trent ST2 8DD
01782 683813
