A simple question Dr Sarah Machale Crocus Medical

A simple question? Dr Sarah Machale – Crocus Medical Practice, Saffron Walden Kate Robson – Citizens Advice

Winter 2017 in the NHS Winter in the NHS

Cold Weather and Health • There is a strong evidence base on the risk to health from cold weather • The effects are predictable and largely preventable

£ 1. 36 Billion a Year (Age UK) Cost to the NHS of Cold Homes In 2014/15 43, 900 Excess Winter Deaths (EWDs) in England Wales were attributable to fuel poverty and cold homes. For Every For every EWD there are an estimated 8 also 100 extra hospital GP admissions (or consultations 10% of (Roche, 2010 Hospital UK Health admissions) Forum). That’s 439, 000 extra GP consultations each winter attributable to fuel poverty and cold homes

Excess winter deaths in the UK are higher than in Finland

HSE: Cold Homes is the 2 nd biggest Health Hazard in the UK

EXCESS WINTER DEATHS, HOSPITAL ADMISSIONS AND GP CONSULTATIONS of these 40% Cardiovascular 33% Respiratory Health impacts of cold homes MENTAL HEALTH 4 x more likely The Health Effects of Cold Homes In all ages CHILDREN Asthma risk doubles Mental health problems X 4 Respiratory illnesses 1. 5 -3 X Low weight gain in babies Estimated to cause 10 -11% falls

How Indoor Temperature affects health

Fuel Poverty is associated with increased mental problems

Fuel Poverty in West Essex

Most energy inefficient homes are owner occupied

NICE guidelines March 2015

Pregnant women People on a low income People who move in and out of homelessness People with addictions People who have attended hospital due to a fall Recent immigrants and asylum seekers People with cardiovascular conditions People with respiratory conditions (in particular, chronic obstructive pulmonary disease (COPD) and childhood asthma) People with mental health conditions People with disabilities Older people (65 years +) Young children (under 5)

Is your home warm?

Primary Care Think about your high risk patients How do we make every contact count? Add it to templates in chronic disease clinics and frailty reviews Ask “Are you finding it hard to keep your home warm? ” Refer for warmer homes support CCG Involve Community Services, Mental Health Services, Care of the Elderly and Falls services

Learning from the Warm Homes Oldham Evaluation Report 2015 Recommended that they needed to: • Increase the number of referrals directly from Health Organisations (which were very low) • Refer more individuals to the Citizens Advice for income maximisation (of 102 benefits checks undertaken 33 individuals secured additional income with the average household income increase equating to £ 3040. 55 a year)

Reduced GP consultations, Reduced out-of-hours calls Reduced attendances at walk-in centres Potential savings to NHS of implementing NICE 2015 guidelines on cold homes Reduced district nurse visits Reduced drug prescriptions. Reduced emergency department visits. Reduced inpatient admissions. Reduced social care service costs. Reduced excess winter deaths

What can be done. . . Warmer Homes Initiatives? Take actions to reduce energy costs – for example; find a better energy tariff; apply for a warm homes discount; identify grants to improve energy efficiency in the home. Take action to increase income – ensure that people are claiming everything they are entitled to - like pension credit, non-means tested disability benefits, ensure people are supported with benefit appeals if appropriate. Deal with debt and utility bill problems – look at practical steps to manage or write-off debt. Deal with housing issues – support people to find handyman services, support relationships with landlords in terms of repairs and heating issues, start a discussion about moving to more suitable housing.

How to refer?

Conclusions 01 02 03 Identify patients at risk Make every contact count Refer directly

And next winter….