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Topic on a Page - Excess Seasonal Deaths & Fuel Poverty

Data Sources:

Excess Winter mortality in England and Wales Statistical bulletins

Public Health Outcomes Framework (PHOF): Fuel Poverty

Older People's Health and Wellbeing

Public Health Profiles

Supporting Information:

Lincolnshire Affordable Warmth Strategy (2010 to 2016)

Local Government Association (LGA):

Climate Ready Councils

National Institute for Care and Health Excellence (NICE):

NICE Pathway: Excess Winter Deaths and illnesses associated with cold homes overview.

Quality Standard: Excess Winter Deaths [QS117] Published: March 2016

Air pollution: outdoor air quality and health [QS181] Published March 2019

NHS England (NHSE):

Severe Weather

Winter health

Department of Energy and Climate Change:

Fuel Poverty Strategy: Cutting the Cost of Keeping Warm Published: March 2015


Clean air strategy 2019

Department of Health and Social Care

How to reduce the risk of seasonal excess deaths systematically in vulnerable older people to impact at population level

Public Health England (PHE):

Local action on Health Inequalities Evidence papers Published: September 2014

Cold Weather Plan for England Published: October 2015

Cold weather plan for England: Research and literature review Published: October 2014

Heatwave plan for England

Keep Warm Keep Well Leaflet

Air pollution: a tool to estimate healthcare costs

Improving outdoor air quality and health: review of interventions Published March 2019

Joseph Rowntree Foundation

Excess Winter Deaths

Kings Fund:

Warmer and Safer Homes

NHS Evidence

Winter deaths

Summer deaths

Air quality and Mortality

Seasonal excess deaths

Pollution and seasonal mortality

Fuel Poverty

World Health Organization:

Making the (Transport, Health and Environment) Link

Met Office

Cold weather and your health

Health: Understanding how human health might be affected by climate change and variability

House of Commons Library Briefing Papers:

NHS Winter Pressures in England 2017/18

Linked Topics:


Topic last reviewed: Apr-18

JSNA Topic: Excess Seasonal Deaths & Fuel Poverty


Groups such as older people, those on low incomes and people in poor health are more likely to be adversely affected by extreme high and low temperatures than others. People in these vulnerable groups may be more sensitive and less able to prepare than other population groups for extreme weather events. There is, therefore, a clear link to reducing inequalities when looking at winter warmth.

Excess seasonal deaths occur mostly in the winter period (December to March) but may also occur in the summer due to excess heat. Heatwaves will be considered further as an extreme weather event in this or another JSNA topic in due course. This topic primarily covers excess seasonal deaths that occur in the winter period - excess winter deaths (EWD) and the contribution fuel poverty makes to those.

  • Excess winter deaths are the number of deaths that occur in the winter period (December to March) less the average number of deaths occurring in the preceding August to November and the following April to July.
  • The excess winter mortality (EWM) index is calculated to enable comparisons between sexes, age groups and regions, and formulated as the number of excess winter deaths divided by the average non-winter deaths.
  • Fuel poverty in England is measured by the low income high costs (LIHC) definition: when a household’s required fuel costs are above the median level; and if they were to spend what is required, then the household would be left with a residual income below the official poverty line.

    The key elements in determining whether a household is fuel poor are:
    • Income
    • Fuel prices
    • Fuel consumption (which is dependent on the dwelling characteristics and the lifestyle of the household).
  • The depth of fuel poverty is also defined for households with low incomes and high costs. This is measured as the difference between a household’s required fuel costs, and what these costs would need to be for them not to be in fuel poverty. This is referred to as the fuel poverty gap, and gives an indication of the severity of the problem for different households. The gap for each household can be summed to produce an aggregate fuel poverty gap, which gives an understanding of the national scale of the problem.

Winter weather has a direct effect on the incidence of: heart attack, stroke, respiratory disease, flu, falls, injuries and hypothermia. Indirect effects include mental health problems such as depression and Seasonal Affective Disorder, and the risk of carbon monoxide poisoning if boilers, cooking and heating appliances are poorly maintained or poorly ventilated (Source: PHE Cold Weather Plan).

The death rate rises by about 2.0% for every degree Celsius drop in the external temperature below 19 degrees Celsius for those in the coldest 10% of homes. For each degree Celsius fall in outdoor temperature, the percentage rise in mortality is greater in those living in cold homes (the rise was about 2.8% per degree Celsius in the coldest 10% of homes and 0.9% in the warmest 10% of homes). Mortality rises at temperatures below 20°C, is fairly constant between 20°C and 28°C, and rises at temperatures above 28°C. (Source: Cold comfort: Joseph Rowntree Foundation (2001)). 'The health impacts of cold homes and fuel poverty' by the Marmot review team, estimated that "excess winter deaths in the colder quarter of housing were almost 3 times as high as in the warmest quarter".

Most excess winter deaths and illnesses are not caused by hypothermia or extremes of cold. Rather, they are usually caused by respiratory and cardiovascular problems during normal winter temperatures – when the mean outdoor temperature drops below 5–8°C (Source: Making the case: Department of Health). The risk of death and illness increases as the temperature falls further. Flu vaccination programmes are influential in reducing deaths – see the JSNA Immunisation topic.

Fuel poverty and social isolation are among the contributing factors to excess winter deaths. Lincolnshire has a low population density and national evidence suggests that most excess winter deaths are amongst older people, especially women, who are socially isolated and live alone. Fuel poverty levels in Lincolnshire at 12.4% in 2015 are above the England estimate (11.0%) but just below the East Midlands figure (12.7%).


National Strategies, Policies & Guidance

There is no specific guidance on excess seasonal deaths; however the Marmot Review supported a systematic multi-agency approach to addressing risk factors associated with cold and high temperatures.

The government Cold Weather Plan helps prevent the major avoidable effects on health during periods of cold weather in England.

The NICE (National Institute of Health and Care Excellence) guideline Excess winter deaths and illness and the health risks associated with cold homes [NG6] makes strategic recommendations on how to reduce the risk of death and ill health associated with living in a cold home.

The government published the first fuel poverty strategy for England in over a decade in 2015 – Cutting the cost of keeping warm.

This strategy is underpinned by the fuel poverty target for as many fuel poor homes as reasonably practicable to achieve an energy efficiency standard of Band C on the Energy Performance Certificate (EPC) scale by 2030 – which became law in December 2014.

There is a further guide to delivering on fuel poverty for public health professionals, Health and Wellbeing Boards and local authorities in England in the UK Health Forum’s ‘Fuel poverty – how to improve health and wellbeing through action on affordable warmth'.

As well as advising people to protect themselves against flu, the NHS continues a general Keep Warm, Keep Well message through its winter health campaign that urges people over 65 or those with long-term health conditions, such as diabetes, stroke, heart disease or respiratory illness, to prepare for winter with advice on how to ward off common illnesses and keep their homes warm.

Local Strategies & Plans

Lincolnshire’s Affordable Warmth Strategy was developed in 2012 with support from the national fuel poverty charity, NEA (National Energy Action) but there have been significant national and local policy changes since then. The Plan is currently being reviewed and plans to republish are described under current activity and services.

Lincolnshire County Council signed up to Climate Local on 12 August 2012. There has been a recent comprehensive risk assessment carried out that will lead to the development of an Adaptation Action Plan to provide a new strategic framework for joint action. Considering the built housing stock the Plan would continue to include a commitment to work with partners to promote energy and resource efficiency, reduce fossil fuel energy dependency – thus helping to alleviate fuel poverty.

Lincolnshire County Council has developed a Winter Health information page for its residents.

What is the picture in Lincolnshire?

What the data is telling us

The standard method of calculating excess winter mortality defines the winter period as December to March and compares the number of deaths that occurred in this winter period with the average number of deaths occurring in the preceding August to November and the following April to July.

The excess winter mortality (EWM) indicator is part of Public Health Outcomes Framework (PHOF) and it is available alongside many other indicators from the Public Health England website (PHOF indicator 4.15).

Key findings:

  • Single year EWM figures for 2015/16 for England were significantly lower than in the previous year: 15.1% compared to 27.7% in 2014/15. In the same period the EWDs in Lincolnshire was 13.1% an equivalent of 329 additional deaths in the winter period.
  • Three year rolling averages are used to smooth the effect of random variation which affects annual EWM figures at a local level. In the 3 year period between August 2013 and July 2016 winter mortality in Lincolnshire was 17.5% higher than in non-winter period. This was very similar to the England figures. Excess winter mortality in Lincolnshire was greater among females (19.3%) than males (15.7%).
  • EWM for people aged 85 and over in Lincolnshire was 24.0% compared to 17.5% for all ages (based on 3 year averages). Differences between age and gender groups in Lincolnshire are not considered statistically significant.
  • Differences in levels of excess winter EWM among the Lincolnshire districts were not considered significant.

Nationally, respiratory disease is one of the leading causes of deaths; it also has the largest seasonal effect of all the causes of mortality investigated by the Office for National Statistics (ONS). Below are some key findings from ONS analysis for England and Wales, the local authority level data by cause of death is not published.

  • Respiratory diseases (ICD-10 codes J00-J99) accounted for over a third of all excess winter deaths in 2015/16 in England and Wales. This cause of death had an EWM index of 41% in 2015/16. This means that there were 41% more deaths from respiratory deaths in the winter months than there were in the non-winter months.
  • Circulatory diseases (ICD-10 codes I00-I99) is also one of the leading causes of deaths, but these numbers remain high throughout the year, so the seasonal effect is not as large as observed with respiratory disease. Nationally, excess winter deaths from circulatory diseases decreased from a EWM index of 23% in 2014/15 to EWM index of 14% in 2015/16.
  • Dementia and Alzheimer’s disease (ICD-10 codes F01, F03 and G30) was the leading cause of death in 2015 and shows seasonality in mortality rates. The disease accounted for 18% of all excess winter deaths (4,300 out of 24,300 excess deaths) and approximately 23% more deaths from dementia and Alzheimer’s disease occurred in winter months than non-winter months.

More information as well as provisional data for 2016/17 can be accessed from the ONS Website.

The fuel poverty indicator is part of Public Health Outcome Framework (PHOF), indicator 1.17:

  • Fuel poverty in Lincolnshire, under the Low Income High Cost (LIHC) definition, was estimated at 12.4% in 2015. It was at a similar level as the East Midlands average (12.7%) and a little above the England rate (11.0%), with some variation between districts.
  • Variation across district and local areas is largely due to hard to heat homes in particular areas such as Lincoln city (14.6%) and Boston (13.9%), and off-gas properties in rural areas. The next highest are the rural, most sparsely populated areas of East Lindsey (12.8%) and West Lindsey (12.7%).

The fuel poverty gap is the amount needed to meet the fuel poverty threshold. In 2015 in England it was estimated at £353 on average, per fuel poor household. No local data can be found on the fuel poverty gap and it will be investigated whether this can be sourced.

(Source: Department for Business, Energy and Industrial Strategy, Fuel Poverty Statistics)

Fuel bills are 'equivalised' by the number of people in the household, rather than the household composition (e.g. lone parent, couples with dependent children). This is to reflect the fact that different sizes of households will have a different required spend on fuel. The Fuel Poverty Statistics Report 2015 shows the retail prices of domestic energy since 2003, and compares these against the prices of a 'typical' basket of goods and services that make up the Consumer Price Index (CPI). 2010 marked the only calendar year that domestic energy prices decreased from the previous year. However from 2011 onwards fuel prices have continued to rise year on year.


The annual number of excess winter deaths (EWD) in Lincolnshire has varied over the last 24 years with no evidence of a clear trend. Further work is needed to understand the relationship between the severity of weather, at whatever time of year it occurs, and mortality.

The Office for National Statistics acknowledges that because the numbers involved are statistically relatively small, they are subject to random fluctuation and there is no consistent pattern across local authorities.

Excess winter mortality is a relative measure; any unusual spike in mortality during the summer months can even out the winter increases. Single year data for 2015/16 shows a decrease compared to the previous year both in Lincolnshire and nationally.

The use of 3 year rolling averages allows smoothing of the effect of random variation which affects annual figures. In recent years, excess winter mortality in Lincolnshire followed a similar pattern to England's figures, staying slightly below the national figures.

The low income, high costs indicator defines fuel poverty as the combination of facing high energy costs and having low income compared to the national median level. Due to the methodology we are unlikely to see significant changes over time. Fuel poverty gap allows measuring how deep in fuel poverty households are. Progressive policies aim to reduce how deep in fuel poverty those on lower incomes are.

In 2015, the proportion of households in fuel poverty in England was estimated at 11.0%. This is a reduction of 0.4% from 2014. At the same time, the average fuel poverty gap in England (estimated at £353 per household) decreased by 5.6% in real terms from 2014 and continues the steady downward trend since 2013. (Lincolnshire data is not available)

Key Inequalities

Excess seasonal deaths can be linked to deprivation, for example: poor housing and low income, access to services and management of long term conditions. Further analysis of Lincolnshire data is needed to understand correlations locally. There is a web based tool called Climate Just that helps map inequalities and demonstrate which different factors contribute to disadvantaged population groups being disproportionately affected in comparison to others. Efforts to address excess winter deaths (EWD) and fuel poverty meet policy objectives in Marmot, in particular to strengthen the role and impact of ill-health prevention.

Whilst in general EWDs are higher in older people, the single year figure for 2015/16 shows that increased mortality affected the youngest age groups; this is associated with the predominant strain of influenza present in winter 2015/16 which had noticeable impact on children and young people. (Source: Public Health England (2016)).

Fuel poverty can affect many groups in society, mostly the elderly but also children who live in cold, damp homes which can cause deterioration in both their health and educational attainment as they may struggle to concentrate in poor environmental conditions.

Department for Business, Energy and Industrial Strategy provides the detailed fuel poverty report at national level. The report identifies household types with increased rates of fuel poverty. Those are:

  • Tenants in privately rented properties
  • Ethnic minorities
  • Single parents with dependent children
  • People who are unemployed or in full time education
  • Households using pre-payment as method of paying for gas and electricity.

(Source: Department for Business, Energy and Industrial Strategy, Fuel Poverty Statistics)

Looking at the proportion of households in fuel poverty, the differences between urban and rural areas are not significant (10.8% and 13.6% respectively). However, there are great inequalities in cost implications: the fuel poverty gap in the rural areas is £726, more than twice the average. This is related to high cost of heating in houses with no grid connection; an average fuel poverty gap in oil heated households was £805 in 2015.

While the inequalities at district level are not very marked, there are small areas in Lincolnshire where over a quarter of households are estimated to be in fuel poverty. Lower Super Output Area (LSOA) fuel poverty data can be accessed at the Lincolnshire Research Observatory website. Measures to tackle the issue need to be effectively targeted to maximise the effect. ONS's Methodology Advisory Service has advised that estimates of fuel poverty at LSOA should be treated with caution. The estimates should only be used to describe general inequalities and identify areas of particularly high or low fuel poverty. They should not be used to identify trends over time within an LSOA or to compare LSOAs with similar fuel poverty levels.

Current Activity & Services

The NHS in Lincolnshire learns from previous winters and puts in place plans to relieve and deal with winter pressures on health care services. Health, social care and community providers respond to both anticipated and unpredicted surges in demand for services. The SRG identifies the shared risks across the health and care system and the joint mitigations in place to reduce risk levels that could lead to excess winter deaths.

Numerous organisations offer services to help reduce incidences of people living in cold homes. The Home Energy Lincs Partnership (HELP) aims to coordinate all energy efficiency advice and schemes across Lincolnshire and better coordination is needed. HELP ran a discount insulation scheme in partnership with the Energy Saving Trust; targeted at the fuel poor through an area based approach of canvassing, in parts of the county with the highest fuel poverty rates. It now operates a collective energy switching scheme to help residents switch to competitive gas and electricity tariffs.

The Lincolnshire Affordable Warmth Strategy was being re-written during 2017 but due to the limited opportunities for action a new approach to completing this needed to be identified. Further work on this was put on hold but the way forward has been agreed and a new action plan is now in development.

HELP is a professional partnership that exists to help shape and inform the agenda going forward. Working together, the partnership allows us to offer a more consistent approach to delivering affordable warmth and domestic energy efficiency to Lincolnshire residents. HELP is the author and coordination vehicle for the Lincolnshire Affordable Warmth Strategy; and works collaboratively to bid for available funding for schemes that can address fuel poverty and energy efficiency to homes in Lincolnshire.

The Housing Health and Care Delivery Group, a sub-group of the Lincolnshire Health and Wellbeing Board supported the HELP proposals to shape the emerging strategy around the following:

  • Implementing appropriate recommendations from NICE Guidance NG6
  • Developing strategic partnership(s) with one or more suppliers or agents with Energy Company Obligation (ECO) funds. ECO is the requirement placed on major energy suppliers by government to introduce schemes to improve energy efficiency of housing, in particular for fuel poor households.
  • Bidding for resources to deliver local health based projects and capital measures (e.g. new heating systems) in people's homes.

Nonetheless, there are some ongoing national and local schemes aimed at tackling fuel poverty:

  • Physical measures to improve energy efficiency can be funded through ECO schemes. However, there are strict eligibility criteria and a householder is often required to part-fund the work which is usually problematic for the fuel poor. In most cases households are left to their own devices to access ECO schemes and can drop out due to the complexities of navigating the system.
  • Lincolnshire County Council received funding from the Department of Energy and Climate Change (DECC) for HELP to develop a scheme for the first time installation of central heating and installed 56 mains gas or oil systems in homes not previously using mains gas to heat their homes in 2017; but the scheme has now come to an end. City of Lincoln Council has recently established a time-limited scheme utilising the Better Care Fund with a similar aim in homes occupied by people with long-term health conditions and disabilities that are adversely affected by the cold.
  • Responders to Warmth (R2W) is a Community Interest Company that provides small measures to mitigate the effect of the cold (e.g. thermal throws, hot water bottles, oil filled radiators) whilst seeking a permanent solution through referral to national energy efficiency schemes supplemented from its own funds provided by Lincolnshire County Council and Lincolnshire Community Foundation and funding sought from other charitable organisations.
  • The Wellbeing Service across Lincolnshire offers short-term generic support to help vulnerable people to live independently. This offers an ideal opportunity to integrate all aspects of climate resilience, emergency preparedness, energy advice, etc. For example, there has been recent work with Western Power Distribution (the electricity Distribution Network Operator (DNO)) in partnership with the Lincolnshire Home Independence Agency; to increase the number of people signing up to its Priority Services Register and further work with DNOs would prove beneficial. Public Health has funded comprehensive energy awareness training to numerous Wellbeing Service staff.
  • For a number of years Community Lincs has been successful in delivering both the Big Energy Saving Network and Energy Best Deal programmes and this continues. They provide basic awareness training to organisations whose staff comes in to contact with people living in cold homes and hold advice sessions for groups. Community Lincs was also successful obtaining funds from the Scottish Power Energy People Trust to establish a Save and Warm project. Financial and energy advice is targeted at families containing children that live in cold homes across East Lindsey and West Lindsey.

Unmet Needs & Gaps

The Home Energy Lincs Partnership (HELP) has been a group predominantly concerned with the Home Energy Conservation Act 1995, a local housing authority (district council) duty. There has been little engagement with other organisations acting to tackle excess seasonal deaths and fuel poverty, in particular Housing Associations and Health. Efforts are being made to identify appropriate representatives.

Action around mobilising schemes to undertake physical improvements in homes has been limited due to national schemes being tailored more to the needs of urban areas. It has been noted that there is disparity in some areas between low fuel poverty levels and high rates of EWD. The data needs more interrogation to explain why this might be the case.

There is an absence of information regarding the composition of households who live in homes that, for example, top down modelling has identified as being susceptible to the health impacts of adverse environmental conditions. The impact on services during extreme weather events such as prolonged cold snaps should also be looked at.

HELP and the Lincolnshire Private Sector Housing Group has recently commissioned a modelled database of housing conditions including energy efficiency and will attempt to do more to model the energy efficiency of the housing stock in Lincolnshire so that this can be overlaid with health profiles and deprivation data for example, to more effectively target advice and schemes. Other target groups or data to be considered as indicators of potential fuel poverty could be:

  • Income deprivation
  • Unemployment
  • Families with preschool age children
  • Older people
  • Disabled people
  • People with long term cold related health conditions
  • Off mains gas homes.

However, the predominant issue is that there are few schemes that provide financial help for low income households struggling to heat their home. Schemes that do exist are not fast track in order to prevent an imminent hospital admission or facilitate hospital discharge.

Park homes are not included in fuel poverty data and in reality are home to some of the most vulnerable people in Lincolnshire, yet are often the least energy efficient properties there are. Issues relate to use of Liquefied Petroleum Gas (LPG) as a heating fuel and occupiers being tied in to electricity contracts through the site owner having control over the choice of supplier and tariff. Gypsies and travellers will also have specific needs. Notwithstanding park homes, caravan dwellers on the East Lindsey coastal strip present a particular challenge in respect of excess seasonal death and illness or resilience during extreme weather events.

Local Views & Insights

Local views have not been sought other than through the JSNA expert panel convened to consider the original topic area, and no direct engagement has been undertaken.

The JSNA expert panel believed that due to climate change rising temperatures might cancel out or become an even bigger issue than winter mortality. It was also noted that excess seasonal deaths cover the winter and summer periods whereas extreme weather can occur outside of these months. NICE did consider the definition of excess winter death when it produced their NG6 guidelines.

Risks of not doing something

Fuel poverty is likely to increase in the current economic climate leading to more households experiencing fuel poverty. Vulnerable people remain at risk from the cold. Vulnerable people's resilience and ability to live independently is compromised.

Hospital admissions can be increased due to underlying conditions such as chronic obstructive pulmonary disease, heart attacks, strokes and falls, which can be exacerbated by the cold.

Age UK has calculated that the estimated cost to the NHS in England arising just from cold homes is around £1.36 billion per year. This incorporates costs of both primary care and treatment. Tackling excess winter deaths would support older people to protect their health and maintain their independence, while having a significant impact on the health budget.

Research nationally has indicated many more deaths could be preventable. Flu vaccination programmes for older people are influential in reducing EWD but the effectiveness of a particular strain of vaccine will contribute towards reducing the annual incidences. ONS analysis 2014 has indicated Dementia and Alzheimer's as further significant causes of Excess Winter Mortalities.

Issues are more likely to go unnoticed where people are not in regular contact with or living in close proximity to others. People who cannot heat their homes properly may become socially isolated, not wishing to invite people in to their homes. A household that cannot afford to heat its home is likely to be under stress, for instance, from being forced to live in a single heated room. Or it may need to choose between heating and food or other commodities or risk falling into debt. These can affect children's educational attainment.

Given that it is estimated that poor insulation results in £1 in every £3 currently spent heating UK homes being wasted; increasing fuel efficiency is a better-targeted public policy measure to tackle fuel poverty than blanket intervention on prices or incomes.

The Chief Medical Officer estimated the annual cost to the NHS of treating winter-related disease due to cold private housing to be £859 million and suggested that each £1 invested in keeping homes warm saved the NHS 42 pence in health costs.

What is coming on the horizon?

The policy landscape to deliver affordable warmth in is continuing to change - with the next iteration of the major source of financial support for fuel poor households, the Energy Company Obligation due to be introduced from September 2018. It is hoped this will continue to include provision for flexible eligibility to enable local authorities to work with energy suppliers and target energy efficiency measures.

New regulations aimed at improving the worst energy performing private rented homes are due to come in to force in 2018. It will become illegal to issue a new tenancy for a home with an EPC rating of F or G and from 2020 all tenancies of homes rated F or G will be banned. However, this is based on the premise that improvements can be funded at no upfront cost to landlords. Consultation is, therefore, underway on introducing a capped financial contribution that landlords would be expected to make. Where landlords do register an exemption to the regulations, local housing authorities are encouraged to revert to enforcing the Housing Health and Safety Rating System (HHSRS) where possible.

The impact of Britain leaving the EU on energy policies and environmental regulations will need to be considered as these implications become apparent.

What should we be doing next?

  • The Home Energy Lincs Partnership (HELP) is to be further developed to become a more strategic group extending to a broader range of organisations with a contribution to make towards tackling excess seasonal deaths and fuel poverty. HELP will assume ownership of this JSNA topic feeding in to the Housing Health and Care Delivery Group.
  • Using the Climate Justwebsite and map tool will enable HELP to make a case for action, including the identification of hotspots of climate disadvantage in Lincolnshire (from overheating, fuel poverty or a combination of these).
  • Work with partners to reduce the level of fuel poverty in the Greater Lincolnshire area through a combination of support to maximise income, improve the energy efficiency of homes and reduce energy consumption through education. The Government's latest Energy Company Obligation is due to commence in September 2018 following a transition period, and it is expected that a new fuel poverty obligation will run for 5 years focusing on heating and insulation measures for households in most need. The existing partnership with ECO providers in North Lincolnshire and North East Lincolnshire is to be extended to cover the entire Greater Lincolnshire area.
  • Following on from this an action plan should be developed based on this case and NICE guidelines and agreement sought from the Health and Wellbeing Board to undertake further work with specific projects to target specific population groups and topic areas covered in this topic.
  • Funding opportunities exist through the National Grid Affordable Warmth Solutions – Warm Homes Fund. Opportunities to deliver a comprehensive, holistic energy advice and improvement service are being explored to form the basis of substantial bid(s) to the Fund for capital measures, emergency measures and a health related project in one or both of September 2018 or February 2019. In the meantime new partnerships are to be developed with Clinical Commissioning Group (CCG) and NHS service providers to establish more effective targeting and outcomes monitoring systems.
  • NICE guidelines note that although lower temperatures have a more significant effect on health, the ill-effects from cold homes are seen when outdoor temperatures drop to around 5–8°C. Periods of temperatures in this range are much more common, and therefore most health problems caused by the cold occur during these periods. The consequences of living in a cold and damp home for long periods need further consideration. It might be possible to better explain the cause of peaks and troughs in EWDs looking at when there were prolonged cold periods, other extreme weather events or strains of flu not effectively vaccinated against. More local data analysis to understand the interrelationship between environmental factors, cold homes, fuel poverty, excess seasonal death and illness is needed to develop well targeted interventions.
  • The NICE guideline NG6 should be put in to practice as far as reasonably practicable, through implementation of specific actions in the emerging new Lincolnshire Affordable Warmth Strategy, coordinated by the Home Energy Lincs Partnership.

The following five key messages are taken from the Local Government Association's 'Reducing harm from cold weather' (November 2013) as recommendations for commissioners in Lincolnshire:

  1. All local authorities, NHS commissioners and their partner organisations should consider the Cold Weather Plan 2013 and satisfy themselves that the suggested actions and the Cold Weather Alert service are understood across their locality. Local cold weather and winter plans should be reviewed in light of this plan.
  2. NHS and local authority commissioners should review or audit the distribution of the Cold Weather Alerts across the local health and social care systems to satisfy themselves that the alerts reach those that need to take appropriate actions, immediately after alerts are issued. Local areas need to adapt these to their particular situations and ensure themselves that the cascades are working appropriately.
  3. Local authority commissioners should assure themselves that organisations and key stakeholders are taking appropriate actions in light of the Cold Weather Alert messages. It is for local areas to amend and adapt this guidance and to clarify procedures for staff and organisations in a way which is appropriate for the local situation. As ever, it is for professionals to use their judgement in any individual situation to ensure that they are doing the best they can for their patient or client.
  4. The community and voluntary sector can help reduce vulnerability and to support the planning and response to cold weather, particularly through identifying and engaging vulnerable people. NHS and local authority commissioners and providers, should take opportunities for closer partnership working with these groups.
  5. Reducing excess winter illness and death is not something that can be tackled in the winter alone. It requires a long-term strategic approach by health and wellbeing boards, directors of public health and commissioners to assess needs and the commissioning, planning and implementation of interventions. Action to reduce cold-related harm should be considered core business by the health and wellbeing board and included in Joint Health and Wellbeing Strategy.


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