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”

Fuel poverty – engaging the NHSOutline 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)

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

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

Excess winter deaths of Greenwich residents aged over 65: a comparison of winter and summer deaths between

1996-99 and 2003-06(APHR)

0

500

1000

1500

2000

2500

1996-99 1997-00 1998-01 1999-02 2000-03 2001-04 2002-05 2003-06

Period (Financial Years)

Nu

mb

er

of

De

ath

s

Summer

Winter

Excess Winter Deaths in Greenwich: Main Causes

Excess Winter Deaths: All Ages (per three year period)

Period All Causes Circulatory Disease

Respiratory Illness

1996-99 355 164  unavailable

1997-00 333 190   unavailable

1998-01 425 222 unavailable  

1999-02 378 173 unavailable  

2000-03 263 88 unavailable  

2001-04 171 29 78

2002-05 283 59 112

2003-06 230 38 105

• 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

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.

0

50

100

150

200

250

300

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Mosaic UK profile of Respiratory DiseasesMosaic UK profile of Respiratory Diseases

Greenwich

Bexley

Greenw ich

Lew isham

Abbey Wood

Bexleyheath

Blackfen

Blackheath

Canning Town

Catford

Charlton

Deptford

Downham

East Wickham

Eltham

Forest Hill

Greenwich

Grov e Park

Hither Green

Isle of Dogs

Kidbrooke

Lee

Lewisham

Mottingham

New Cross

New Eltham

North Cray

Plumstead

Poplar

Sidcup

Sydenham

Thamesmead

Welling

Woolwich

North Cray

Abbey Wood

Bexleyheath

Blackfen

Blackheath

Canning Town

Catford

Charlton

Deptford

Downham

East Wickham

Eltham

Forest Hill

Grov e Park

Hither Green

Isle of Dogs

Kidbrooke

Lee

Mottingham

New Cross

New Eltham

Plumstead

Poplar

Sidcup

Sydenham

Thamesmead

Welling

Greenwich

Lewisham

Woolwich

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)

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

Percentage of private sector non-decent dwellings:2006

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

0

5

10

15

20

25

30

Thermal Comfort HHSRS Disrepair Modernisation

Per

cen

t F

ailu

re

EHCS 2001 EHCS 2006

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

Local Authority Flu Jab LettersEAGA grants Grand Total

Kingston upon Thames 1 11

Richmond upon Thames 11

Bromley 4 42

Southwark 1 53

Wandsworth 53

Hackney 1 54

Brent 1 60

Haringey 1 65

Tower Hamlets 5 67

Ealing 10 68

Bexley 26 71

Lambeth 4 72

Lewisham 3 81

Croydon 1 91

Greenwich 212 277

Barking and Dagenham 225 313

Newham 262 355

Havering 363 410

Redbridge 344 433

  1,519 3,342

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

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

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