National Institute for Health and Clinical Excellence (NICE)
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‘Hidden army’ could help tackle cold home deaths and illnesses, says NICE

A ‘hidden army’ of heating industry, health and social care professionals could help tackle deaths and illnesses caused by cold homes, says NICE in a new guideline issued yesterday (Thursday 5 March).

The guideline on how to reduce excess winter deaths and illness highlights that there is a huge untapped opportunity to spot and help vulnerable people whose health is at risk because of living in a cold home. Every contact that a vulnerable person has with health and care staff and heating engineers is a chance to improve health and save lives.

There are around 24,000 excess winter deaths each year, and many more people are made ill by living in a home that is too cold.  Importantly, health can be affected when outside temperatures drop to around 6°C. This means people are at risk at normal winter temperatures not just during extremely cold weather.

A key recommendation for helping this ‘army’ of support is having a single-point-of-contact referral system, so that all staff in contact with vulnerable people have a quick and easy way to get help for someone who needs it. People who are worried that their home is cold are also encouraged to get in touch with the single-point-of-contact system for help in making their home warmer.

The European Union classes a comfortable temperature in the home to be 21°C, so a cold home is one where the temperature falls below this level. People who are vulnerable to health problems linked with cold homes are those with cardiovascular or respiratory conditions, babies and children under age 5, people aged over 65, people with mental health conditions or disabilities, pregnant women and people on low incomes.

“Each year in England and Wales there are around 24,000 excess winter deaths.”said Professor Gillian Leng, Deputy Chief Executive of NICE. “Deaths and illnesses linked to living in a cold home are preventable. NICE recommends that health and wellbeing boards should ensure that a single-point-of-contact health and housing referral service is commissioned to help vulnerable people who live in cold homes. Anyone who comes into contact with vulnerable groups should be able to refer people to the service, including health and social care staff, safety services staff and workers from charities and voluntary organisations. Properly using this huge number of contact opportunities can make a big difference in preventing illness and saving lives.”

Professor Leng added: “We must stop the revolving door scenario where people are made ill by living in a cold home, they go into hospital for treatment, but then are discharged back to the cold home which continues to damage their health. What help the person needs should be assessed well before plans are made for discharge so they can get home without delay, and even simple actions like asking someone to switch the heating on before a person returns home can make a difference. This guideline can help break that cycle and instead get support to people whose health is at risk because they live in a cold home.”

 The guideline makes a wide range of recommendations including:

  • Establish a single-point-of-contact health and housing referral service to help vulnerable people who live in cold homes
  • Primary health and home care practitioners should identify people at risk of ill health from living in a cold home, and make every contact count by assessing the heating needs of people who use health and care services
  • Discharge vulnerable people from health or social care settings to a warm home. Assess soon after admission or when planning a booked admission whether the person is likely to be vulnerable to the cold and if action is needed to make their home warm enough for them to return to
  • Provide access to tailored solutions such as housing insulation,  heating improvement programmes and grants, and advice on managing energy effectively in the home and securing the most appropriate fuel tariff and billing system
  • Train heating engineers, meter installers and those providing building insulation to help vulnerable people at home, and to be able to spot if someone is at risk because of a cold home, and know who to call if there is a problem
  • Raise awareness among practitioners and the public about how to keep warm at home, including addressing commonly held misconceptions, such as that drinking alcohol can help keep someone warm, that hypothermia is the main health problem caused by the cold, or that sleeping in a cold bedroom is good for your health.

Dr David Sloan, Co-Chair of the NICE committee which developed the guidance, said: “As a former GP and director of public health, I’ve seen at first hand the effects that living in a cold home can have on a person’s health.  People with respiratory conditions like chronic obstructive pulmonary disease (COPD), heart disease and children with asthma are particularly at risk. So are those in “fuel poverty” who cannot afford to heat their homes adequately but may be reluctant to admit it.

“Doctors, nurses and other health staff prevent and treat illnesses every day but we are suggesting that thinking about the health effects of cold homes is also their business. This new NICE guideline says that health, social care and other professionals should always take a minute to consider the health risk of cold homes when in contact with patients and clients, and know what steps to take to get help to the people who need it. Action on cold homes can prevent early deaths.”

Simon Roberts OBE, Chief Executive of the Centre for Sustainable Energy, and NICE guideline developer said: “Many people will know how miserable it feels when their heating breaks down in winter, even for a few days. The desperation to keep warm, living mostly in one room, not wanting family or friends to visit because of the cold. That’s what it’s like day in day out in winter for the millions in England who struggle every winter to keep their homes warm – because their heating is inadequate, their home is poorly insulated or they are on expensive energy tariffs.  As this NICE guideline makes clear, living in a routinely cold home is bad for your health and wellbeing and makes existing health problems worse.

“The good news is there are simple steps that can be taken to address this, starting with the health service recognising the problem and putting in place systems to refer patients to local initiatives that can help to tackle their cold homes – and thereby reducing the harm done to their health.”

John Kolm-Murray, head of the Seasonal Health and Affordable Warmth Team at Islington Council and NICE guideline developer, said: “Health problems and deaths start to increase when outside temperatures drop to 6°C, so we’re talking about regular winter temperatures, not extremely cold weather with snow and ice. This guideline shows that local areas don’t need to start from scratch – it’s about  stitching together existing services, so that they work together smoothly to help people at risk of health problems because of cold homes.  There is financial help to assist with improvements to make homes warmer and alternative fuel tariffs available but often people don’t know about them. The guideline recommends that vulnerable people are helped to secure this funding and move to a better tariff for their needs.”

Neil Schofield, a member of the Heating and Hotwater Industry Council, said:“Our members include the 150,000 heating engineers who make 8 million home visits each year to install, service and maintain boilers and heating systems. Heating industry staff are seeing people affected by cold homes every day – this is a massive opportunity to identify these vulnerable people and direct them to help, an opportunity which is currently being missed. So we very much welcome this NICE guideline on tackling the excess winter deaths and health risks associated with cold homes.  We encourage heating engineers to think about whether their customers are at risk because of a cold home or poor ventilation, and with the person’s consent, to pass on concerns about vulnerable people to services that can help as NICE recommends.”

Commenting on the NICE guideline, Dr Tim Ballard, Vice-Chair of the RCGP Council said: “The Royal College of General Practitioners understands the importance of tackling health inequalities. There are few better examples of this than addressing the cold damp homes that many in our society live in. Healthcare has an important part to play but this is another example of why integration of services is essential. We welcome this guidance from NICE and look forward to it being a catalyst resulting in some of the most vulnerable in our society having the opportunity for a better quality of life in dryer warmer homes.”

The new guidance on tackling cold homes is available at

For more information call Dr Tonya Gillis at the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

About the guidance

  1. The guidance, ‘Excess winter deaths and morbidity and the health risks associated with cold homes’, will be available at from Thursday 5 March 2015.
  2. NICE public health guidance applies to England and is not mandatory.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

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