Excess winter deaths and illness and the health risks associated with cold homes

Include the health consequences of living in a cold home in the joint strategic needs assessment process.

Develop a strategy to address the health consequences of cold homes. This should include:

Ensure planning includes identifying relevant local interventions and providers from all sectors (such as relevant local authority departments, the health sector, utilities, housing organisations and organisations in the voluntary sector).

Consider how the issues and actions identified are reflected in health and wellbeing and other relevant local strategies or plans and ensure actions take account of other local and national strategies.

Ensure the strategy includes monitoring and evaluation. Also ensure any evaluation is used to improve the strategy and is made publicly available.

Ensure a local single‑point‑of‑contact health and housing referral service is commissioned (see recommendation 3) to help vulnerable people who live in cold homes. A wide range of people are vulnerable to the cold. This is either because of: a medical condition, such as heart disease; a disability that, for instance, stops people moving around to keep warm, or makes them more likely to develop chest infections; or personal circumstances, such as being unable to afford to keep warm enough. In this guideline, the term vulnerable refers to a number of different groups including:

Ensure anyone who comes into contact with vulnerable groups is able to refer people to the referral service. This includes: health and social care practitioners, fire prevention and safety services personnel and workers from charities and voluntary organisations, such as advice agencies.

Ensure the referral service links with relevant national and local services that can provide a range of solutions. These are likely to include: health and social care providers, local housing providers, advice agencies (such as Citizens Advice Bureaux and money advice organisations), health and social care charities, voluntary organisations and home improvement agencies.

Ensure the referral service:

Housing insulation and heating improvement programmes and grants. Programmes should be led, or endorsed, by the local authority and include those available from energy suppliers.

Advice on managing energy effectively in the home and securing the most appropriate fuel tariff and billing system (including collective purchasing schemes, if available). Note: the most appropriate fuel tariff may not be the cheapest if, for example, someone does not have a bank account or needs to budget on a weekly basis.

Help to ensure all due benefits are being claimed, as people receiving certain benefits may be entitled to additional help with home improvements – and may get help to manage their fuel bills and any debt.

Registration on priority services registers (for energy supply and distribution companies) to ensure vulnerable households get tailored support from these companies.

Advice on how to avoid the health risks of living in a cold home. This includes information about what these health risks are (see Public Health England's cold weather plan for further information).

Access to, and coordination of, services that address common barriers to tackling cold homes. For example, access to home improvement agencies that can fix a leaking roof, or to voluntary groups that can help clear a loft ready for insulation.

Short‑term emergency support in times of crisis (for instance, room heaters if the central heating breaks down or access to short‑term credit).

In collaboration with relevant local authority departments, use existing data, professional contacts and knowledge to identify people who live in cold or hard-to-heat homes. This includes people who are particularly vulnerable to the cold (see recommendation 5).

Include this information in the person's records and use it (with their consent) to assess their risk and take action, if necessary (see recommendations 2 and 3).

Ensure data sharing issues are addressed so that people at risk can be identified.

At least once a year, assess the heating needs of people who use their services, whether during a home visit or elsewhere, taking into account the needs of groups who are vulnerable to the cold.

Use their time with people to assess whether they (or another member of the household) are experiencing (or are likely to experience) difficulties keeping their home warm enough.

Be aware that living in a cold home may have a greater effect on people who have to spend longer than an average amount of time at home. This could include those with chronic health conditions (including terminal illnesses) or disabilities.

Be aware that people may not want to admit they are having difficulties paying for heating and may try to hide this. (For instance, they might only put the heating on when expecting a scheduled home visit.)

Give people at risk, and their carers, information about how living in a cold home can affect their health. They should also tell them about services that can help and refer them if necessary. Ensure recipients can understand and act on the information they are given.

If a cold home is a risk to someone's health and wellbeing, assess the likely effect and identify how the situation could be improved. Make sure relevant services are aware who will take action and when. This could include:

Record assessments and actions in the person's notes or care plans. Make this information available to other practitioners, while respecting confidentiality.

Refer anyone who needs help with the problems of living in a cold home to the local single‑point‑of‑contact health and housing referral service, if they give their consent (see recommendations 2 and 3).

Give people who may be vulnerable to the cold information on the effect that living in a cold home can have on their health and what can be done to remedy this.

Assess whether the person is likely to be vulnerable to the cold and if action is needed to make their home warm enough for them to return to. This assessment should take place at any time of the year, not just during colder weather, and well before they are due to be discharged to allow time for remedial action. For instance, it could take place soon after admission or when planning a booked admission.

As part of the planned discharge, coordinate the efforts of all the practitioners involved to ensure the home 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. It could also involve more complex measures:

If needed, refer the person to the local single‑point‑of‑contact health and housing referral system (see recommendations 2 and 3). For example, refer them if the heating system needs replacing or the property needs insulating, or to prevent or address fuel debt. (The latter may accrue during someone's stay in health or social care accommodation.)

Ensure any heating issues are resolved in a timely manner, so as not to delay discharge from hospital.

Ensure training to support continuing professional development includes detail on the effect on health and wellbeing of living in a cold home and the benefits of addressing this issue (for example, insulation could save money on heating bills).

Ensure ongoing training programmes raise awareness of local systems and services to help people who are living in homes that are too cold for their health.

Ensure practitioners can raise the issue of living in a home that is too cold. They should also be able to advise on sources of support and help and know how to refer someone, if necessary.

Ensure those in contact with people who may be vulnerable:

Trained to deal sensitively with the needs of the person they are visiting. For instance, they should provide information about the work they are doing in a form that can easily be understood by the recipient.

Aware of how a cold home can affect someone's health and are able to spot if someone is vulnerable to the cold and the risks they are facing.

Able to identify if ventilation is adequate – and know how to put this right if it is not. This includes knowing who to call if there is a problem.

Given accreditation for these skills.

Ensure up‑to‑date information is available in appropriate formats for both practitioners and the public on how cold homes can affect people's health.

Address commonly held misconceptions, for instance, that drinking alcohol can help keep someone warm, that hypothermia is the main health problem caused by the cold, or that sleeping in a cold bedroom is good for your health.

Ensure up‑to‑date details of national and local support is available for both practitioners and the public. This support might include: help to improve the fabric of the housing or the heating system; help to make heating the home more affordable; or general advice on how to keep warm.

Ensure national advice takes into account local and regional variations in the kind of support offered.

Ensure changes to buildings are carried out at least to the standards required by building regulations, in particular with respect to ventilation (see the government's building regulations planning portal).

Use existing powers to identify housing (particularly in the private rented sector) that may expose vulnerable residents (see recommendation 5) to the cold. Existing powers fall under both the housing health and safety rating system and trading standards legislation (in relation to energy performance certificates).

Ensure any relevant problems are addressed.