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



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


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 (i.e. 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



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 23C - not 21C 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 1C 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



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


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