Warm Homes for Health – Think Piece 3
For all that many of us, and particularly the most vulnerable, spend lots of time in our homes, both policymakers and health professionals appear to rate housing very lowly as a determinant of health. A focus on the biomedical model of health associated lifestyle factors means that it is quite rare for a General Practitioner to identify harmful housing conditions or an NHS manager to factor in poor housing in discharge planning. In 2013 it was identified by Age UK that few of the new health and wellbeing boards had acknowledged excess winter deaths and hospital admissions despite the clear potential for effective action across a number of partners in the new health system. Given the clear and growing evidence for the impact of cold and damp housing and health this must change, not least to ease the steadily growing winter burden on our health service and the looming crisis in social care costs.
Two things are about to happen which will bring the planets into alignment:
The forthcoming new fuel poverty strategy from DECC is the first opportunity for many years for central government to clearly set out a cross-departmental approach to the health impacts of cold homes. No longer should fuel poverty be pigeonholed as merely an energy issue but must also have input from the Department of Health and the disparate organs of the NHS. Local authorities, who now have responsibility for housing, public health, social care and energy conservation, are key to the delivery of any effective strategy.
In 2015 the National Institute for Health and Care Excellence (NICE) will also publish its first guidance on reducing excess winter deaths and illness and this will be strongly focused on tackling cold homes. Health practitioners and researchers should engage fully in this process, coming forward with evidence and their experiences to create clear and compelling guidance. NICE guidance is highly regarded not just in England but across the world and the release of the guidance presents an enormous opportunity.
These are the tools that will soon be available to those of us who battle cold homes every day but more is needed to truly win the war, principally a retrofit programme both ambitious and coherent in scope. We need a national energy efficiency plan, focussed on the fuel poor, which means no vulnerable person has to live in a cold home. That programme should target areas of greatest health need first, amongst both older people and children, in addition to being open to referrals from health professionals on behalf of individual patients. The absurd complexity of current energy efficiency programmes must end and prescription of a warm home for the most vulnerable should be no different from a referral for a hip replacement. A core principle of any programme should be that no vulnerable patient is discharged to a cold home.
It is time that the both practitioners and policymakers in the health and social care sectors stopped regarding housing quality as peripheral to healthy, independent living and started regarding it as central.
John Kolm-Murray is Chair of the NRFC’s Health and Fuel Poverty Working Group, which is bringing together local authorities, charities and health experts to develop recommendations for the NRFC’s campaign for a national energy efficiency infrastructure plan.