Memorandum submitted by the County Durham Healthy Homes Partnership (FP43)
The County Durham Healthy Homes Partnership has been established to co-ordinate the work of key organisations and services that have within their remit the potential ability to tackle fuel poverty, Excess Winter Deaths (EWD) and cold-related illness. Key agencies involved are NHS County Durham, Durham County Council, Energy Saving Trust, Durham and Darlington Fire and Rescue Service and Age Concern. The following information, viewpoints and evidence summarise key findings of the above partnership over the last two to three years. Note: prior to January 2010, the County Durham Healthy Homes Partnership was known as the County Durham Rights to Warmth Partnership.
The impact of fuel poverty on health, and a need to target those most at risk in terms of EWD and cold-related illness.
In 2008 the County Durham Rights to Warmth Partnership commissioned the North East Public Health Observatory (NEPHO) to undertake a baseline review of the extent of excess winter deaths (EWD) and hospital admission rates for County Durham residents.
The baseline review found that excess winter deaths have been consistently higher in County Durham than regional figures, except in 2003/04, culminating in a large difference in 2005/06. See figure 1 below. As well as variation in EWD over time, the report also found considerable variation between the districts of County Durham and that the over-85 age group were most at risk of dying in winter compared to other age groups.
In looking at hospital admission rates for heart disease, chronic obstructive pulmonary disease (COPD), diabetes and dementia, the report found that although County Durham had lower emergency admission rates regionally, they were higher than national figures. Emergency rates were also found to be increasing in County Durham for all the above conditions. COPD had the highest re-admission and multiple admission rates compared to the other conditions.
There is recognition that fuel poverty is a significant issue for residents of County Durham, and that tackling the problem can only be done through partnership working. This is why the National Indicator 187 (fuel poverty) is included in the County Durham LAA. Also included is NI 186 (reducing carbon emissions), which will contribute to alleviating fuel poverty through promoting domestic energy efficiency measures.
Fuel poverty and excess winter deaths also feature in the 2008/09 County Durham JSNA. The JSNA provides a detailed picture of the health and wellbeing needs of the residents of County Durham, in order to inform priority setting processes of key strategies such as the Sustainable Community Strategy. Excess Winter Deaths are highlighted in the assessment as being a complex problem in the county, with considerable variation in rates between urban and rural areas.
Our experiences with WarmFront and a need to provide more immediate help for particularly vulnerable people (the elderly, those living with long-term health conditions, etc.).
Early in 2008, the Rights to Warmth Partnership launched County Durham Hotspots. Hotspot is a simplified multi-agency referral mechanism that links together a wide range of existing services via the Energy Saving Trust advice centre. Any person referred via Hotspots can receive the following service as appropriate:
· A home energy check and advice on keeping warm
· Referral onto home heating and insulation schemes such as WarmFront
· A benefit entitlement check by Welfare Rights
· A home fire safety check by the fire service
· Access to the Emergency Fund if necessary
· Referral onto other existing services
Furthermore, the Hotspots referral scheme is able to target vulnerable and hard-to-reach residents by working with health and social care practitioners, or any agency that has face-to-face contact with elderly people or vulnerable families in their homes. Simple training sessions are delivered to teams of staff on how to use the Hotspots referral card, which is then completed by the health practitioner on behalf of the client and sent via freepost to the Energy Saving Trust. An advisor will then call back the client and take them through standard questions in order to provide advice or refer on to an appropriate service.
As mentioned above, one of the key services that vulnerable residents are referred to via Hotspots is WarmFront. Although WarmFront clearly offers a lifeline for households in need of support to keep warm and healthy, there are major weaknesses in the system where our most vulnerable residents are concerned. The partnership has encountered countless cases of people in old age and/or suffering from long-term illnesses, often devastating conditions, who have been left for months on end with no heating or hot water. There is simply no scope to fast track these people, despite the best efforts of all agencies making the referrals. Below is a case study, highlighting the issues raised above:
Mrs 'V' wrote a letter to her MP in January 2010 complaining about the length of time her mother had to wait for her WarmFront grant. Her mother is 80 years old and suffers heart and respiratory conditions, dementia and has mobility problems due to a broken hip. After her boiler broke down in August 2009, a WarmFront grant application was made. Fast forward to December 09, and the boiler broke down completely and hot water was lost altogether. Despite efforts from other agencies, the case could not be progressed as urgent.
Mrs V wrote, 'due to the seriousness of this situation and the total lack of confidence in WarmFront, I had to make the decision to have an installer replace my mother's boiler as a matter of urgency so that she could keep living in her home as the only other option by Social Care was temporary respite care... During one of my phone calls with WarmFront I was actually advised that due to the length of time it takes to progress these grants, a lot of people actually withdraw from the grant.'
Recent changes to WarmFront will perhaps shorten the length of time general applications take. However, there needs to be put in place a fast track process for urgent cases such as the one above where a client's health is being seriously compromised by a lack of adequate heating. The Healthy Homes Partnership has an 'emergency fund' for vulnerable residents of County Durham, provided by NHS County Durham. The fund is currently being used to address the time delay of WarmFront applications and provide immediate help for those over 75 and suffering long-term health conditions.
Rising fuel prices can outweigh any impact of increasing incomes and energy efficiency.
The above statement is one of the conclusions drawn in the 2009 Annual Report on Fuel Poverty Statistics published by DECC, and an issue our partnership is looking to address. In May 2009, the Rights to Warmth Partnership welcomed a GP from the Durham Dales PBC Cluster to join the steering group. The GP is leading a Fuel Poverty workstream of the Durham Dales ICO (Integrated Care Organisation) pilot which is one of 16 two-year pilot ICOs across the country and aims to bring together all key health and social cares services, with GP patient registers providing the focus of all targeted activity. As part of the workstream, the partnership is about to trial 'energy on prescription' where a selected group of 80+ year olds, with long-term health conditions, will have their winter fuel bills paid for. In working with GP practices, any health benefits of this trial can be closely monitored.
There is perhaps a need to further investigate the true impact of rising fuel prices on vulnerable households. The majority of schemes that aim to alleviate fuel poverty are addressing the energy efficiency of the home/heating system or maximising uptake of benefits. If a vulnerable household cannot afford to turn their heating on, having an energy efficient property with the latest energy efficient boiler will still not enable them to stay warm.
The challenges of rural fuel poverty.
It is well acknowledged that fuel poverty is exacerbated in rural areas due to the high number of hard-to-treat properties, namely off-mains gas and solid-walled homes. Salaries also tend to be lower than average and communities/individuals can be geographically isolated. County Durham has a large rural population, but the vast majority of support via WarmFront has been in urban areas. Treating rural properties is very expensive, but that should not mean that they are ignored. Additional funding and targets for rural areas could encourage schemes like WarmFront to address these issues. To date, around £44,000 emergency fund has helped residents in rural areas of County Durham but this will have only helped a fraction of the people who need it.
Helping 'hard to reach' minority groups such as Gypsy and Traveller Communities
Gypsies and Travellers are one of the largest ethnic minority groups in County Durham and there are currently six accommodation sites provided by Durham County Council. The nature of Gypsy/Traveller's lifestyles can mean that access to health, or other services can be very difficult across all age groups. The Healthy Homes Partnership has been approached by the Travellers Liaison Service asking for support to ensure these vulnerable families are able to keep warm and healthy. This has proved rather difficult.
Although referral to relevant services can be provided through training the Traveller Liaison Officers, providing financial support to, say, insulate a caravan is difficult. There is a lack of available information on what can and can't be done to keep caravans insulated or heated adequately and safely. The Healthy Homes Partnership has put the issue of funding on hold until more information is available. It would be useful to learn if other areas with Gypsy/Traveller populations have trialled any measures with success.