A NICE Guideline is not mandatory, but it is pretty firm – it uses the language ‘should’. So its Guideline on how Health and Wellbeing Boards – and indeed health professionals across the board – should deal with excess winter deaths and the issue of winter morbidity is very welcome, and offers encouragement to campaigners who have been looking for a greater focus on this age-old problem.
NICE starts unambiguously by pinning the problem to cold and hard-to-heat homes. And although the level of public concern rises when there is a spell of really cold weather, NICE points out that the health consequences begin to appear in ‘normal’ cold weather – when temperatures fall to six or five degrees (and that happens much more frequently that touching zero or below).
Age UK was very disappointed when the Health and Wellbeing Boards were first being established to see how little winter mortality and morbidity featured in the Joint Strategic Needs Assessments which are a requirement of the new Boards, and how few adopted the matter in their Joint Strategic Plans. Now, NICE is saying that the public health authorities should be considering the issues. It goes further and says that there should be a referral mechanism in every public health authority by which any health professional can refer people whose health appears to be at risk because of living in a cold home to an agency which can provide advice and support. In the best of circumstances, this would be an agency which was able to offer practical help to people to access home improvements, so enabling households to keep adequately warm at an affordable cost.
There are energy efficiency measures offered by the energy companies and by some home improvement agencies, and this is a clear attempt to join up what the health services find when presented with the consequences of cold homes with the rather fitful way these thermal improvements are delivered at present. The new Fuel Poverty Strategy (for England) is still far from robust, but at least takes a baby step in this direction too.
Another NICE recommendation is that people considered vulnerable should not be discharged from hospital treatment into a systemically cold home. This is breathtakingly obvious, but too often not the practice. NICE comments that when these vulnerable people are admitted to hospital, their homes should be assessed for possible improvements, and not left till the point of discharge is imminent. The point is also among the calls Age UK has put to the parties for inclusion in their manifestos.
Every upper tier local authority has a Health and Wellbeing Board and a Director of Public Health. Now, armed with the NICE Guideline, local campaigners have more ammunition to call for action.
Each winter, 1 older person dies every 7 minutes from the cold weather. Many more older people become seriously ill due to living in a cold home. Support our campaign for warm homes