Report to Adults Health and Wellbeing Commissioning Group

AGENDA ITEM

REPORT TO ADULTS HEALTH AND WELLBEING COMMISSIONING GROUP

21 JUNE 2016

REPORT OF WHHP STEERING GROUP

EVALUATION OF THE WARM HOMES HEALTHY PEOPLE (WHHP) PROGRAMME 15/16 AND PROPOSAL FOR WHHP 16/17.

SUMMARY

The WHHP programme was first developed and delivered in the winter of 2011/12 and is a partnership project providing help and support to vulnerable members of the community whose physical and mental health can be made worse by the cold, and who require support for affordable warmth. The project provides a range of assistance measures under the areas of crisis, preventative and resilience interventions, delivered by WHHP providers who receive a budget for measures. In the fifth programme (winter of 2015/16) these providers were Stockton District Advice and Information Service, The Five Lamps, Broadacres, Cleveland Fire Brigade, Stockton-on-Tees Borough Council Contact Centre and Heating Ventilation and Electrical Services.

The project has evolved into an important response to the issues of fuel poverty and excess winter death in Stockton-On-Tees. The most recent programme, WHHP 5 introduced a change in eligibility criteria with the aim of supporting the most vulnerable members of the community and to ensure value for money. This programme has been evaluated and the main findings from this evaluation process are addressed within this report.

RECOMMENDATION

Members of the Adults Health and Wellbeing Joint Commissioning Group are requested to receive and note the contents of this report.

Members of the Adults Health and Wellbeing Joint Commissioning Group are requested to consider the proposal to continue with the unchanged eligibility criteria for WHHP 6 16/17.

DETAIL

BACKGROUND

The National Institute for Health & Care Excellence (NICE 2015) guidance on Excess Winter Deaths (EWDs) and morbidity, and the health risks associated with cold homes issued on 5 March 2015 highlights the following recommendations for Health and Wellbeing Boards and Local Authorities for tackling the problem of cold homes;

Develop a Strategy (SBC Seasonal Health and Wellbeing Strategy 2013-2016 and Affordable Warmth Strategy 2013-17 already in place)
Ensure there is a single-point-of-contact health and housing referral service for people living in cold homes (delivered by the WHHP project in 2015/16)
Provide tailored solutions via a single-point-of-contact health and housing referral service for people living in cold homes (delivered by the WHHP project in 2015/16)
Raise awareness amongst practitioners and the public about how to keep warm at home (previous WHHP programmes have raised awareness regarding how to keep warm at home, further awareness raising is planned as part of future WHHP programme delivery)

Public Health England’s 2015 Cold Weather Plan identified that winter weather can have a direct effect on health and well-being. Cold weather increases the risk of heart attacks, strokes, lung illnesses, flu and other health conditions (PHE 2015). NICE Guidance highlights that most excess winter deaths are not caused by hypothermia or extremes of cold, they are usually caused by respiratory and cardiovascular problems during normal winter temperatures, generally when the mean outdoor temperature drops below 5-8oC (NICE 2015). The risk of death and illness does increase as the temperature drops further, however the majority of cold related ill health and death occurs during these milder periods.

Cold homes can also lead to indirect effects including mental health problems such as depression and an increased risk to health posed by poorly maintained boilers, cookers and heating appliances which could lead to carbon monoxide poisoning. In addition, dangerous and inadequate heating appliances could increase the risk of fire.

A cold home can contribute to social isolation, as vulnerable people who spend longer within their home have an increased financial pressure to afford fuel which can lead to reluctance to invite friends to their property. In addition, fear of returning to a cold home can discourage vulnerable people from going out. Some older people are likely to spend a larger part of their time at home, increasing both the likely cost of heating and their potential exposure to an inadequately heated home.

An estimated 43,900 excess winter deaths occurred in England and Wales in 2014/15; the highest number since 1999/00, with 27% more people dying in the winter months compared with the non-winter months*. The majority of deaths occurred among people aged 75 and over; there were an estimated 36,300 excess winter deaths in this age group in 2014/15, compared with 7,700 in people aged under 75. The Excess Winter Mortality Index across Stockton for 13/14 was 13.3** whilst the National index for the same period was 11.6. The population of Stockton-on-Tees is forecast to grow by 25% in the next 10 years and to continue to grow in the following decade to stand at 48,000 in 2031 (Stockton JSNA). The ageing population will increase the number of those most vulnerable to cold homes and EWD’s.

Fuel poverty affects the most vulnerable residents in our communities and can have significant adverse impacts on their health and well-being. Increasing fuel price rises are combining with real term decreased incomes to increase fuel poverty levels in the UK, with 2.35 million households nationally living in fuel poverty in 2013 compared to 1 million households in 2004. As fuel bills continue to rise we recognise that an increasing number of Stockton Borough residents may be at risk of falling into fuel poverty. People are generally considered to be in fuel poverty when they need to spend more than 10% of their household income on heating their home to an adequate standard of warmth to promote well-being and good health. In 2013 11.1% of households in Stockton experienced fuel poverty.

Warm Homes Healthy People has been a key intervention across Stockton Borough to address the joint aims of promoting health & wellbeing and addressing fuel poverty. The first WHHP intervention was delivered between February to March 2012; the second intervention was delivered between October 2012 and March 2013; WHHP 3 covered October to March 2013/14 and WHHP4 October 2014 to March 2015.

The Warm Homes Healthy People project was the subject of a comprehensive evaluation during the summer of 2015 which highlighted that between February 2012 and March 2015 the initiative processed 3,867 referrals and delivered up to 5,355 separate interventions including:-

1800 people received a winter warmth assessment and a slips trips and fall assessment in their home

Over 1121 beneficiaries received welfare benefits advice and £791,056 has been claimed by individuals who were identified as entitled to claim as a result of these checks identifying under claiming.

371 beneficiaries received a boiler service, heating repair or boiler replacement

A further evaluation into the WHHP 5 project was completed in April 2016 by officers from Economic Growth and Development Services (EGDS) and Public Health. The evaluation process included consultation with the current providers and evaluation of the programme delivery processes to identify how the interventions had been delivered over the last year and to identify areas of future development.

WARM HOMES HEALTHY PEOPLE 5

On the 5th October 2015 the WHHP programme for 15/16 was launched with a revised eligibility criteria designed to ensure the most vulnerable Stockton-on-Tees residents received the necessary help and support in a timely manner. Stockton Council’s Customer Contact centre managed all referrals into the project, this was an additional change from previous programmes designed to ensure consistency and accuracy of the referral and evidence collection process.

The criteria for WHHP 5 included the introduction of a two-tier system of support.

To be eligible for Tier 1 support one of the following statements must apply to the beneficiary;

Aged over 75
Registered disabled
Have a long term illness made worse by the cold
Live with a child (under 5) who has a long-term illness made worse by the cold.

Evidence required for the Tier 1 support was in the form of a signed pro-forma with the aim of maintaining access to preventative interventions and ensuring crises were dealt with as quickly as possible. The support on offer ranged from help with emergency heating, energy tariff, debt and welfare advice to the installation of smoke alarms, a home handyman service and carbon monoxide detectors.

For Tier 2 support, which includes potentially higher cost boiler repairs and replacements, the applicant was required to be in receipt of means tested benefit before becoming eligible and evidence needed to be provided and recorded before works are undertaken. In the majority of cases, this eligibility check was completed by the customer contact centre, making the process as straightforward as possible for the client. The full eligibility criteria can be found attached as Appendix 1. Signposting to other possible routes of assistance for those who are ineligible for the WHHP project was included in the process.

A communications plan saw properties in areas of high fuel poverty provided with WHHP leaflets through doorstep delivery, posters and leaflets made available in local community centres, pharmacies and doctors surgeries along with press releases and an article in Stockton News. Areas where householders were most at risk of fuel poverty were targeted as part of the project launch with the aim of reaching the most vulnerable.

Bringing the boiler repair and replacement service back to Stockton Council’s Heating, Ventilation and Electrical Service (HV&E) has seen 68 interventions delivered to the most vulnerable members of the community. Although this is a reduction from 111 interventions delivered during WHHP 4, evaluation suggests that this reflects the targeted approach of WHHP 5. Full details of the performance can be found in Appendix 2.

PROPOSED PROGRAMME DELIVERY 2016/17

It is proposed that the WHHP 5 programme will run from 1 October 2016 to 31 March 2017 and as in previous years will be jointly commissioned and led by Public Health and Economic Growth and Development Services (EGDS) with the operational delivery of the project remaining within EGDS.

It is proposed that the WHHP 6 project will continue to include the eligibility criteria introduced in WHHP 5. With the continuation of these criteria, attempts are being made to ensure that essential interventions can still be delivered within a timely manner whilst ensuring that those most in need can access support within the project budget.

The WHHP 6 project including intervention delivery and financial monitoring will be monitored by the WHHP steering group which includes representatives from SBC Strategic Housing, SBC Adult Social Care Services, Public Health and Economic Growth and Development Services. The WHHP 6 programme also forms a very important part of the wider Affordable Warmth Strategy led by the Borough’s Fuel Poverty Partnership designed to deliver wide ranging affordable warmth measures to alleviate fuel poverty.

The available funding for the 2016/17 programme is set at £100,000 from the Public Health Grant. As in previous years, it is proposed that this funding will be allocated by the WHHP steering group across a range of providers based on the type of intervention delivered and the outcomes to be achieved.

The proposed future delivery will include;

Stockton Council’s Heating, Ventilation and Electrical Service (HV&E) continuing to provide service, repair and where required replacement boilers to those eligible.
Stockton Council’s Customer Contact Centre continuing to provide the single point of referral alongside benefits checks to check and evidence eligibility for Tier 2 interventions
Following evaluation, the income maximisation, benefits advice and energy tariff advice interventions will be explored further with the aim of introducing a single provider for these services which includes home visits for vulnerable clients. It is proposed that this change will be managed following standard procurement processes and overseen by the WHHP steering group.
Broadacres continuing to provide handyperson services whilst WHHP steering group members continue to liaise with Adult Strategy Commissioners to ensure this service complements other commissioned services.
Cleveland Fire Brigade continuing to provide emergency crisis support out of hours.
Further awareness raising across WHHP providers to increase onward referral and joint working between organisations.
Targeting of vulnerable people through an updated communications plan including identifying opportunities for closer working with GP practices, charity and voluntary organisations.

FINANCIAL IMPLICATIONS

The available annual funding for the project is £100,000 from the public health grant.

LEGAL IMPLICATIONS

There are no specific legal implications arising from this report.

RISK ASSESSMENT

The risks arising from what is proposed can be categorised as low risk.

CONSULTATION

Details of the extensive consultation undertaken as part of the evaluation can be found within the evaluation report.

Name of Contact Officer: Stephen Shaw

Post Title: Environmental Policy Officer

Telephone No: 01642 526446

Email address:

Name of Contact Officer: Jenny Cowell

Post Title: Business Manager

Telephone No: 01642 528442

Email address:

**Excess Winter Deaths Index (EWD Index) is the ratio of extra deaths from all causes that occur in the winter months compared with the expected number of deaths, based on the average of the number of non-winter deaths.

Appendix 1

Warm Homes Healthy People - Eligibility Criteria

YES

**If a home contains a serious defect which may affect the occupiers health they may be qualify for an affordable loan from the Council. Examples of works a loan may be provided for include; essential repairs, installing double glazing, renewal of electrical wiring and to provide a new efficient heating system.

APPENDIX 2

Warm Homes Healthy People 5 – Outputs from Partners

Warm Homes Healthy People 5 ran from October 2015 to the 31st March 2016 and provided a package of support to help sustain vulnerable people through the winter months.

The intervention was delivered by a partnership consisting of:-

Stockton Council’s Customer Contact Centre who provided the hub-function passing on 335 referrals to the partner organisations.

85 to HV&E for Boiler Repairs
65 to SDAIS for Benefits Advice
139 to Broadacres for Handyperson services
16 to Broadacres for slips trips and falls assessments
20 to Cleveland Fire Service for emergency heating and fire safety advice
1 to TVCF for access to TERF
8 to the Five Lamps for Energy Efficiency Advice

Stockton Council’s Heating, Ventilation and Electrical Service (HV&E) attended 61 different households to service, repair and in some instances replace heating boilers. Some complicated repairs required more than one visit and in total 68 separate interventions were delivered at a cost of £34,830.57. The 68 interventions included 12 replacement boilers and 30 repairs.

Stockton District Advice and Information Service (SDAIS) provided benefits advice and income maximisation support, substantially, within the client’s own home. So far £153,966.36 in previously unclaimed benefit has been confirmed whilst applications for a further £214,043.59 are being processed.

Broadacres provided handyperson support in response to 139 referrals which produced 417 specific interventions for example fitting pipe lagging; fitting draft excluders; conducting slips, trips & falls surveys and providing carbon monoxide monitors. £1,050 was raised from a charity to purchase and install replacement windows at one address where the living room windows were beyond repair.

Tees Valley Community Foundation supported 3 clients via the Teesside Emergency Relief Fund.

The Five Lamps Organisation provided energy switching advice and practical support to customers helping resolve complex issues.

The WHHP interventions were delivered Borough wide to clients meeting the eligibility criteria, the age profile of the beneficiaries is set out below:-

Age
29 and under / Age
30’s / Age
40’s / Age
50’s / Age
60’s / Age
70 - 74 / Age
75 - 79 / Age
80’s / Age
90+
5 / 2 / 22 / 29 / 31 / 15 / 56 / 144 / 22

Over 70% of beneficiaries are aged 70 and above.

The distribution of beneficiaries across Stockton Borough

Ward / Clients Referred / Ward / Clients Referred / Ward / Clients Referred
Billingham Central / 16 / Hardwick / 15 / Norton West / 11
Billingham East / 13 / Hartburn / 17 / Parkfield & Oxbridge / 13
Billingham North / 14 / InglebyBarwick East / 8 / Roseworth / 16
Billingham South / 12 / InglebyBarwick West / 5 / Stainsby Hill / 12
Billingham West / 13 / Mandale & Victoria / 11 / Stockton Town Centre / 10
Bishopsgarth & Elm Tree / 8 / Newtown / 22 / Village / 25
Eaglescliffe / 8 / Northern Parishes / 1 / Western Parishes / 7
Fairfield / 23 / Norton North / 13 / Yarm / 13
Grangefield / 13 / Norton South / 16 / TOTAL / 335

The customer contact centre have recorded that callers originally became aware of Warm Homes Health People from the following sources:-

%of Clients Recorded
Broadacres / 14%
Citizen’s Advice Bureau / 7%
Cleveland Fire Service / 1%
1st Contact or a social worker / 2%
WWHP Leaflet / 11%
Newspaper Coverage / 4%
Previous WHHP Client / 6.25%
Word of mouth / 49%
Other / 5.75%

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