Minor home repairs bring major benefits to health
This article was originally published on the HSJ website
Around 9,000 people died during the winter of 2014-15 as a result of living in a cold home. These figures, from a study by University College London, show that one fifth of the 43,900 excess winter deaths were caused by health conditions brought on or exacerbated by fuel poverty.
The risks of cold weather to health are well known. Recent research by the University of Bristol, University College London and the British Heart Foundation found that cold snaps double the risk of a major cardiovascular event. Numerous studies have shown that levels of influenza also rise in the winter, along with respiratory diseases, dementia and increased blood pressure.
Tackling the health consequences of low indoor temperatures is something that Sheffield Hallam University’s Centre for Regional, Economic and Social Research (CRESR) has been investigating. Our aim is to assess simple, low cost ways to help vulnerable people stay warm in their homes; measures that could be adopted at scale across different heath economies.
We evaluated energy efficiency improvements made to the homes of 4,000 vulnerable people in 2016 by housing charity, Foundations Independent Living Trust (FILT). The ‘Warm at Home’ programme provided £637,000 to pay for thousands of repairs, from fitting reflector radiator panels and replacing boilers to draught-proofing windows.
Our evaluation showed that these minor repairs had a sizeable impact on health, wellbeing and likely admission avoidance. Results indicated that the programme led to an additional 121.8 QALYs (quality-adjusted life years). Every £1 spent on home interventions led to £4 in health benefits and the total value of benefits gained was £2,436,000.
There are some important, practical lessons from this evaluation that could be useful for health professionals looking to reduce acute admission.
The first is around home improvement agencies - local, not-for-profit organisations, sometimes council or housing association-run - that provide services including handyperson repairs and Disabled Facility Grants. There are almost 200 of them in England.
FILT distributed all grants via 71 HIAs across 183 district councils. Case workers were instrumental in identifying people at risk. Individuals on low incomes, with a disability or chronic illness can be hard to reach as they might not be registered with a GP, they might be mistrustful of council services or socially isolated. But HIA case workers are seen as safe and trusted by local communities and they quickly identified those living in cold homes.
This ties in with NICE’s guidelines on excess winter deaths, which recognise the role that local networks can play in identifying people at risk from poor health due to fuel poverty.
Another lesson is around the speed of repairs. Many examples were identified where funding was provided in a few days for urgent home repairs and this prevented further illness or harm such as falls, carbon monoxide poisoning, burns and possible admissions to hospital and residential care.
HIAs were able to act quickly due to their local networks – they have strong relationships with a range of agencies that can provide additional support and funding.