Investing to support people with health conditions and improving their wellbeing and financial security
One of the government’s first acts on taking the keys to Downing Street was the removal of Winter Fuel Payments for all pensioners.
Here, our Deputy Director for Homes at the Centre for Ageing Better, Holly Holder, outlines how local NHS commissioners are increasing their interventions to limit the health impacts of cold homes.
Earlier this year, the government announced that it would restrict Winter Fuel Payments to the small minority of pensioners who are in receipt of qualifying means-tested benefit such as Pension Credit, Universal Credit or Income Support.
It means that, in the case of Pension Credit, only pensioners with incomes of less than £218.15 per week, or less than £332.95 as a joint weekly income with a partner, will now receive the £200-£300 annual payment towards their heating bills.
The logic of this decision may appear sound – the government is trying to reduce spending and so it is focusing its support on those who need it the most. There are, however, two main flaws.
First, in order to qualify for the Winter Fuel Payment, older people need to be receiving a benefit, but in the case of Pension Credit and we know that one third of eligible people are not claiming it. The previous design of universal access sidestepped this problem.
Secondly, it assumes that only people with extremely low incomes need support to pay their energy bills. But the threshold of Pension Credit was selected for administrative ease, not because it marked the threshold of need.
In reality, the pool of people struggling to heat their homes is much wider and so the government’s estimates for how much money this decision will save ignores the fact that older people’s health is at risk of deteriorating, in turn creating greater demand for the NHS which is, of course, paid from the public purse.
This reality has not been overlooked, however, by some local NHS systems who increasingly exploring their role in creating safe homes for people with certain health conditions.
Cold homes can cause or exacerbate a number of serious and common health conditions, particularly prevalent among older people who are likely to spend longer at home and may be less mobile. For people with an existing heart condition, cold temperatures can cause high blood pressure, strokes and heart attacks.
Cold air can also inflame the lungs, worsening chronic obstructive pulmonary disease (COPD). Damp and mould – which is often found in cold homes – also causes asthma and other respiratory conditions. Mental health conditions, injuries and falls are also linked to low indoor temperatures.
It is difficult to quantify the exact number of people whose homes negatively affect their health but nearly eight million people live in a property that falls below the nationally set minimum criteria for decency. Around a third of these households have been specifically categorised as lacking sufficient thermal comfort. Many more people live in homes that sit just above this threshold, homes that could also pose a significant risk to people’s health.
These are largely avoidable housing issues and ones that can have life-changing consequences for older people. They also translate into an avoidable burden on the NHS and social care systems in the form of GP appointments, surgery, delayed discharges, rehabilitation provision, medication, etc.
Estimates suggest that the cost of unsafe homes to the NHS is £1.1 billion per year and a further £1.1 billion in formal social care costs. The equivalent of £3.5 billion in unpaid social care is also provided by partners, family and friends as a result of these homes. These are substantial figures at a time of significant pressure on government spending.
In some regions of the country, Integrated Care Systems (local NHS and social care commissioners and providers) are turning their attention to housing. One such example is the West Yorkshire Health and Care Partnership who invested £1 million to support people with certain health conditions (e.g. asthma) who were at risk of fuel poverty and living in cold homes.
Unlike the government’s new criteria for the Winter Fuel Payment, which is based solely on income, the definition of fuel poverty also takes account of the energy efficiency of a property and the cost of energy prices.
The initiative in West Yorkshire resulted in NHS funding being invested in fixing boilers, carrying out home repairs, installing energy efficiency measures and appliances, providing information and advice and directly paying for fuel. Support was targeted at individuals and families who had one or more of the health conditions most affected by cold and damp.
The Centre for Ageing Better co-funded an independent evaluation of the programme with the West Yorkshire Health and Care Partnership. The evaluation found that the initiative had led to improvements to residents’ health, wellbeing and financial security. It also created greater collaboration between the health, care and housing sectors and the establishment of new referral routes to identify those most at risk. Other evaluations of similar programmes have come to similar conclusions.
With local authority budgets stretched beyond breaking point, it cannot be assumed that they are able to support the housing needs of all their residents. Other Integrated Care Systems should reach out to their local housing partners and consider implementing programmes similar to those in West Yorkshire.
Integrated Care Systems should be directed by NHS England and the Local Government Association to involve local authority housing teams as members of the Integrated Care Partnership or relevant sub-committees to contribute to strategic decisions and the design of services.
Locally, health, care and housing teams should come together to design cross-sector initiatives that serve their mutual interests. Key lessons from past schemes include the need for flexible funding, adapt existing services, set clear objectives, focus on building professional partnerships and provide a combination of long and short-term interventions.
We have a number of simultaneous housing crises in this country, with the impact of poor-quality housing on our nation’s health probably the one that receives the least attention.
In the long-term to tackle this issue, we need to ensure that no one lives in a poor-quality home that poses a risk to their health. Which is why the Centre for Ageing Better launched the Safe Homes Now campaign this year with nine other charities and organisations, including St John Ambulance, Race Equality Foundation and The Runnymede Trust, calling on the government to halve the number of dangerous homes over the next decade.
To do this we need a national strategy to tackle poor quality housing and local services and a national network of local one-stop shops offering advice and support for home repair and adaptations, a model we call Good Home Hubs.
Doing this would remove the need for the temporary stop-gap measures, such as Winter Fuel Payments, which are not a long-term or sustainable solution.
But in the meantime, we need a greater appreciation that good homes are key to good health and that improving the quality of homes is a preventative health measure. A warm home is as important as the right medicine in the pursuit of good health.
