Excess winter deaths, fuel poverty and flu

National and local strategies (best practice)

Public Health England’s Cold Weather Plan 2013 stated that “reducing excess winter illness and death is not something that can be tackled in winter alone”.  It advocates a year-round, on-going strategic approach, which should led by health and wellbeing boards and considered part of their core business.

The National Institute for Clinical and Healthcare Excellence (NICE) is currently developing a guideline on excess winter deaths which is due for publication in January 2015.  The guideline focuses specifically on health risks associated with living in a cold home (and hence fuel poverty) but takes a broader approach to those health risks by including the effect on winter illnesses as well as deaths.  For example, children living in cold homes are more likely to develop asthma; cold weather is also an important cause of depression.  Taking a broader perspective enhances the importance of the issue, along with the cost effectiveness of interventions to address it.

The draft recommendations were published for consultation on 13 June 2014.  Changes may be made as a result of the consultation but the recommendations can be summarised as follows:

  • Health and wellbeing boards should consider the effects of cold homes in their JSNA and develop a strategy to address them
  • The strategy should include providing a local referral service which directs people who are risk towards multidisciplinary help to reduce their risk factors for winter illness or death
  • All professionals who see people who may be at risk should be trained and alert to ask about how warm their homes are, to record their answers and to refer accordingly
  • New technology should be exploited to reduce the risks from cold homes (such as temperature alert systems)
  • When home energy efficiency improvements are made, technicians should ensure that vulnerable people know how to use their new equipment

Local authorities should use their enforcement powers to require improvements to private rented accommodation which is putting vulnerable tenants at risk.

A “How to” guide for reducing the risk of seasonal excess deaths in vulnerable older people compiled by the Department of Health’s Health Inequalities National Support Team in 2010 described nine interventions which should be offered as part of a multidisciplinary approach to reducing risk factors:

  • Assessment for affordable warmth interventions, including energy efficiency, household income and fuel cost.
  • Regular review of benefits entitlement and uptake.
  • Annual flu and pneumococcal vaccination.
  • Provision of an annual medication review (every six months if taking four+ medicines).
  • Provision of an annual medicines utilisation review (MUR) and follow-up support for adherence to therapy.
  • Implementation of a personal brief health interventions plan that includes advice and support to stop smoking, sensible drinking, healthy eating, adequate hydration and daily active living.
  • Assessment and support programme to prevent falls.
  • Assessment for appropriate assistive technologies, e.g. alarm pendants to call for help.
  • Help to develop a personal crisis contingency plan (e.g. including a buddy scheme, where no close friends or family, to watch for danger signs and provide someone to call).

Many case studies of good practice around fuel poverty or flu vaccination uptake have also been reported, such as collective energy supplier switching schemes.


Last updated Tuesday, 12th July 2016