ADDRESSING THE HEALTH IMPACTS OF COLD HOMESA review of national and local action

NICE guideline NG6Aims• To provide an overview of the guideline• To outline the process used locally• To present findings• To discuss implications

Overview of NG6Aims• reducing preventable excess winter death rates, • improving health and wellbeing among vulnerable groups, • reducing pressure on health and social care services, • reducing ‘fuel poverty’ and the risk of fuel debt or being

disconnected from electricity and gas supplies • improving energy efficiency of homesRationale• outlines the case for year round planning where a focus is on

prioritising which homes are tackled first• shaping and influencing decisions about how homes are

improved • outlining a case for research, implementation and evaluation.

GET WARM SOON?Progress to Reduce Ill Health Associated with Cold Homes in England

Methodology• Stage 1 document review: Strategies and JSNAs of 152

HWBs that were publicly available online evaluated against three criteria:A. Action to address the PHOF indicator on fuel povertyB. Action to address the PHOF indicator on EWDsC. Action to implement the NICE guidance recommendations or

action that is in line with the recommendations• Stage 2 stakeholder feedback: stress-testing and

supplementing this document review with a call for evidence issued to all HWBs, local Citizens Advice Bureaux and local fuel poverty service providers

Key findings from document reviewFigure 4. Performance rating of HWBs to address fuel poverty, excesswinter deaths and the NICE guidance according to their JSNAs and health and wellbeing strategies

3%

20%

28%23%

9%

9%

9%

Rated 0 (4 HWBs)Rated 1 (31 HWBs)Rated 2 (42 HWBs)Rated 3 (35 HWBs)Rated 4 (14 HWBs)Rated 5 (13 HWBs)Rated 6 (13 HWBs)

NB: The maximum score a HWB could achieve was 6. This means a HWB is prioritising both fuel poverty and EWDs in their strategy, as well as specifying actions to address the NICE guidance

Area-based performance• NEA regraded areas to account for feedback received from

stakeholders during Stage 2. Performance reflects that of an area as a whole – covering schemes and initiatives addressing the health impacts of cold homes which are in place locally but do not necessarily involve the HWB:• 47 areas (31%) demonstrating minimal evidence of action to reduce ill health

from cold homes• 105 areas (69%) demonstrating good to excellent evidence of action to

reduce ill health from cold homes (performance varies markedly within this group)

• 31 areas (20%) demonstrated that they have local and strategic partnerships and action plans in place to coordinate and deliver services to address cold-related ill health (R1)

• Evidence of operating a single point of contact health and housing referrals service (R2) was collected for 45 areas (30%)

• Evidence of discharge planning services (R7) was collected for 19 areas (13%)

Conclusions and recommendations• KEY RECOMMENDATION: Health and wellbeing boards update their joint strategic needs

assessments and joint health and wellbeing strategies to apply the NICE guidance recommendations and quality standard on cold homes to their local contexts

• KEY RECOMMENDATION: The Department of Health, Public Health England and NHS England, along with boards themselves, consider how health and wellbeing boards can transition from a coordination to a commissioning role in order to deliver high-quality, cost-effective and joined-up health and housing services

• KEY RECOMMENDATION: Department of Health amend its statutory guidance on joint strategic needs assessments and joint health and wellbeing strategies to recommend that health and wellbeing boards review and refresh these documents annually, in order to inform yearly planning and commissioning cycles.

• Public Health England lead on improving the preparation and transparency of joint strategic needs assessments and joint health and wellbeing strategies. This should include establishing good practice guidance for the production of these

• KEY RECOMMENDATION Health and wellbeing boards take steps to make sure initiatives which meet the relevant NICE recommendations are sufficiently funded. To support this Government must commit to substantive and sustainable levels of public health funding and health and wellbeing boards should transition to have a greater role in commissioning from integrated budgets

Local process• Self-assessment two stage process

• Desktop exercise • Self selected Affordable Warmth partnership members

Results presented to PH SMT and AWP

Local process cont’d

1. Develop a strategy2. Single point of contact3. Tailored solutions offered4. Identified of those most at risk5. MECC to assess heating needs of allHeating needs assessed by SC practitioners7. Discharge arrangement8. Training of health/social care practitioners9. Train housing, faith & VCS practitioners10.Train heating engineers, meter installers, insulation fitters11. Awareness raising among practitioners12 Ensure buildings meet standards 6.

FindingsRecommendations Judgement1,2,3,11 Compliant

4,5,8,12 Non- compliant

6.7.9 Partially compliant

Implications• Guidance –shared responsibilities (national & local

bodies)• Complete omission of CCGs’• Collations of suggested actions for non & partial

compliance.• So what?