Quality statement 4: Asking people about keeping warm at home

Quality statement

People who are vulnerable to the health problems associated with a cold home are asked at least once a year whether they have difficulty keeping warm at home by their primary or community healthcare or home care practitioners.

Rationale

Primary or community healthcare and home care practitioners can make every contact count, by asking the person whether they or someone in their household is experiencing difficulties keeping warm at home. If keeping warm is a problem, the person can be referred for help to reduce any risks that are identified (for example through a single‑point‑of‑contact health and housing referral service). People should be asked whenever appropriate, and at least annually. People who spend a lot of time at home may be particularly affected by living in a cold home. This may include some people with chronic conditions or disabilities who are likely to be in regular contact with primary healthcare and home care services.

Quality measures

Structure

a) Evidence of local protocols to define people who are vulnerable to the health problems associated with a cold home.

Data source: Local data collection.

b) Evidence of local protocols for primary healthcare professionals to ask people who are vulnerable to the health problems associated with a cold home at least once a year whether they have difficulty keeping warm at home.

Data source: Local data collection.

c) Evidence of local protocols for community healthcare practitioners to ask people who are vulnerable to the health problems associated with a cold home at least once a year whether they have difficulty keeping warm at home.

Data source: Local data collection.

d) Evidence of local protocols for home care practitioners to ask the people they visit at home who are vulnerable to the health problems associated with a cold home at least once a year whether they have difficulty keeping warm at home.

Data source: Local data collection.

Process

a) Proportion of people who are identified as being vulnerable to the health problems associated with a cold home who are asked at least once a year whether they have difficulty keeping warm at home by primary healthcare practitioners.

Numerator – the number in the denominator who are asked at least once a year whether they have difficulty keeping warm at home by primary healthcare practitioners.

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

Data source: Local data collection.

b) Proportion of people who are identified as being vulnerable to the health problems associated with a cold home who are asked at least once a year whether they have difficulty keeping warm at home by community healthcare practitioners.

Numerator – the number in the denominator who are asked at least once a year whether they have difficulty keeping warm at home by community healthcare practitioners.

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

Data source: Local data collection.

c) Proportion of people who are identified as being vulnerable to the health problems associated with a cold home who receive home care who are asked at least once a year whether they have difficulty keeping warm at home by home care practitioners.

Numerator – the number in the denominator who are asked at least once a year whether they have difficulty keeping warm at home by home care practitioners.

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

Data source: Local data collection.

Outcome

Referral rates to a local single‑point‑of‑contact health and housing referral service.

Data source: Local data collection.

What the quality statement means for service providers, primary and community healthcare and home care practitioners, and commissioners

Service providers (such as local authority departments, healthcare organisations and home care providers) ensure that local protocols are in place that define people vulnerable to the health problems associated with a cold home. The protocols should require primary and community healthcare and home care practitioners to ask vulnerable people, at least once a year, whether they have difficulty keeping warm at home. The protocols should ensure that primary and community healthcare and home care practitioners also take into account room temperature when they are making home visits and ensure good communication between agencies to ensure that any needs identified are addressed and avoid duplication.

Primary and community healthcare and home care practitioners (such as GPs, district nurses, health visitors, allied health professionals, outreach workers and social care practitioners) ask people who are vulnerable to the health problems associated with a cold home according to local protocols whether they have difficulty keeping warm at home. This can be done at least once a year when visiting the person's home, when they should also be aware of the room temperature, or through discussions with the person during a primary care consultation. They should refer the person appropriately and communicate with the relevant agencies to ensure the person's needs are addressed and avoid duplication.

Commissioners (such as clinical commissioning groups, local authorities and NHS England) ensure that they commission primary and community healthcare and home care services that have protocols in place that provide a local definition of people who are vulnerable to the health problems associated with a cold home. The protocols should require primary and community healthcare and home care practitioners to ask such people at least once a year whether they have difficulty keeping warm at home.

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 asked whether they have difficulty keeping warm at home. This can be done by healthcare or home care workers who visit their home, or when they visit their GP, and should happen at least once a year.

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]

Difficulty keeping warm at home

Practitioners should take into account the needs of people who are vulnerable to the health problems associated with a cold home by asking whether they have, or are likely to have, difficulties keeping their home warm enough. This can be done either on home visits (by visiting health and home care practitioners) or elsewhere, for example during a routine consultation with a GP. The conversation should include, but not be limited to, the following considerations:

  • The amount of time the person spends at home.

  • How and when they use their heating.

  • If the cost of their heating makes them limit its use and risk being cold.

  • Any illnesses or temporary or long‑term physical or mental health conditions they have, how their condition might be affected by being cold at home and how it might prevent the person from operating their heating system effectively.

[Adapted from Excess winter deaths and illness and the health risks associated with cold homes (NICE guideline NG6), recommendation 5 and expert consensus]

Primary and community healthcare and home care practitioners

These are practitioners who are likely to have regular contact with people who may be vulnerable to the health problems associated with a cold home and will, in many cases, visit these people at home. They include, but are not limited to, GPs, district nurses, health visitors, allied health professionals, outreach workers, dementia support workers, family support workers and other social care practitioners.

[Expert consensus]

Equality and diversity considerations

Good communication between primary and community care and home care practitioners 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 when asked about their home heating needs.