Reducing Hospital Admissions Through an Effective Health and

Reducing Hospital Admissions Through an Effective Health and Housing Partnership Anees Mank – Oldham Council

Fuel Poverty Definition • Low Income High Costs (LIHC) indicator. • A household is considered to be fuel poor if: – they have required fuel costs that are above average (the national median level); – were they to spend that amount, they would be left with a residual income below the official poverty line. • There are three important elements in determining whether a household is fuel poor: – household income; – household energy requirements; – fuel prices. 2

Warm Homes Oldham Funding • In August 2012, Oldham Council, NHS Oldham Clinical Commissioning Group (CCG) and Oldham Housing Investment Partnership (OHIP) signed the country’s first ‘Joint Investment Agreement’ for £ 300, 000 to help tackle fuel poverty in the borough. • They established the ‘Warm Homes Oldham’ service under which free home assessments, income maximisation and energy efficiency works are delivered across the borough. 3

Warm Homes Oldham Aims • To provide holistic and integrated fuel poverty support through a seamless co-ordination of services. • To enable those who are vulnerable to the negative effects of living in a cold home to maintain their health and wellbeing for as long as possible. 4

Warm Homes Oldham Objectives • • • Reduce fuel poverty. Improve energy efficiency and thermal comfort. Reduce carbon emissions from the domestic sector. Reduce health inequalities. Reduce excess winter deaths. Reduce the number of unplanned hospital admissions and GP visits due to illnesses caused or exacerbated by living in a cold home. 5

Warm Homes Oldham Eligibility • Anyone living in Oldham who is struggling to heat their home can contact Warm Homes Oldham for help – regardless of tenure, age or income. • However, the service cannot fund the larger measures to rented housing, which are referred to the landlord instead. 6

Warm Homes Oldham Home Assessment • Currently, Warm Homes Oldham receives around 100 -200 enquiries per month. These numbers fluctuate depending on the season and what funding for energy efficiency measures is available. • The support offered is based on a comprehensive professional assessment of what needs to change to bring a household out of fuel poverty. 7

Warm Homes Oldham Advice • • • Energy Efficiency Advice – Behaviour Change Energy Tariff Switching Emergency Credit for Energy Benefit Entitlement Check Energy Debt Reduction Water Debt Reduction White Goods (e. g. fridge) Referral to Age UK for minor repairs / adaptations Referral to Fire Service for smoke alarms Referral to Food Bank for food parcels 8

Warm Homes Oldham Measures • • • Draught-proofing LED Light Bulbs Reflective Radiator Foils Emergency Oil Filled Radiators Boiler Replacement Central Heating System Cavity Wall Insulation External Wall Insulation Loft Insulation 9

Sheffield Hallam University Evaluation Monitoring and Survey Data • Collected monitoring data about participating residents, their homes, and the works and advice they received as part of the project. • Asked a series of questions pre- and postintervention about health, wellbeing and energy use. • 427 people in 176 households took part in both waves of the survey – around a third of participants. • The general picture is one of a statistically significant change in almost all key change variables, including improvements in fuel poverty, general health and wellbeing, life satisfaction, and condition of homes. 10

Sheffield Hallam University Evaluation Key findings • It was predicted that three-quarters of participants would move out of fuel poverty as a result of the initiative. • 60 per cent of respondents with a physical health problem felt that the initiative had a positive impact on their health. • Four-fifths reported that the project had a positive impact on their general health and wellbeing. 11

Sheffield Hallam University Evaluation Key findings • Almost all (48 out of 50) of those who self-reported as being at 'high risk' of mental illness on completion of the General Health Questionnaire (GHQ-12) moved to 'low risk' following the initiative. • 96 per cent of respondents agreed that their home was easier to heat as a result of their involvement in the project. • 84 per cent agreed that they now spend less on their heating. 12

Sheffield Hallam University Evaluation Qualitative data • Conducted interviews with 25 residents who had received support through the scheme. • Respondents were largely very positive about the ‘journey’ from contacting the service to the point at which works were completed. • Most respondents reported an improved ability to control the warmth of their home. • Some respondents felt that the support received had led to reduced fuel bills, although others thought that it was too early to tell, or that it was difficult to disentangle other factors. 13

Sheffield Hallam University Evaluation Qualitative data • Around a third of respondents said that the support received had made a big difference to their ability to socialise. For instance, one older respondent had not felt able to invite people into her house during the winter prior to receiving support. The service had made a big difference. Most importantly she was now able to have her grandchildren to visit. • The most common health impacts experienced by respondents were reduced stress levels and improved emotional wellbeing. In some cases this was also linked to improved physical health. 14

Sheffield Hallam University Evaluation Valuing the benefits Direct financial gains for participants Value Energy Efficiency Works £ 133, 632 Energy Tariff Switching £ 22, 925 Warm Homes Discount £ 18, 225 Income Maximisation £ 17, 968 Total £ 192, 750 15

Sheffield Hallam University Evaluation Valuing the benefits Modelled valuations Value Quality Adjusted Life Years (QALYs) £ 793, 000 Extended Life Years £ 399, 000 GDP uplift (higher employment and lower sickness absence) * £ 215, 700 Exchequer saving (reductions in benefit claims) * £ 137, 300 NHS savings (reduced counselling, treatment and medication) * £ 45, 000 * Savings from impact on numbers of individuals with a Common Mental Disorder (CMD). 16

Warm Homes Oldham Achievements in the last five years • Helped 5, 785 people stay warm and well at home. • Brought in over £ 3. 7 million of external grant funding. • Replaced 1, 177 boilers. Insulated 574 cavity walls and lofts, and 257 solid walls – all for free. • Installed 4, 659 small measures for free (draughtproofing, LED light bulbs, reflective radiator foils). • Secured £ 608, 654 of extra benefits for residents who weren’t claiming what they were entitled to. • Secured £ 215, 031 of trust fund grants to wipe off fuel debt or pay for boilers or white goods. • Achieved over £ 350, 000 total savings to household bills for Oldham residents per year. 17

Oldham Latest data Statistic Population Households in Fuel Poverty 2015 2016 232, 724 91, 541 93, 018 11, 032 10, 976 Proportion Households Fuel Poverty Excess Winter Deaths 12. 1% 100 11. 8% 40 18

Excess Winter Deaths Related costs • Roche (2010) estimates for every Excess Winter Death there are eight hospital admissions and 100 GP consultations. • The Department for Health says the average daily cost of a hospital bed is about £ 400. • NHS England says each GP appointment costs an average of £ 30. 19

NICE Guideline NG 6 Excess winter deaths and illness and the health risks associated with cold homes Recommendations: • Provide “a single-point-of-contact health and housing referral service for people living in cold homes”. • Identify people at risk of ill health from living in a cold home. • Assess the heating needs of people who use primary health and home care services. • Provides tailored solutions for them. 20

NICE Guideline NG 6 Excess winter deaths and illness and the health risks associated with cold homes Vulnerable: • People with cardiovascular conditions. • People with respiratory conditions (COPD, asthma). • People with mental health conditions. • People with disabilities. • Older people (65 and older). • Households with young children (0 to school age). • Pregnant women. • People on a low income. 21

Oldham Cares Social Prescribing • By working closely together with GPs, nurses and other health care professionals, patients are now being referred to a range of local, non-clinical services. • To help with poor health linked to housing or housing conditions, referrals are being made to Warm Homes Oldham. 22

Warm Homes Oldham Typical referrals • • Needs help with gas and electric. She has meters for both and has only around £ 1 emergency left. Has 3 children aged 16, 9 and 5. In receipt of Universal Credit and has no money left. Has only £ 3 on gas and electric meters. Has three children aged 4, 6 and 7. Been sanctioned from Universal Credit. States has no electricity at all. Has seven children ages from 15 to 3 years old. Sanctions from Universal Credit. No money for food, gas and electric. No credit on gas meter. Has two children, one is 6 and the other is 3. The 3 year old has health issues, which requires him to be warm. She is 9 weeks pregnant, got no gas and electricity and not had any for a week. She is waiting on her payment of Universal Credit. Urgent! This lady has phoned. She has 10 p left on her electric meter and her gas ran out 3 days ago. She has children. 23

Warm Homes Oldham Typical feedback • • • Very good scheme for poor and low income family. Scheme improves physical and mental health for Oldham people. Scheme is wonderfully brilliant. Grateful for all the help given. It has had a huge impact on my health and well being. Before this, I had no hot water or adequate warmth. I was literally shivering every winter and there were damp areas in the house. Every single day I am extremely thankful for receiving so much comfort in my old age. I really appreciate this scheme. It has increased my and my children's health and wellbeing. We used to be looked down on by other family and friends for not being able to afford any central heating. This scheme has changed their perspective. Oldham Council have done this for us and we appreciate it a lot. Thank you. 24

Warm Homes Oldham Christine’s story • Video: https: //vimeo. com/299026457 25

Warm Homes Oldham Further information • Website: www. warmhomesoldham. org • Evaluation Report: http: //shura. shu. ac. uk/15738/ • E-mail: Anees. Mank@oldham. gov. uk • Twitter: @Anees. Mank 26