NICE has begun a consultation on draft guidance on how to reduce the risk of death and ill health associated with living in a cold home.  

Cold weather has a direct effect on the number of people experiencing heart attacks, stroke, respiratory disease and flu. Around 24,000 more people die each year in England and Wales between December and March and 3 in 4 of these deaths are in the over 75 population. As well as those who are already living with an existing respiratory or circulatory disease, people most likely to be affected often have a low income or a home which is hard to heat.

Commenting on the draft guideline Professor Mike Kelly, Director of the Centre for Public Health at NICE, said: “Although most causes of death and illness vary throughout the seasons, there is a clear increase during winter months. Around 24,000 additional people die during this time each year in England and Wales, mostly from cardiovascular and respiratory conditions. This is not just about extreme cold weather, but normal winter temperatures – when outdoor temperatures drop below 6°C.  

“Services to ensure people are warm enough at home already exist, but they are patchy across the country, and this lack of consistency makes it very difficult for professionals to know what support is available locally and how to get help for those who need it.  This draft guideline covers people who are vulnerable to the cold, including those over 65, people with respiratory conditions such as children with asthma, and people with cardiovascular conditions.

“This new draft guideline aims to help reduce these preventable deaths and ill health. Recommendations include identifying those at risk, ensuring that a referral can be made for insulation or heating improvements if necessary and raising awareness of local systems and services to help people who are living in homes that are too cold. People need to be aware of how the cold affects their health and where they can seek help if they need it.”

Draft recommendations issued for consultation include:

Provide services via a 1-stop local health and housing referral service for people living in cold homes: Health and wellbeing boards and their partners should ensure the referral service provides access to housing insulation and heating, more affordable fuel options (where available) and advice on how to avoid the health risks of cold homes. This includes:

• Access to insulation and heating improvement programmes and grants.
• Tailored solutions to address identified needs (rather than providing off-the-shelf solutions).
• Access to, and coordination of, services that address common barriers to tackling cold homes. For example, access to a home improvement agency service that can fix a leaking roof, or to a voluntary group that can help clear a loft ready for insulation.
• Help to ensure all due benefits are being claimed.

Identify people at risk of ill health from living in a cold home: Health and social care professionals should use existing data and professional contacts and knowledge to identify people who live in a cold or hard-to-heat home, or are particularly vulnerable to the cold because of a medical condition and include this information in the person’s records. Use it to assess their risk and take action, where necessary.

Ensure vulnerable hospital patients are not discharged to a cold home: Those responsible for arranging someone’s discharge from hospital should coordinate efforts to ensure their housing 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.

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 should ensure employees who visit vulnerable people are:

• Trained to deal sensitively with their needs. For instance, they should provide information about the work they are doing in a form that can easily be understood by the recipient. Ensure these skills are accredited.
• Able to spot if someone is vulnerable to the cold and the risks they are facing at home.
• Aware of who to call if there is a problem.

Ends

For more information call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

Notes to Editors

 Number of ‘excess’ deaths above the average for the rest of the year. Statistical bulletin: Excess Winter Mortality in England and Wales, 2012/13 Office for National Statistics 2013.

About the guidance

1. The draft guidance will be available at http://guidance.nice.org.uk/PHG/70 from 13 June 2014. Embargoed copies of the draft guidance are available from the NICE press office on request. Final guidance is expected to publish this winter.
2. 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.
3. Many factors may influence the variation in death rates between winter and summer. This includes the weather, seasonal infections, air pollution, behavioural changes and micronutrient levels. Most studies on the subject are based on data analyses for large populations (often whole cities or regions) for which health outcomes are related to outdoor, rather than indoor, temperatures. These studies show an effect attributable to cold. Often they also show a time-lag of up to 2 or 3 weeks between exposure to the cold and death or disease.
4. 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 (which indicates how well buildings retain heat). Such properties are sometimes described as ‘hard to treat’.