FUEL POVERTY AND HEALTH: IMPROVING POLICY AND PRACTICE IN HEALTH AND SOCIAL CARE

Introduction

The 1998 ‘ Independent Inquiry into Inequalities in Health (Acheson Report), commissioned by the Department of Health, indicated that much of the variation in health across different socio-economic groups was the result of material deprivation and that housing conditions were clearly implicated in poor health. Acheson specifically recommended “policies to improve insulation and heating systems in new and existing buildings in order to reduce the prevalence of fuel poverty”.

Poor quality housing is a major factor in fuel poverty.  Cold damp homes, which are inadequately heated and ventilated, have repeatedly been linked to both increased morbidity and mortality particularly amongst more vulnerable households such as those containing older people, young children and/or those living with chronic illness or disability.  Conditions such as cardiovascular disease and respiratory illness are likely to be exacerbated by cold, damp homes.  In addition, those living in cold, damp conditions are at a higher risk of falls and accidents in the home.  The mental health impact of inadequate housing is still an emerging field of study, although evidence supports the view that householders do suffer stress that is detrimental to their quality of life and general well-being.

Fuel poverty and health strategies

The connection between cold, damp housing and adverse health consequences has been addressed in a number of Government strategies since publication of the Acheson Report.  The introduction of the Decent Homes Standard and the Housing Health and Safety Rating System is likely to have a positive impact since both are key to ensuring that all dwellings provide a safe and secure living environment. The Programme for Action on Health Inequalities has also encouraged action to address a number of health-related issues including fuel poverty.  Similarly the White Paper Choosing Health contained several commitments directly or indirectly related to improving living environments.  Developments in Supporting People; improving care for those living with long-term conditions through the Single Assessment Process; and, more recently, developments with the Common Assessment Framework, have all highlighted commonalities with the wider affordable warmth agenda.

The UK Fuel Poverty Strategy (2001) recognised the different health aspects of fuel poverty in establishing a framework for delivery of the Government’s overall goal of eradicating fuel poverty for vulnerable households by 2010 and all other households by 2016.   The Strategy identified housing, energy, health, general poverty and social exclusion as factors in fuel poverty whilst recognising that simply referring householders to energy efficiency services is insufficient to solve their problems. The emphasis on the health and well-being benefits of affordable warmth activity presents health and social care services with both challenges and opportunities to develop, in partnership with other agencies, policies and practice to address the wider health impacts of fuel poverty.

NEA's involvement with the health agenda

NEA’s work in recent years recognises that the emergence of Local Area Agreements, Local Delivery Plans, Choosing Health and wider healthy housing and communities initiatives provide new and valuable opportunities for the health sector to work in partnership with both local government and the wider fuel poverty/ energy efficiency sector to identify, support and implement different approaches to address cold-related morbidity and mortality and, in doing so, contribute to cross-sectoral and shared priorities in key areas both locally and nationally.  Whilst it is not the role of the health and social care sector to provide decent housing NEA believes that the sector has a role to play in influencing the provision of affordable warmth by ensuring that:

• Health and well-being considerations are factored into planned housing or community renewal developments
  
  
• Analysis is made of how resources are being targeted within the wider community to reduce health inequalities associated with cold, damp homes
  
  
• Referral pathways and protocols are developed and delivered in partnership to maximise access to housing and energy efficiency improvements as well as income maximisation and advice services (including energy advice and money advice)
  
  
• Awareness-raising activities are developed to ensure policy makers, practitioners and the wider community all understand and lend support to affordable warmth policies and programmes.

More specifically:

Primary Care Trusts, Care Trusts and Social Care Agencies should be aware of their responsibility to ensure that fuel poverty/affordable warmth considerations are championed within existing and future health and social care policy. Health Improvement and Modernisation Programmes, action on health inequalities and Choosing Health-related initiatives, all of which focus on prevention work, should acknowledge the cross-cutting benefits of affordable warmth activities.

• Awareness raising and/or training in fuel poverty/affordable warmth issues should reflect broader community priorities.  Understanding the links between fuel poverty, ill health and inadequate housing should be a priority for policy makers as well as frontline practitioners including those with access to people living with chronic illness or disability e.g. Community Matrons, social workers and home care staff.  Health and social care agencies can promote awareness of these issues internally, through partnership development, and through community health education activity.
  
  
• Questions on affordable warmth and information on referral pathways should always be included within Single Assessment Process and the forthcoming Common Assessment Framework, particularly at a Contact Assessment stage.  This need not require major changes to established procedures although it may be necessary to supplement existing guidance and protocols and raise awareness amongst staff in order for the knowledge to inform practice.
  
  
• NEA has published guidance entitled ‘Prevention is better than cure – a guide to assessing the risks to vulnerable people living in cold, damp homes through the Single Assessment Process and recommendations for action’.  Staff involved in assessment activity should be trained to recognise the signs of fuel poverty and the appropriate remedial actions.
  
  
• Affordable warmth considerations should be factored into discharge planning and winter planning arrangements (in keeping with SAP/CAF developments noted above)
  
  
• Enhancements to clinical/social care information systems should be actioned to target assistance to fuel-poor clients/patients in keeping with established good practice.  Health and social care agencies have a role to play in identifying households at risk; targeting, engaging, informing and referring clients/patients to sources of available assistance by helping to develop and/or support local partnership initiatives
  
  
• Consideration must be given to the powers afforded by the Housing, Health and Safety Rating System to address poor housing conditions and provide key interventions for patients/clients, particularly where a Category 1 Hazards presents an immediate risk to the health and well-being of the occupant(s).  Health and social care agencies have an obligation to work with local authority Environmental Health Departments to develop protocols for this activity.
  
  
• NEA’s guidance pack ‘Responding to Health Risks in Fuel-Poor Private-Rented Households’ provides guidance and resources for community practitioners on integrating relevant considerations into work activity in this area

Local Area Agreements- There is good evidence that some forward-thinking PCTs (via Public Health intervention) have been instrumental in championing the development of affordable warmth commitments via LAAs, to help meet broader health priorities.  PCTs and other agencies should learn from this good practice and replicate commitments as LAAs roll-out in every local authority area from 2007.

• Guidance is available from NEA entitled “Achieving Affordable Warmth through Local Area Agreements” which provides examples of targets/ stretch targets and recommendations for action.

Local Strategic Partnerships– LSPs bring strategic planning to meet health and social care priorities within the scope of broader-based community plans.  Health and well-being theme groups should recognise how affordable warmth actions can help to meet a range of priorities across a number of policy areas.  The introduction of statutory health and well-being groups as a result of the recent Local Government White Paper is likely to place greater emphasis on prevention activity and this can be directed at affordable warmth through developments in work plan priorities.

• NEA’s work plan in recent years has offered LSPs guidance and support to develop and deliver affordable warmth commitments

Scrutiny Committeeshave an important role to play in investigating the response of local agencies to the impacts of cold, damp homes on the community.

• NEA’s guidance note ‘ Fuel Poverty Policies and Progress’ provides scrutiny committees with a framework of questions and recommendations when undertaking scrutiny directly or indirectly on fuel poverty/ affordable warmth issues and places emphasis on heath and well-being issues. 

Updated: 09/05/2007