Quality statement 3: Single‑point‑of‑contact health and housing referral service

Quality statement

People who are vulnerable to the health problems associated with a cold home receive tailored support with help from a local single‑point‑of‑contact health and housing referral service.

Rationale

Many socioeconomic factors can cause people to be vulnerable to health problems associated with cold homes, and there may be a range of potential solutions depending on personal circumstances. A single‑point‑of‑contact health and housing referral service can ensure people receive the help that they need effectively, with knowledge of services available and links with relevant national and local agencies, including health and social care providers, local housing providers, advice agencies (such as Citizens Advice and money advice organisations), health and social care charities, voluntary organisations and home improvement agencies.

Quality measures

Structure

Evidence of local arrangements to ensure that people who are vulnerable to the health problems associated with a cold home receive tailored support with help from a local single‑point‑of‑contact health and housing referral service.

Data source: Local data collection.

Process

a) Proportion of people identified as being vulnerable to the health problems associated with a cold home who are referred to the local single‑point‑of‑contact health and housing referral service.

Numerator – the number in the denominator who are referred to the single‑point‑of‑contact health and housing referral service.

Denominator – the number of people identified as being vulnerable to the health problems associated with a cold home.

Data source: Local data collection.

b) Proportion of people identified as being vulnerable to the health problems associated with a cold home and referred to the single‑point‑of‑contact health and housing referral service whose tailored support needs are agreed.

Numerator – the number in the denominator whose tailored support needs are agreed.

Denominator – the number of people identified as being vulnerable to the health problems associated with a cold home and referred to the single‑point‑of‑contact health and housing referral service.

Data source: Local data collection.

c) Proportion of people identified as being vulnerable to the health problems associated with a cold home with tailored support needs agreed with the single‑point‑of‑contact health and housing referral service whose needs were met.

Numerator – the number in the denominator whose needs were met.

Denominator – the number of people identified as being vulnerable to the health problems associated with a cold home whose tailored support needs were agreed with the single‑point‑of‑contact health and housing referral service.

Data source: Local data collection, which could include a breakdown of achievement by type of support needed.

d) Proportion of people identified as being vulnerable to the health problems associated with a cold home and referred to the single‑point‑of‑contact health and housing referral service who are no longer vulnerable to the health problems associated with a cold home.

Numerator – the number in the denominator no longer considered vulnerable to the health problems associated with a cold home.

Denominator – the number of people identified as being vulnerable to the health problems associated with a cold home and referred to the single‑point‑of‑contact health and housing referral service.

Data source: Local data collection.

Outcome

a) People who used the local single‑point‑of‑contact health and housing referral service who feel able to manage their home heating needs.

Data source: Local data collection.

b) The number of people living in fuel poverty.

Data source: Local data collection.

What the quality statement means for service providers, health, public health, social care and third sector practitioners, and commissioners

Service providers (such as local authority departments, local NHS organisations, fire and rescue services, housing providers, energy companies and voluntary organisations) ensure that processes are in place to enable referral or self‑referral to the local single‑point‑of‑contact health and housing referral service for people who are identified as being vulnerable to the health problems associated with a cold home. The local single‑point‑of‑contact service should ensure that people living in cold homes using the service receive tailored support by assessing the person's needs and working with identified partners (local organisations providing relevant interventions and services) to help them.

Health, public health, social care and third sector practitioners (such as GPs, community nurses, health visitors, home care practitioners and housing association officers) ensure they are aware of the local single‑point‑of‑contact health and housing referral service and refer people who are identified as being vulnerable to the health problems associated with a cold home to the service. Anyone, such as gas and electricity engineers and fire and rescue officers, whose employment requires them to visit people vulnerable to the health problems associated with a cold home at their home should consider their heating needs and refer them to the single‑point‑of‑contact health and housing referral service if needed.

Commissioners (such as clinical commissioning groups and local authorities) jointly commission a local single‑point‑of‑contact health and housing referral service that helps people who are identified as being vulnerable to the health problems associated with a cold home to receive tailored support.

What the quality statement means for patients, people using services and carers

People who are vulnerable to the health problems associated with a cold home are referred (usually by health or social care professionals, or people from voluntary organisations, but sometimes by referring themselves) to a local health and housing referral service. Staff at the service can discuss the person's needs and organise help so that they can keep their home warm.

Source guidance

Definitions of terms used in this quality statement

People who are vulnerable to the health problems associated with a cold home

People living in cold homes who are vulnerable to the associated health problems include:

  • 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)

  • young children (under 5)

  • pregnant women

  • people on a low income

  • people who move in and out of homelessness

  • people with addictions

  • people who have attended hospital due to a fall

  • recent immigrants and asylum seekers.

[Adapted from Excess winter deaths and illness and the health risks associated with cold homes (NICE guideline NG6) and expert opinion]

Health problems associated with a cold home

Cold homes and poor housing conditions have been linked with a range of health problems in children and young people, including respiratory health, growth and long‑term health. In older people, cold temperatures increase the risk of heart attack, stroke and circulatory problems, respiratory disease, flu and hospital admission. They also lower strength and dexterity, leading to an increase in the likelihood of falls and accidental injuries. Home temperatures also have implications for mental health because cold is linked with increased risk of depression and anxiety.

[Adapted from Local action on health inequalities evidence review 7: fuel poverty and cold home-related health problems (2014) Public Health England]

Single‑point‑of‑contact referral service

A local single‑point‑of‑contact health and housing referral service provides access to interventions to address the needs of people living in cold homes. When setting up and monitoring the service, health and wellbeing boards should identify all local providers of interventions and services (such as relevant local authority departments, the health sector, utilities, housing organisations and organisations in the voluntary sector) to address health problems associated with a cold home and encourage their integration to create a single‑point‑of‑contact for access to available assistance. The service should actively assist the people who self‑refer or are referred to it by providing access to tailored interventions and services. It should not act as a signposting service.

[Adapted from Excess winter deaths and illness and the health risks associated with cold homes (NICE guideline NG6), recommendations 2 and 3 and expert opinion]

Tailored support

Tailored support is the delivery of interventions and services designed for vulnerable people living in cold homes to address their specific needs. This support takes into account the language and reading ability of the person, including any vision or hearing problems, and their ability to understand and act on information provided to them.

Support includes but is not limited to:

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

  • Advice on being energy efficient in the home and having the most appropriate fuel tariff and billing system (including collective purchasing schemes, if available).

  • 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 households at risk 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 England 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 example, room heaters if the central heating breaks down or access to short‑term credit).

[Adapted from Excess winter deaths and illness and the health risks associated with cold homes (NICE guideline NG6), recommendation 3]

Equality and diversity considerations

Good communication between the referral service and people who may be vulnerable to the health problems associated with a cold home is essential. Those at risk are likely to include people with communication needs, people who are frail or confused, and people who have difficulty understanding and acting on information provided to them. These people may have different support needs. The referral service should provide people with the level of support they need to ensure any needs identified can be acted on.