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HEALTH THROUGH WARMTH IN BIRMINGHAM Elaine Di Vito, a nurse by training, managed the Birmingham specialist
community health trust’s involvement in the ‘Health through
warmth’ scheme in 2001, in an area with an average of 740 excess
deaths each winter. “Our initial step was to set up a simple referral process and train 600 health professionals and support staff to recognise when patients’ health was being affected by fuel poverty,” says Di Vito. “We taught staff to give patients a more holistic health assessment,
using a simple tick-box form including questions about living conditions.
This was faxed to our partners, Birmingham city council, who assessed
each case and arranged suitable grants. “Our partners, npower, also had a crisis fund available. If someone is ill and living without heating or hot water, they can’t always wait several months for central heating to be installed. "A crisis fund meant we could provide short-term measures
such as electric radiators within 48 hours – which is often
enough to prevent people going into hospital. In very needy cases,
we can also access grants to clear outstanding fuel bills. In the
first year, we had 650 referrals.” Di Vito admits that, initially, she was cynical about the project’s
potential. But she’s now so enthusiastic about an increasingly
holistic approach to healthcare that she’s become NHS advisor
to Health through warmth. “We recently saw a terminally ill man who wanted to die at home, but had no heat or hot water,” says Di Vito. “Within 24 hours, we were able to access a grant to improve his living conditions and give him comfort in his last days. It’s something I’ve never seen in 20 years as a community nurse.” FURTHER INFORMATION
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Up to 50,000 people will die this winter because they can’t afford to heat their homes. Catherine Francis explores the relationship between fuel poverty and health – and how local action can make a difference
The cold war
Right now, around eight million households in the UK cannot afford to
heat their homes adequately. And each winter, up to 50,000 Britons pay
the ultimate price: death.
Most winter deaths are due to respiratory infections, asthma, heart disease
and strokes, all of which are exacerbated by cold, damp conditions. Countries
with more severe winters than Britain, such as Sweden and Canada, have
less seasonal variations in mortality – this shows housing standards
play a crucial role.
‘Fuel poverty’ is defined as having to spend more than 10%
of income on heating the home to adequate temperatures for health and
comfort, and providing hot water and lighting. This is the situation for
one in four households in the UK – including many housing vulnerable
people such as pensioners, children and those with disabilities.
Cold, damp homes aren’t just an issue for the individuals living
in them – they dramatically increase the burden on the hospitals,
care homes and social services that care for people suffering illness
and loss of independence.
The NHS spends an estimated £1bn a year treating illnesses caused
by inadequate heating. And it is a significant cause of bed blocking,
when patients return to hospital with recurring conditions worsened by
cold homes, or are kept in hospital or moved into residential care facilities
because their home is unfit to return to.
In November 2001, the government declared its aim to end fuel poverty in vulnerable households by 2010, and in others by 2016.
Its strategy included compulsory targets for energy companies to help
low-income customers manage their payments and improve energy efficiency
in their homes; and setting up a scheme called Warm Front, which offers
grants for energy efficiency improvements in low-income households.
“Having the problem recognised by the government is a big step forward,
but there are still insufficient resources to tackle it,” says Mary
Unan of National energy action (NEA). “And the government’s
definitions of income are arguable. Housing benefit is included in income,
for example, even though this is often paid directly to the landlord.”
The NEA runs ‘Health through warmth’, a project aimed at improving
energy efficiency in vulnerable homes (see case study).
“Working alongside local NHS trusts, and the energy company npower, frontline workers are trained to identify people suffering from fuel poverty,” says Unan.
“They can then refer them for grants to improve or install central
heating and insulation to reduce fuel bills and provide warmer conditions.
The pilot scheme of five projects proved successful, and Health through
warmth is now being rolled out to around 40 communities.”
Another charity fighting fuel poverty is the National right to fuel campaign
(NRFC), of which UNISON is a long-standing member and major funder.
“Fuel poverty doesn’t only affect physical health,” points
out NRFC chairman Michael King. “Inhumane living conditions, debt
problems and space shrinkage (where people or families end up living in
one room) impact dramatically on mental health.”
A volunteer organisation, NRFC undertakes research and lobbies the government
to alleviate the causes of fuel poverty by increasing pensions, income
and housing quality, and combating energy company policies such as disconnection
for debt, and payment schemes that favour customers who can afford to
pay bills in advance.
“UNISON has worked closely with NRFC, and has been at the forefront of campaigns to push through Private Members’ Bills in 1995, 1998 and 2001, which have now become legislation,” says UNISON policy officer and vice-chairman of NRFC Dick Barry.
“Thanks to our work, and that of other organisations, thegGovernment
now has a coherent programme for ending fuel poverty.”
Contact the article's author
*If you know someone struggling with fuel poverty, call 0800 512012 for your nearest Energy efficiency advice centre. To enquire about a Warm front grant, call (free) 0800 952 0600.
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PORTSMOUTH'S ENERGY CHAMPION “Portsmouth city had 200 excess deaths
each winter – twice the average for a city of this population,”
says Smith. “Grants to improve energy efficiency were available
from Warm front, the local authority and energy companies. But residents
were largely unaware of this, as were health workers, who were unable
to access them anyway. “Many health workers were also unaware of the effects of cold, damp housing on health – not to mention the strain on hospitals, care homes and social services. "I used to be an elderly care physician myself, and didn’t fully appreciate its significance. And healthcare staff play so many roles, fuel poverty may not be at the front of their minds, so my first aim was to raise awareness. I spoke at every meeting that would have me, and made use of local media. "We trained staff who visit patients
at home, such as district nurses, occupational therapists and care
workers, to recognise fuel poverty and refer people for grants. “However, different grants were appropriate for different circumstances (for instance, you must be on benefits to receive a Warm front grant – but many pensioners’ incomes are a few pence over the benefits limit). Our local energy efficiency advice centre
(EEAC) became the central referral point – health workers could
contact the EEAC, who’d take it from there.” To ensure sustainability, Smith’s third
objective was to include fuel poverty strategies in the PCT’s
local delivery plan and business plan, so it remains part of its
long-term development strategy – and new health workers would
continue to receive training. Smith is looking forward to learning how
his strategy will benefit Portsmouth City’s population over
the coming winter. There are plans to extend the system to neighbouring
districts. “It took just four staff members to get this project off the ground, and it will make a real difference to residents and health services,” says Smith. “Yet the Department of Health still
doesn’t give PCTs around the country any guidance or targets
regarding fuel poverty. This is an NHS issue, and the DoH must recognise
that.” *NEA has received funding from DEFRA for a further 15 energy champions at PCTs around Britain. |
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