Memorandum submitted by Rights to Warmth
(FP 45)
EXECUTIVE SUMMARY
Rights to Warmth was founded to address the
problem of low take-up of the whole raft of energy
support programmes, including both investment in
energy efficiency in homes and financial benefit to enable people
to afford heating. The issue dwarfs road deaths and injuries.
Until the health service is fully engaged in making warmth a priority
for everyone, as a nation we will neither address the impact of
cold on health nor achieve the necessary improvement in energy
use.
From its inception in 2007, supported by Age
UK Group and Attend, Rights to Warmth has undertaken both formal
research (with the support of the Wolfson Research Institute at
Durham University, the Kings Fund and Royal Society of Medicine),
and a range of social marketing programmes in Co Durham funded
by the PCT as part of the Co Durham Rights to Warmth Partnership.
Our evidence to the Committee is thus both evidence and practically
based.
It is important that all initiatives to alleviate
fuel poverty address an important cultural issue: it is part of
our culture to believe that cold can be endured. People do not
understand the importance for their health that they keep warm.
Furthermore, they distrust the commercial motives of suppliers
and are reluctant to engage with state support that they perceive
to be bureaucratic—a significant proportion of those affected
are first generation home owners whose aspiration has always be
to maintain their independence.
Public policy must therefore address three issues:
1. attitudes towards cold and the essential need
for heating to maintain health and wellbeing;
2. investment in homes, particularly those which
are hard to heat; and
3. access to both social tariffs and benefit
support to support those on low income.
Fundamental change is needed in the delivery
mechanism of national programmes to improve energy efficiency
of homes and to address energy poverty. In particular, the involvement
of doctors in picking up when cold living conditions are contributing
to poor health is important, together with referrals to appropriate
agencies. Focus on a local community basis is also vital, so that
people heed the warning in their own homes, where the problem
begins, to keep themselves properly warm and to use the support
available to do so.
We propose the following specific changes should
be made to government policy:
— The focus should be a health-related
marketing programme to encourage people to ensure that their homes
are properly warm.
— There should be a strategic engagement
from the Department of Health and the NHS to identify those who
are putting their health at risk through living in cold conditions,
and creating an appropriate treatment pathway, including referral
to trusted community agencies.
— Eligibility criteria for social tariffs,
energy efficiency measures and the priority services register
should be expanded beyond the passport benefits to include long-term
health conditions.
— More direct targeting mechanisms are
needed, such as a trusted party asking whether a person felt cold
in their home all or most of the previous winter. Targeting homes
with a poor SAP rating (ie with low energy efficiency) where these
can be identified effectively would be another more direct approach.
1. The impact of cold homes on health
1.1 Whilst the Government's original 2001
fuel policy strategy paper placed a great deal of emphasis on
the impact of fuel poverty on the health of affected households,
the emphasis of most of the subsequent initiatives have been concerned
with energy efficiency, and the health dimension either sidelined
or discounted from support programmes altogether.
1.2 We believe this is wrong, for two important
reasons:
— The problem of excess winter deaths masks
the bigger problem of excess winter illness. The Department for
Health estimate that for every excess winter death, there are
eight emergency admissions associated with the cold. In the current
winter, 40,000 excess winter deaths would generate around 320,000
emergency admissions, prompted by the cold. In addition, many
people will visit their doctors because their symptoms have got
worse. The cost to the NHS is both high and avoidable. The problem
needs the engagement of the Department of Health and the NHS in
order to diagnose those who are at risk and provide them with
both information and signposting to where they can get help.
— Prevailing attitudes towards heating
treat it as discretionary and not fundamental to health and well
being. Certainly made significantly more problematic by low income,
the motivation of both those on low income who struggle to pay
their energy bills, and those who could pay but see heating as
a balancing element on their budget, actually ration their use
of heating for that reason.
1.3 It is important also to understand that
the problem of inadequate heating is not only one of lack of means.
There is a cultural dimension to the problem. This is why studies
have failed to find a statistically valid correlation between
excess winter deaths and socio-economic status. There is a tendency
in this country not to take cold weather seriously—to think
it is something that can be endured, and that it is extravagant
and self-indulgent to heat our homes adequately (there is also
a tendency not to wear warm enough clothes when going outside).
Of course, this is not a universal attitude, but is common amongst
those who find it difficult to afford more heat, and is a way
of preserving dignity in the face of hardship.
1.4 We believe that so strong are these
motivations that they deflect any interest in carbon savings.
Moreover this problem has been exacerbated by inappropriate marketing
and channelling of carbon saving initiatives. People tend to be
highly resistant to being sold to and are particularly suspicious
of perceived commercially motivated offers from energy companies
in reducing energy use.
1.5 Therefore, most conventional approaches
to them are not couched in terms that are likely to generate their
interest However, they are interested in maintaining their health
and independence, and are also likely to trust the health professionals.
Understanding how the cold can undermine health, and referral
by trusted parties to agencies who can provide support in helping
to make the appropriate level of heating affordable, are both
crucial in improving take-up.
1.6 We are therefore pleased to see some
increase in engagement by the Department of Health. The South
East Regional Public Health Group updated its Health and winter
warmth factsheet in December 2009, providing a great deal
of information and research on the issue.
1.7 In contrast, we find it both extraordinary
but symptomatic of the marginal engagement of healthy programmes
that the recently published Marmot report on health inequalities
does not feature cold homes as a contributor to the problem of
health inequality. We believe that in fact it is a major contributor.
1.8 However, even if this view was more
mainstream, it is a big step from understanding at the central
level that there is a problem to putting in place steps to indentify
the individuals affected and create an appropriate pathway both
to ensure effective treatment (recognising that cold is a contributory
factor in the primary condition) and that the patient is referred
to an agency that can help them effectively.
1.9 We are also aware that some PCTs and
other health trusts are beginning to demonstrate an understanding
of the impact of cold health on health—indeed, much of our
work has been funded by a PCT. But there is only a limited strategic
recognition across the NHS of the impact of cold as a discrete
contributor to illness.
2. Attitude and behaviour survey
2.1 We surveyed 257 older people in County
Durham, and found that:
— nearly a quarter of older people felt
cold all or most of the time the previous winter;
— 35% of older people turned their heating
down or off, or failed to use heating appliances, when it was
cold outside;
— overall, older people were unlikely to
accept advice from energy suppliers and or local authorities—their
preferred sources of advice were from their GP, practice nurses,
or trusted charities such as CAB or Age Concern Help the Aged;
— they also generally believe they are
doing all they can to stay warm; and
— although older people with long term
conditions were likely to say that the cold made their symptoms
worse, there did not appear to be a recognition that the cold
was likely to undermine their health in a more permanent way.
2.2 It is clear from our survey that people
tend to use their energy usage as a form of household budgeting.
It is because of this that 35% turn their heating down when it
gets cold although most common amongst those with pre-payment
meters, it is also prevalent amongst those who pay by quarterly
bill. For both of these sets of people, there is a need for a
way of evening out the cost of heating over the year. Of course,
this is achieved for those who pay by monthly direct debit It
is precisely those who are most concerned about budgeting who
do not pay by this method.
3. Definition of fuel poverty
3.1 Irrespective of the definition, the
use of the term "fuel poverty" is unhelpful. People
do not consider themselves to be in "poverty", whether
of fuel or otherwise, and will shy away from anything that calls
them "poor". With over 70% of people owning their own
homes, to be asked to respond to "fuel poverty" initiatives
can be seen as an admission of failure. The term should never
be used in anything that goes directly to people.
3.2 The definition is unhelpful in another
way, too. It is at best an academic definition, but is not very
useful as a practical definition as it does not translate into
an understanding whether someone is in fuel poverty or not. This
results in the poor targeting of those in fuel poverty.
3.3 We do not want to comment on the minutae
of whether the definition should be basic or full income. However,
there is an anomaly in the UK. In Scotland, the definition of
fuel poverty considers the cost of heating as that required to
keep the living room at 23°C—not 21°C as in England.
It is not clear to us why this is, but it does suggest that there
is a weakness in the underlying research. It seems likely that
the best temperature (although this will vary for individuals)
may depend on the ages of those in the household, and should be
higher for the very old, and also for those who are sedentary
or who have a long-term condition. Although the basic research
needs to be done, there is a case for consideration of raising
the guideline temperature by at least -1°C for each decade
over 70.
4. Coherence of government initiatives
4.1 Warm Front is a good initiative, although
it is poorly targeted (see next section), and it is difficult
for many people to find out about it—especially in rural
areas. It also fails to address adequately the problems in increasing
the energy efficiency of rural homes, which tend to be older,
larger and harder to treat than average.
4.2 The suppliers also have obligations
to provide energy efficiency measures under CERT. The problem
is that many people do not understand why suppliers would offer
things that would reduce the amount they sell. Because suppliers
are a potential source of funding for fuel poverty initiatives,
many of these are branded by suppliers—this makes the initiatives
less successful.
4.3 Local authorities also have statutory
responsibilities for reducing carbon emissions in their areas,
and this can lead to further schemes aiming to help people improve
the energy efficiency of their homes. All these different schemes
have a diversity of brands, eligibility criteria, agencies involved,
and measures that can be funded, which people can find confusing.
4.4 On the other hand, because the definition
of fuel poverty is unsuited to practical application and leads
to poor targeting, the diversity of criteria can be a good thing,
since people who are ineligible under one set of criteria may
be eligible under another.
4.5 An overall concern is that the initiatives
and core fuel poverty model have forgotten the people—changing
attitudes and behaviours needs to be a core part of the government's
initiatives. Furthermore, the initiatives are input-focussed,
not outcomes oriented. Policy development has forgotten the impact
on health and education. Initiatives are either benefit-or environment-driven.
And it is not enough to provide measures unless attitudes and
behaviours change, too.
5. Targeting
5.1 Warm Front and other schemes are poorly
targeted, as the National Audit Office report last year made clear
As argued above, one reason for this is the definition of fuel
poverty itself. Another significant part of the problem is that
many of those who would be eligible do not claim the benefits
that would entitle them to the help.
5.2 We think that targeting should be based
on two distinct principles. First, those who live in homes which
are energy inefficient should be encouraged to upgrade them as
much as possible. This should be through tax breaks, or grants
for those who have no capital.
5.3 Secondly, those whose health is vulnerable
should be helped. We think that eligibility should be extended
to include those who have a long-term health condition that is
exacerbated by living in cold conditions. It is particularly important
that people with heart and respiratory system conditions are able
to keep themselves warm. There is a case for providing such people
with subsidised energy until such time as energy efficiency measures
are actually installed—this can prevent a health crisis
which would impose higher costs on the NHS.
6. Social tariffs
6.1 Although social tariffs can make a useful
contribution to helping make heating affordable for individuals,
we are uneasy about increasing the obligations of suppliers. This
is because so many people struggle to pay their for their energy,
even if they do not fall within the definition of fuel poverty,
that increasing their energy prices to support those who may not
be very much worse off than themselves seems unfair. One way this
could be done more fairly would be to impose a "tax"
on those who use a lot of energy—and to use this as the
fund from which to support social tariffs. This would need to
be mandated as the competitive market would not support such a
mechanism, but would mean that different suppliers would generate
different proportions of their revenue, as they would have a different
mix of customers.
6.2 There are, however, other roles for
suppliers which would not depend on such a mechanism. For example,
it would be really useful if energy suppliers could be mandated
to develop tariffs which spread costs out more evenly over the
year, even though usage is concentrated in the winter. This needs
to be done without a high profit being added. We recognise that
suppliers already have stamp schemes that enable people to save
for future consumption, but these are not widely publicised and
do not meet most people's needs.
6.3 Associated with this problem is the
fact that where prepayment meters are loaded to recover debt,
the winter problem becomes even worse; consideration should be
given to recovering debt through the summer only (possibly through
daily, not energy charges).
6.4 Another associated problem is that social
tariffs are not available to those who are dependent on oil central
heating.
7. Winter fuel payments and cold weather
payments
7.1 Given the importance of enabling people
to budget their winter energy payments, we support the continuation
of the winter fuel allowance. However, there may be merit in considering
how to pay it in such a way that it can most usefully be applied
to heating. For example, it could be paid on a weekly or monthly
basis over the heating season. This, though would not help those
who pay by quarterly bill. One way of addressing this might be
for suppliers to offer a discount on energy charges to those who
pay their £250 up front when they receive it.
7.2 The problem with cold weather payments
is that is they are not easily predicable, and do not help those
who depend on prepayment meters because the cash is not available
to help when the weather is actually cold and the extra heat is
needed. Overall, it is unlikely that they encourage people to
use extra heating.
8. Conclusions and Recommendations
8.1 The evidence from the RtW research and
social marketing programmes has demonstrated that if this problem
is to be addressed four key factors need to brought together,
nationally and locally.
1. Challenging prevailing attitudes in the
UK towards the cold that it is something that can, if necessary,
be endured without damage to health and well being.
Practical Step 1. People should be made
aware that minimum recommended temperatures are just that—a
minimum, and that if they are old or have specific health problems
they may well need to maintain higher temperatures GP's need to
advise their vulnerable patients.
2. Enabling people to be aware of actual
home and external temperatures and to adjust their responses accordingly.
Practical Step 2. GP's should provide
vulnerable people with two thermometers (one for the living room,
and another for the bedroom) so that they can monitor their own
homes and make sure they are using sufficient heating to stay
properly warm.
3. Targeting support programmes on the premise
that being enabled to stay properly warm is an essential pre-requisite
to maintaining health, well being and independence.
Practical Step 3. GP's should check with
each of their old and vulnerable patients what steps they are
taking to keep warm and to prompt them for their health and independence
sake to take the support available to help them do so.
4. Marketing energy efficiency programmes
on the premise that maximising of fuel efficiency at home is the
responsible response to reducing the risk of loss of independence
through damage to health, mitigating rises in long term fuel bills,
and also to tackling climate change.
Practical Step 4. Promote these programmes
through trusted local community agencies, who can keep a look
out for vulnerable people. Once people understand the importance
to their health and independence of keeping properly warm, they
will be more likely to apply for the support that they may be
entitled to.
February 2010
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