** 'Cold Society? Improving the UK's strategy for coping with the cold' **
Date(s) - 04/03/2013
5:30 pm - 7:00 pm
Location:
British Library Conference Centre
A British Library and Strategic Society Centre public debate about excess winter deaths and the cost of cold-related illness.
As winter draws to a close, the countdown begins until the Office for National Statistics publishes its annual estimate of ‘excess winter deaths’ – usually around 25,000 pensioners each year.
These deaths, and the cost of cold-related illness to the NHS – estimated to be £1.36 billion a year in England – are widely acknowledged to be unnecessary and preventable, particularly given the outcomes achieved in countries much colder than the UK.
Four government departments deploy policies directed at the effect of cold weather on the population: DH, DECC, DCLG and – spending by far the most – DWP.
However, it is still far from clear that the UK has an effective, adequate and joined up strategy for dealing with the effects of cold.
This event will therefore explore:
Are excess winter deaths and cold-related illness a problem of public health, low incomes, fuel poverty, poor home insulation or human behaviour?
Is government policy in this area effective or targeted?
As the biggest item of public spending in this area, what proportion of Winter Fuel Payments is spent on keeping warm? What would be the effect of scrapping Winter Fuel Payments on household fuel spending?
What is the scope for more joined-up policy interventions and choices?
Speakers at this event include:
Reg Platt, Research Fellow, Institute for Public Policy Research
Cormac O’Dea, Senior Research Economist, Institute for Fiscal Studies
James Lloyd, Director, Strategic Society Centre
3. Excess winter deaths
!
Excess winter mortality!
ONS standard definition: December to March!
Number of deaths in this period minus average
of preceding and following period!
Around 25,000 excess winter deaths a year in
England and Wales!
Fluctuations year to year!
Excess winter deaths are preventable!
4. Who dies because of the cold?
!
2011-12: ! !!
10,700 men and 13,300 women!
!
For 2010-11: !
Age 0-64: !3,630 deaths!
Age 65-74: !3,050 deaths!
Age 75-84: !7,350 deaths!
Age 85+: ! !12,040 deaths!
!
5. Why do people die?
!
ONS data: !
!
Respiratory diseases: ! ! ! ! ! !10,110!
Circulatory diseases ! ! ! ! ! !6,850!
Dementia and Alzheimer’s disease:!4,110!
Injury and poisoning: ! ! ! ! ! !500!
!
!
6. Who is at risk?
!
DH Cold Weather Plan identifies those who are: !
!
• Over 75 years old;!
• Otherwise ‘frail’ older people;!
• Have pre-existing chronic medical conditions such as heart disease, stroke
or transient ischaemic attack (TIA), asthma, chronic obstructive pulmonary
disease (COPD) or diabetes; mental ill-health that reduces individual’s
ability to self-care; dementia; !
• Assessed as being at risk of, or has had, recurrent falls; !
• Housebound or otherwise low mobility; !
• Living in deprived circumstances; !
• Living in houses with mould; !
• Fuel-poor (needing to spend 10% or more of household income on heating
the home); !
• Older people who live alone and do not have additional social services
support. !
!
!
7. Excess winter deaths in context
!
Prevalence varies among countries: typically
lower in Scandinavia!
!
Link with income or socio-economic
characteristics is inconclusive: age, health
and housing factors can be more important.!
!
!
8. Cost of cold to the Exchequer
!
DH 2009 estimate using historic data: £850
million annual cost to the NHS in England of
cold-related conditions.!
Age UK 2012 updated estimate: £1.36 billion. !
Context: cost of an older person staying in
hospital for one week is estimated to be
£1,750–£2,100. !
!
!
9. Which government departments
are involved?
!
Four implement relevant policies:!
!
Department for Communities and Local Government!
Department for Energy and Climate Change!
Department of Health!
Department for Work and Pensions!
!
However, no department has cross-departmental
coordinating or leading role.!
!
!
10. How are these problems framed in
policy debate?
!
An income poverty problem – “people don’t have
enough money to stay warm”;!
A fuel poverty problem – “poor home insulation and
rising energy costs push people into poverty or
causing them to ‘under-consume’ heating”;!
A home insulation problem – “people get cold
because of poor quality housing”;!
A public health problem – “people don’t know how
to stay healthy or warm in cold weather”;!
11. How are the problems framed?
!
A behavioural problem – “people get cold because
they are afraid to turn the heating on, don’t wrap
themselves up, and other poor behavioural
responses to the cold”;!
An energy market competition problem – “there
isn’t enough competition in the energy market to
ensure affordable heating for households”;!
A consumer behaviour problem – “people don’t
shop around for the cheapest energy tariffs so end
up becoming cold”.!
!
!
12. What have policy interventions
focused on?
!
Affordability of heating!
– Winter Fuel Payments (DWP);!
– Cold Weather Payments (DWP);!
Changing household and public services
behaviour in response to the cold!
– The Cold Weather Plan (DH);!
General public health interventions!
– Seasonal flu vaccination programme (DH);!
– Public Health Outcomes Framework (DH, DCLG);!
13. What policy interventions have
been deployed?
!
Home insulation!
– The Green Deal (DECC);!
– Energy Company Obligation (DECC);!
– Code for Sustainable Homes (DCLG);!
– Warm Front Programme (DECC);!
– Home Energy Conservation Act (DCLG);!
Generalised attempts to address the effects of
the cold:!
– Warm Homes, Healthy People funds (DH).!
14. But the scandal of excess winter
deaths continues
!
Is government policy in this area effective or
targeted?!
!
What is the scope for more joined-up policy
interventions and choices?!
25. Improving the UK’s strategy
for coping with the cold:
The energy perspective
Reg Platt
March 2013
26. A challenging context:
Energy bills are rising
Average dual fuel bill (£)
1400
1200
1000
800
600
400
200
Committee
0 on Climate
2004 2011 (weather adjusted) Change 2012
27. A challenging context:
Energy bills are rising
Average dual fuel bill (£)
1400
1200
1000
800
600
400
200
Committee
0 on Climate
2004 2011 (weather adjusted) 2020 Change 2012
28. A challenging context:
Energy bills are rising
Average dual fuel bill (£)
1400
1200
1000
800
600
400
200
Committee
0 on Climate
2004 2011 (weather 2020 - without energy 2020 - with energy
adjusted) efficiency measures efficiency measures) Change 2012
30. 3 potential policy responses
1. Tariff/market reform
– Older people and vulnerable groups tend to switch less and not
be on cheapest tariffs, i.e. direct debit/online
– Government is implementing IPPR’s recommendation to limit
the number of tariffs suppliers can offer
• Platt 2012 The True Cost of Energy
– Collective switching is a useful innovation but with limited
scope to reduce bills
– Wider action to increase competition also needed
32. Energy efficiency policy:
Green Deal:
• Households install energy efficiency measures at no up-
front cost and pay for them through a levy on their
energy bills.
• Levy attached to property rather than householder.
Energy Company Obligation:
• Energy companies provide subsidies to support
installation of high cost energy efficiency measures for all
households and any type of measure for fuel poor.
• Results in increases to energy bills.
33. Energy efficiency policy:
Green Deal:
• Confidence in policy to deliver is low
Energy Company Obligation:
• Funding provision is woefully inadequate.
– Just 125,000 to 250,000 households removed from fuel poverty
by 2023
• Millions who don’t receive measures pushed further
into fuel poverty. Outcomes worse if costs are high.
• Targeting of provision is very poor
35. Priorities for reform and joining up
policy to reduce fuel poverty, winter
deaths and cold-related illness:
• Increase funding for energy efficiency
• Improve targeting of resources, i.e. identifying at-risk
households
• Reduce the costs of policy delivery / remove policy costs
from energy bills
37. What do we want to achieve?
!
Excess winter deaths!
1. Lowest prevalence among comparable
countries!
2. Eliminate completely!
Cold-related illness!
1. Reduce prevalence!
2. Eliminate cost to the NHS!
38. How?
!
Household behaviour: changes in cold-
related behaviour!
Household cold weather responses!
Home insulation!
Cost of heating!
!
All focused on high-risk groups.!
39. Winter Fuel Payments
!
Much maligned: cost the Exchequer £2 billion+ each year!
!
But, identifiable and measurable effect on fuel expenditure. !
!
Focused on changing household behaviour and reducing cost of
heating!
!
Evidence: WFPs are effective in increasing pensioner
expenditure on fuel.!
!
Labelling cash payments = behavioural economics intervention.!
40. Winter Fuel Payments
!
What would scrapping WFPs do to pensioner
expenditure on fuel?!
!
What would be the public health effect of
scrapping WFPs?!
!
Would means testing WFPs be significantly
different?!
41. Winter Fuel Payments
!
Other alternatives: reconfigure WFPs!
!
Change age threshold !
Change value for different age groups!
Convert to taxable income!
Target by health condition!
Reclassify as part of State Pension for public
accounting purposes!
!
42. Winter Fuel Payments
!
Other alternatives: get more VFM from WFP
system!
!
Annual public health campaign to coincide with
payment!
Change name!
Rolling opt-in programme as ‘soft-conditionality’
to change behaviour and collect information!
!
!
44. Improved targeting
!
Clinical Commissioning Groups (CCGs) +
Health and Wellbeing Boards (HWBs) potential
role in targeting at risk groups for:!
!
Green Deal assessments!
Tariff switching support!
Information and awareness campaigns!
Other measures!
!
45. Other measures
!
CCGs and HWBs target at risk groups with: !
!
Automatic tariff switching!
Free home insulation under the Energy
Company Obligation!
Free energy during Level 3 and 4 Cold
Weather spells!
!
46. Conclusion
!
Significant scope for improved targeting +
joined up policy!
!
WFPs could have improved role!
Need to join up HWBs with energy market
and energy efficiency policy!
!
47. Are excess winter deaths and cold-related illness a
problem of public health, low incomes, fuel poverty, poor
home insulation or human behaviour?!
!
Is government policy in this area effective or targeted?!
!
As the biggest item of public spending in this area, what
proportion of Winter Fuel Payments is spent on keeping
warm? What would be the effect of scrapping Winter
Fuel Payments on household fuel spending?!
!
What is the scope for more joined-up policy interventions
and choices?!
!