Recommendation 1 Develop a strategy

Health and wellbeing boards should:

  • Include the health consequences of living in a cold home in the joint strategic needs assessment process.

  • Develop a strategy to address the health consequences of cold homes. This should include:

    • Identifying people whose health is at risk from cold homes.

    • Groups that may face particular problems, such as those living in hard-to-heat homes or who need more warmth (for instance, because of limited mobility or specific health conditions).

    • Assessing how heating and insulation needs to be improved to raise properties to an acceptable standard assessment procedure (SAP) rating. As a minimum, properties should be raised to a band C (69 to 80) and ideally, to a band B (81 to 91) rating.

    • A tailored programme to make any necessary changes, including preventive measures, all year round – not just in the winter.

    • Provision for 'normal' winter temperatures not just periods of severe cold. (Although lower temperatures have a more significant effect on health, the ill effects from cold homes are seen when outdoor temperatures drop to around 6°C. Because temperatures in this range are much more common, this is when the greatest number of health problems caused by the cold occur.)

    • Preventing mental and physical health problems as well as deaths from cold homes.

    • An outline of how the other recommendations in this guideline will be put into practice locally.

    • Identifying and meeting the training needs of local practitioners involved in providing the services.

  • Ensure planning includes identifying relevant local interventions and providers from all sectors (such as relevant local authority departments, the health sector, utilities, housing organisations and organisations in the voluntary sector).

  • Consider how the issues and actions identified are reflected in health and wellbeing and other relevant local strategies or plans and ensure actions take account of other local and national strategies.

  • Ensure the strategy includes monitoring and evaluation. Also ensure any evaluation is used to improve the strategy and is made publicly available.

Recommendation 2 Ensure there is a single‑point‑of‑contact health and housing referral service for people living in cold homes

Health and wellbeing boards should:

  • Ensure a local single‑point‑of‑contact health and housing referral service is commissioned (see recommendation 3) to help vulnerable people who live in cold homes. A wide range of people are vulnerable to the cold. This is either because of: a medical condition, such as heart disease; a disability that, for instance, stops people moving around to keep warm, or makes them more likely to develop chest infections; or personal circumstances, such as being unable to afford to keep warm enough. In this guideline, the term vulnerable refers to a number of different groups including:

    • people with cardiovascular conditions

    • people with respiratory conditions (in particular, chronic obstructive pulmonary disease and childhood asthma)

    • people with mental health conditions

    • people with disabilities

    • older people (65 and older)

    • households with young children (from new‑born to school age)

    • pregnant women

    • people on a low income.

  • Ensure anyone who comes into contact with vulnerable groups is able to refer people to the referral service. This includes: health and social care practitioners, fire prevention and safety services personnel and workers from charities and voluntary organisations, such as advice agencies.

  • Ensure the referral service links with relevant national and local services that can provide a range of solutions. These are likely to include: health and social care providers, local housing providers, advice agencies (such as Citizens Advice Bureaux and money advice organisations), health and social care charities, voluntary organisations and home improvement agencies.

  • Ensure the referral service:

    • Takes account of existing services.

    • Involves face‑to‑face contact, if necessary, with the person using the service, their families and their carers.

    • Works with the person and their carers to identify problems caused by living in a cold home and the possible solutions.

    • Makes it clear to the person and their carer what actions are planned (or taking place) and coordinates activities to minimise disruption in the home.

    • Encourages self‑referrals using a free phone number.

    • Monitors and evaluates the impact of actions taken and gives feedback to the practitioner or agency that originally referred the person.

Recommendation 3 Provide tailored solutions via the single‑ point‑of‑contact health and housing referral service for people living in cold homes

Health and wellbeing boards and their partners (see who should take action?) should ensure the local single‑point‑of‑contact health and housing referral service provides access to tailored solutions to address identified needs, rather than an off‑the‑shelf approach. Solutions should take into account the language and reading ability of recipients, including any vision or hearing problems. Solutions should include:

  • Housing insulation and heating improvement programmes and grants. Programmes should be led, or endorsed, by the local authority and include those available from energy suppliers.

  • Advice on managing energy effectively in the home and securing the most appropriate fuel tariff and billing system (including collective purchasing schemes, if available). Note: the most appropriate fuel tariff may not be the cheapest if, for example, someone does not have a bank account or needs to budget on a weekly basis.

  • Help to ensure all due benefits are being claimed, as people receiving certain benefits may be entitled to additional help with home improvements – and may get help to manage their fuel bills and any debt.

  • Registration on priority services registers (for energy supply and distribution companies) to ensure vulnerable households get tailored support from these companies.

  • Advice on how to avoid the health risks of living in a cold home. This includes information about what these health risks are (see Public Health England's cold weather plan for further information).

  • Access to, and coordination of, services that address common barriers to tackling cold homes. For example, access to home improvement agencies that can fix a leaking roof, or to voluntary groups that can help clear a loft ready for insulation.

  • Short‑term emergency support in times of crisis (for instance, room heaters if the central heating breaks down or access to short‑term credit).

Recommendation 4 Identify people at risk of ill health from living in a cold home

Primary health and home care practitioners should:

  • In collaboration with relevant local authority departments, use existing data, professional contacts and knowledge to identify people who live in cold or hard-to-heat homes. This includes people who are particularly vulnerable to the cold (see recommendation 5).

  • Include this information in the person's records and use it (with their consent) to assess their risk and take action, if necessary (see recommendations 2 and 3).

  • Ensure data sharing issues are addressed so that people at risk can be identified.

See also Public Health England's health risks of cold homes: data sources to support local services tackling health risks of cold homes.

Recommendation 5 Make every contact count by assessing the heating needs of people who use primary health and home care services

Primary health and home care practitioners should:

  • At least once a year, assess the heating needs of people who use their services, whether during a home visit or elsewhere, taking into account the needs of groups who are vulnerable to the cold.

  • Use their time with people to assess whether they (or another member of the household) are experiencing (or are likely to experience) difficulties keeping their home warm enough.

  • Be aware that living in a cold home may have a greater effect on people who have to spend longer than an average amount of time at home. This could include those with chronic health conditions (including terminal illnesses) or disabilities.

  • Be aware that people may not want to admit they are having difficulties paying for heating and may try to hide this. (For instance, they might only put the heating on when expecting a scheduled home visit.)

  • Give people at risk, and their carers, information about how living in a cold home can affect their health. They should also tell them about services that can help and refer them if necessary. Ensure recipients can understand and act on the information they are given.

  • If a cold home is a risk to someone's health and wellbeing, assess the likely effect and identify how the situation could be improved. Make sure relevant services are aware who will take action and when. This could include:

    • referral to the local health and housing service

    • referral to a health service (for instance, to ensure the person is offered flu vaccinations at the start of the winter). (See also the NICE guideline on flu vaccination: increasing uptake for further information about who is eligible for the free flu vaccination and increasing uptake among eligible groups in primary and secondary care.)

  • Record assessments and actions in the person's notes or care plans. Make this information available to other practitioners, while respecting confidentiality.

Also see recommendations 2 and 3.

Recommendation 6 Non-health and social care workers who visit people at home should assess their heating needs

People who do not work in health and social care services but who visit people at home (see who should take action?) should:

  • Refer anyone who needs help with the problems of living in a cold home to the local single‑point‑of‑contact health and housing referral service, if they give their consent (see recommendations 2 and 3).

  • Give people who may be vulnerable to the cold information on the effect that living in a cold home can have on their health and what can be done to remedy this.

Recommendation 7 Discharge vulnerable people from health or social care settings to a warm home

Those responsible for arranging and helping with someone's discharge from a health or social care setting (see who should take action?) should:

  • Assess whether the person is likely to be vulnerable to the cold and if action is needed to make their home warm enough for them to return to. This assessment should take place at any time of the year, not just during colder weather, and well before they are due to be discharged to allow time for remedial action. For instance, it could take place soon after admission or when planning a booked admission.

  • As part of the planned discharge, coordinate the efforts of all the practitioners involved to ensure the home is warm enough. This could include simple measures such as turning on the heating before discharge, providing advice on the ill effects of cold on health, or providing advice on how to use the heating system. It could also involve more complex measures:

  • If needed, refer the person to the local single‑point‑of‑contact health and housing referral system (see recommendations 2 and 3). For example, refer them if the heating system needs replacing or the property needs insulating, or to prevent or address fuel debt. (The latter may accrue during someone's stay in health or social care accommodation.)

  • Ensure any heating issues are resolved in a timely manner, so as not to delay discharge from hospital.

Recommendation 8 Train health and social care practitioners to help people whose homes may be too cold

Training providers for health and social care practitioners (see who should take action?) should:

  • Ensure training to support continuing professional development includes detail on the effect on health and wellbeing of living in a cold home and the benefits of addressing this issue (for example, insulation could save money on heating bills).

  • Ensure ongoing training programmes raise awareness of local systems and services to help people who are living in homes that are too cold for their health.

  • Ensure practitioners can raise the issue of living in a home that is too cold. They should also be able to advise on sources of support and help and know how to refer someone, if necessary.

Recommendation 9 Train housing professionals and faith and voluntary sector workers to help people whose homes may be too cold for their health and wellbeing

Training providers for housing professionals and for people working in the faith and voluntary sector (see who should take action?) should:

  • Ensure those in contact with people who may be vulnerable:

    • are aware of how cold housing can affect people's health and wellbeing

    • can spot when and how someone is at risk of being too cold at home

    • know of local services designed to address these problems

    • understand how to refer someone for help.

Recommendation 10 Train heating engineers, meter installers and those providing building insulation to help vulnerable people at home

Employers who install and maintain heating systems, electricity and gas meters and building insulation and those involved in employee training (see who should take action?) should ensure employees who visit vulnerable people are:

  • Trained to deal sensitively with the needs of the person they are visiting. For instance, they should provide information about the work they are doing in a form that can easily be understood by the recipient.

  • Aware of how a cold home can affect someone's health and are able to spot if someone is vulnerable to the cold and the risks they are facing.

  • Able to identify if ventilation is adequate – and know how to put this right if it is not. This includes knowing who to call if there is a problem.

  • Given accreditation for these skills.

Recommendation 11 Raise awareness among practitioners and the public about how to keep warm at home

Health and wellbeing boards, Public Health England and the Department of Energy and Climate Change should:

  • Ensure up‑to‑date information is available in appropriate formats for both practitioners and the public on how cold homes can affect people's health.

  • Address commonly held misconceptions, for instance, that drinking alcohol can help keep someone warm, that hypothermia is the main health problem caused by the cold, or that sleeping in a cold bedroom is good for your health.

  • Ensure up‑to‑date details of national and local support is available for both practitioners and the public. This support might include: help to improve the fabric of the housing or the heating system; help to make heating the home more affordable; or general advice on how to keep warm.

  • Ensure national advice takes into account local and regional variations in the kind of support offered.

Recommendation 12 Ensure buildings meet ventilation and other building and trading standards

Building control officers, housing officers, environmental health officers and trading standards officers should:

  • Ensure changes to buildings are carried out at least to the standards required by building regulations, in particular with respect to ventilation (see the government's building regulations planning portal).

  • Use existing powers to identify housing (particularly in the private rented sector) that may expose vulnerable residents (see recommendation 5) to the cold. Existing powers fall under both the housing health and safety rating system and trading standards legislation (in relation to energy performance certificates).

  • Ensure any relevant problems are addressed.

Terms used in this guideline

Excess winter deaths

Almost all causes of death show some variation with season. Overall, the death rate is higher during winter months and these deaths are referred to as 'excess winter deaths'. In the UK, these figures are based on death rates from December to the end of March.

Hard-to-heat homes

Hard‑to‑heat homes include:

  • those with solid walls

  • those with no loft space

  • those in a state of disrepair

  • high rise blocks

  • those not connected to (and that cannot be connected to) the gas grid.

Other factors, such as listed architectural features, accessibility or construction quality may make it difficult to significantly improve the SAP rating (see standard assessment procedure). Such properties are sometimes described as 'hard to treat'. Although important, the major issue from a health perspective is to ensure properties are not 'hard to heat'.

Home improvement agencies

Home improvement agencies are local organisations that help older people, people with disabilities and vulnerable people to live in safety and with dignity in their own homes. Services focus on ensuring existing housing is fit for purpose and that vulnerable people, predominantly homeowners, can live independently for as long as possible. Locally they may be known as 'care and repair' or 'staying put' agencies.

Priority services registers

The priority services registers are schemes offering extra free services to people who are of pensionable age, are registered disabled, have a hearing or visual impairment, or have a long-term health problem. They are run by energy suppliers and distributors.


Self‑disconnection occurs when a pre‑payment meter is not topped‑up (either accidentally or intentionally) before all the credit, including emergency credit, is used and the supply is cut off.

Standard assessment procedure

'Standard assessment procedure' (SAP) refers to an index that reflects the cost of heating a dwelling. The index depends on the rate of heat loss determined by: building fabric, degree of insulation, ventilation and the cost of the heating. This last factor is determined by heating efficiency, fuel price and solar gain. SAP ratings are frequently divided into 7 bands (A to G). A (most efficient) runs from 92 to 100, B from 81 to 92, C from 69 to 80, D from 55 to 68, E from 39 to 54, F from 21 to 38 and G from 1 to 20.

Registered social landlord

Registered social landlord is the general name for not‑for‑profit housing providers approved and regulated by the government through the Housing Corporation. Most registered social landlords are also known as housing associations.